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Head injury
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Primary injuries may manifest as focal lesions such as skull fractures, intracranial haematomas, cranial nerve lesions, lacerations, contusions and penetrating wounds, or more widespread damage including diffuse axonal injury (7,8). Coup and contre-coup cerebral contusions result from a combination of vascular and tissue damage. There is injury at both the site of impact to the skull (coup) and on the opposite side of the head (contre-coup). The impact accelerates first the skull and then its contents away from it. As the skull stops, the brain then impacts on the internal surface of the skull resulting in damage. Diffuse axonal injury is characterised by extensive, generalised damage to the white matter tracts of the brain as a result of shearing forces (Box 12.1).
Trauma
Published in Sam Mehta, Andrew Hindmarsh, Leila Rees, Handbook of General Surgical Emergencies, 2018
Sam Mehta, Andrew Hindmarsh, Leila Rees
Diffuse brain injury occurs due to acceleration/deceleration injury, and varies in severity from mild concussion to diffuse axonal injury. Mild concussion: to make a diagnosis of mild concussion there must be no reduction in consciousness level, with temporary and mild symptoms only, including confusion, disorientation and retrograde/antegrade amnesia.Classical concussion: there may be a short period of loss of consciousness, with post-traumatic amnesia, the length of which indicates the severity of injury. A post-concussion syndrome may occur. This includes lethargy, memory problems, dizziness, nausea and depression. Up to one-third of patients with a mild head injury have some symptoms of memory, sleep or sexual disturbance.Diffuse axonal injury: post-traumatic coma which is not due to haematoma or ischaemia, although it may occur in combination with ischaemic damage.
Post-traumatic headache
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
In the post-traumatic headache patient, two processes may occur simultaneously. The first process is diffuse axonal injury, which is due to acceleration/deceleration forces. When diffuse axonal injury is more severe, it is associated with abnormalities on MRI, positron emission tomography, SPECT, and certain neuropsychological tests. Clinical improvement may occur over several months, with these tests normalizing or improving. A second process, separate from diffuse axonal injury, may be responsible for the persistent headache, psychopathology, and neurocog-nitive deficits that occur after head injury. This process is often heralded by more severe early headache. A preexisting factor or vulnerability may be a necessary precon-dition for this process to present itself folly in a given individual.
The Cardiac Autonomic Response Recovery to the Modified Tilt Test in Children Post Moderate–Severe Traumatic Brain Injury
Published in Brain Injury, 2022
Gilad Sorek, Isabelle Gagnon, Kathryn Schneider, Mathilde Chevignard, Nurit Stern, Yahaloma Fadida, Liran Kalderon, Sharon Shaklai, Michal Katz-Leurer
Out of 80 children post-moderate–severe TBI who were screened, 37 consented and participated in the study. Participant’s demographic, medical and injury severity characteristics at baseline are presented in Table 1. Most participants had sustained a severe TBI. Motor vehicle collisions were the cause of injury in most cases (n = 31). All participants had multiple findings in brain imaging, 18 were diagnosed with diffuse axonal injury. At the time of the first assessment, the median time since injury was 42 days (min 14-max 162 days). At the time of the first assessment 16 participants were able to transfer independently from the wheelchair to the bed, 10 needed supervision and the rest needed assistance. In addition, only eight participants could walk independently (with or without walking aids), 16 needed a supervision, and the rest needed assistance while walking. At the time of the second assessment, most participants (n = 30) managed transfers independently, six needed a supervision, and only one needed assistance. In addition, 28 could walk independently (with or without walking aids), seven needed a supervision, and only two needed an assistance while walking. The functional improvement over time was significant (p < 0.01).
Prognosticating outcome using magnetic resonance imaging in patients with moderate to severe traumatic brain injury: a machine learning approach
Published in Brain Injury, 2022
Moumin Mohamed, a Alamri, M Mohamed, N. Khalid, Pj O’Halloran, Ve Staartjes, C Uff
Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity in young patients (1). Diffuse axonal injury (DAI) is a common form of closed TBI, caused by high energy rotation resulting in shear forces acting on the brain (2–4). Classically, the lesions seen in DAI are small which historically made the noninvasive diagnosis of DAI difficult (5). It was not until the advent of Magnetic Resonance Imaging (MRI) that reliable pre-mortem diagnosis of DAI could be made (6–8). Using MRI scans to prognosticate the outcome of DAI has been examined in multiple studies, however no clear prognostic indicator for either function or survival has been identified (9–12) however Haghbayan et al, suggested that brain stem lesions, detected on acute-phase MRI, may predict mortality and morbidity based on lesion location and characteristics (11).
Effect of axonal fiber architecture on mechanical heterogeneity of the white matter—a statistical micromechanical model
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Hesam Hoursan, Farzam Farahmand, Mohammad Taghi Ahmadian
Human brain white matter consists of axonal bundles which connect nerve cell bodies mostly located in the grey matter. A sudden inertial loading on the head can cause Diffuse Axonal Injury (DAI) of white matter, which involves axonal damage in a variety of modes. Among the failure modes of axons, rapid stretching of neural tracts, leading to the impairment of axoplasmic transport and subsequent swelling and neuropathologic problems, has been reported to be the prevailing failure mode (McKenzie et al. 1996; Smith and Meaney 2000; Di Pietro 2013). DAI tends to occur in three anatomical regions of white matter, known as the “injury triad”: the lobar white matter (including corona radiata), the corpus callosum, and the dorsolateral quadrant of the rostal brainstem, adjacent to the superior cerebellar peduncle (Tsao 2012).