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Traumatic Brain Injury Case Studies

1272 Words6 Pages

Zagazig University
Faculty of Medicine
Department of Anesthesiology and Surgical Critical Care

Predictive value of combining Middle Cerebral Artery Pulsatile Index and Glasgow Coma Scale on outcomes of Traumatic Brain Injury Patients in Zagazig University Hospital

Protocol of thesis submitted in partial fulfillment of MD degree in Anesthesiology and Surgical Critical Care

By
Dr. Naglaa Fathy Abdelhaleem Abdelhaleem
(M.B.B.Ch, M.Sc.)

Under supervision of

Faculty of Medicine
Zagazig University
-2015-

1. Introduction
Traumatic brain injury (TBI), defined as an alteration in brain functions caused by an external force, is responsible for high morbidity and mortality around the world. It is important to identify and treat TBI victims as early as possible, Reis et al. (2015). …show more content…

(2004), Vigué et al. (2011)]. As the physiologic mechanisms against ischemia in cerebral tissue are impaired, the traumatized brain become highly vulnerable to ischemic injuries, these ischemic injuries, even for a few minutes, have a dramatic negative impact on long-term outcomes. Thus, prediction of outcomes is urgently needed.

The primary aim of managing patients with acute brain injury is to minimize secondary injury by maintaining cerebral perfusion and oxygenation. The pathophysiology of secondary brain injury, i.e., the cascade of deleterious events that occur in the early phase following initial cerebral insult is complex, involving a subtle interplay between cerebral blood flow, (CBF) oxygen delivery and utilization, and supply of main cerebral energy substrates (glucose) to the injured brain. Regulation of this interplay depends on the type of injury and may vary individually and overtime, Bouzat et al.

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The diction used in this source is passionate while still being academic. The tone that presents this article is persuasive. Some facts that are presented include, 1.6 to 3.8 million traumatic brain injuries occur each year, more than 75 percent of these are sports related. A study that was conducted by researchers at Mayo Clinic to demonstrate the accuracy of this when determining if a player should be pulled from play. The claims made are fact-based because it is backed up by research findings.

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A new medicine in development, called Prevacus, could change the way we prevent and treat concussions. It is being researched and developed by Jacob VanLandingham Ph.D., who is a neuroscientist at Florida State University in the department of biomedical sciences (Fleming). As explained by VanLandingham “Prevacus should be taken nasally within minutes of an initial head trauma. Once absorbed into the brain, the drug is said to trigger three different positive reactions--the reduction of inflammation, swelling and stress--at the cellular level. In rats, it's been shown

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Concussions are increasingly being recognized as a public health issue. Traumatic brain injuries, like concussions, have short and long term side effects. The long term effects of concussions are not fully known, however, it has been observed that multiple concussions have cumulative effects. (Kutcher et al., 2013). Understanding the effects of concussions on brain activity is key to developing assessments and preventing future injury.

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A TBI occurs when the head is stroke suddenly and violently by an object that pierces the skull and enters the brains tissues. Depending on the severity of the blow to the brain the symptoms one experiences are mild, moderate or severe. Typical symptoms present in individual experiencing TBI include; vertigo, blurred vision, headaches, confusion, fatigue, lethargy, attention, judgment, memory, and behavioral or mood swings. Early treatment is vital once an individual is diagnosed with TBI by supplying oxygen to the brain and the bodies to maintain blood flows and control blood pressure. Additionally, rehabilitation and various imaging test including skull and neck X rays and computed tomography (CT) scans are conducted to determine prognosis and severity of the injury (National Institute of Neurological Disorders and Stroke,

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People cannot diagnose CTE until an autopsy has taken place, and they diagnose it with Tau protein. CTE is believed to have four stages that affect the human body. These stages are dangerous because many victims think it’s normal aging, and then they catch it too late (“What is CTE”). The first stage might not come until months to years after the head trauma. This stage includes bad headaches and

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Concussions despite being mild or severe need to be correctly attended to, as there will always be some form of effect. Concussions need to be handled correctly to minimize the risk of dangerous and life-altering outcomes. A concussion is a disturbance of brain function that involves a complex pathophysiological process and is referred to as a brain injury (Harmon et al., 2013; Echemendia, 2012). Consequently, being unconscious is a pathological state.

