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Publisher Summary This chapter presents a discussion on traumatic brain injury (TBI). The chapter presents a practical approach to the diagnosis and management of the TBI patient, with a discussion of the basic pathologic conditions that drive that management.TBI is the leading cause of death and disability in young adults in the United States. Brain injury may be caused by any of several types of head trauma, including the more typical closed head injury, in which rapid acceleration or deceleration produces shearing and other forces in the brain and impacts against the frontal and temporal fossae of the skull; direct impact to the head; and penetration by a bullet or other foreign object. Although some details of the pathosis of these types of trauma may differ, the principles of acute and especially long-term management are similar in most cases. TBI is traditionally classified by its severity, but distinctions between mild, moderate, and severe head injury can often be blurred. Nevertheless, the distinctions are generally useful in guiding the approach to the patient. Proper evaluation and diagnosis of the TBI patient is made especially challenging by the multifactorial nature and complexity of the pathologic conditions induced by the trauma and their evolving character. The discussion on the pathology of TBI includes focal injury, diffuse microvascular injury, hypoxia-ischemia, diffuse axonal injury (DAI), neuronal loss/excitotoxic injury, and diffuse gray matter dysfunction. |
