Traumatic Brain Injury
Traumatic brain injury (TBI) is a common injury that is sustained in the face of most blunt mechanisms of injury. TBI may be classified as mild, moderate, or severe. These classifications are based on the Glasgow Coma Score (GCS) and findings on computed tomography (CT) scan or magnetic resonance imaging (MRI). Patients with loss of consciousness or amnesia to the event should undergo imaging studies to identify intracranial injury.
Because of the spectrum of brain injury and possibility of a lucid period despite a severe TBI, one must have a high level of suspicion for a TBI that requires neurosurgical intervention such as epidural or subdural hematoma to optimize survival and minimize morbidity. For those with moderate TBI, frequent neurological assessment must be undertaken to ensure that they do not deteriorate neurologically and go on to require surgical intervention such as intracranial pressure monitoring or decompressive hemicraniectomy.
Traumatic brain injuries of all severities have the potential to result in severe long-term sequelae that may seriously impact functionality and quality of life. One must ensure that patients with TBI undergo appropriate follow-up and brain rehabilitation to maximize long-term outcomes. The following algorithm provides a systematic approach to the initial evaluation and management of those with all types of TBIs. While used as a helpful guideline, one must use clinical judgment while assessing each individual patient to optimize short- and long-term outcomes after TBI.
KeywordsTraumatic brain injury Concussion Epidural hematoma Subdural hematoma Subarachnoid hemorrhage Glasgow Coma Score (GCS) Hemicraniectomy Neurosurgery and trauma