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When a concussion occurs, the brain is slammed against the inside of the skull and can be bruised. The brain tissue can tear due to different parts moving at different speeds. The ion and chemical ratio becomes unbalanced, causing nerve failure and unconsciousness. Oxygen is limited, slowing recovery. Multiple concussions and swelling can cause progressive cognitive decline which is like dementia (Brain Facts).

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“Long-term effects of concussions are very rare. Moderate to severe traumatic brain injury (TBI) can cause symptoms similar to a concussion, but individuals with TBIs often experience more severe problems with attention and short-term memory, have difficulty performing daily tasks, and report feeling ‘slower’ overall” (Long-term Effects of Brain Injuries). Brain injuries can always improve, but may never completely go away. “Difficulty making decisions or processing a lot of information, or trouble resolving problems, can have a significant impact on one 's life” (Long-term Effects of Brain Injuries). The matter is very serious and impacting the lives of many athletes around the world.

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I have learnt that concussion is a brain injury that is caused by a direct blow to the head or an indirect blow to the body. The human brain is a very fragile organ that basically floats inside the skull. Cognitive problems after concussion includes headaches, concentration issues, memory problems and impaired mood. It was really sad to watch Mike Webster who was the ironman of the Steeler not being able to finish sentences during an interview and not being able to express himself. Personally, I think that this segment is sign of a symptom of a concussion.

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While a severe concussion will normally be referred to as a traumatic brain injury or TBI, normal concussions are referred to as being mild traumatic brain injuries (MTBI) due to the fact that a single injury of this type will not typically cause any serious long term health consequences. Several repeated mild traumatic brain injuries, however, may lead to the life-changing and potentially debilitating condition known as chronic traumatic encephalopathy (CTE).” Recent evidence suggests that concussions are caused by rotational motion, rather than forward and backward

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Axon tearing occurs in more severe brain injuries, but proof is lacking for this mechanism in concussion. It is more likely that concussion is due to rotational acceleration of the brain (jiggling of the brain) that produces a disordered metabolic cascade or biochemical injury such as altered metabolism of glucose or derangement of adenine nucleotides. It is still uncertain where in the brain concussion occurs, or the exact origin of the symptoms of acute concussion. (Tator,1) There needs to be more scientific studies to help provide the mechanisms of a concussion and figure out more information about the exact mechanisms of a concussion.

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As concussion became the sports injury “issue” of the 1990s, numerous researchers began projects regarding concussions. It became apparent from the findings of the earlier projects that a variety of different methods of identifying a concussion exist. Some clinicians described a concussion as a loss of consciousness. Others identified a concussion only if memory problems were associated with the injury. Still other clinicians considered a very minor impact to the head, often called a “ding,” to be a concussion.

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This may damage or ultimately kill nerve cells, and spread as the disease progresses; one of the advanced stages is that brain shrinkage may occur. Researchers are working to refine brain scan techniques to identify Chronic Traumatic Encephalopathy tau deposits in living brains. They are also looking for clues in people’s blood or cerebrospinal fluid that would allow them diagnose the disease before death. A large-scale study found that concussions in adolescents can increase the risk of developing multiple sclerosis later on in life. There are hints that head trauma may also be linked to the development of many other conditions, including multiple sclerosis.

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This research shows the impact one may have as a result of a brain related injury and the important of clinical research and medication to treat such condition. In conclusion, the visual pathway plays a critical

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A hemorrhagic stroke is caused when an artery is ruptured or leaks blood in the brain (National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention, Types of Stroke (2013). Another form of strokes are Transient Ischemic Attacks (TIAs) often referred to as “mini strokes” (AHA/ASA, 2012). These are often warning signs that a stroke could occur if an individual’s lifestyle or risk factors are not modified. During a TIA, there is a temporary decrease in blood supply to the brain; symptoms usually last less than 24 hours before disappearing (NSA, 2012). Epidemiology Fifteen million people suffer stroke worldwide each year (World Health Report, 2002).

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