Advertisement

Pathophysiology of Head Trauma

  • M. Cormio
  • G. Citerio
Conference paper

Abstract

Traumatic brain injury (TBI) shares the same basic mechanisms of any organ trauma but, at the same time, it is unique. Some aspects render TBI extremely peculiar and very attractive to study:
  • — The brain is the most complex and highly organized system within the human body. It carries on extraordinary “superior” functions. TBI affects brain delicate potentialities and eventually leads to coma.

  • — The brain is contained in a rigid container. A perfect volume equilibrium of its components (blood/parenchyma/CSF) is required to maintain normal pressures, essential to allow normal brain perfusion. The rigid nature of the brain’s container introduces the topic of intracranial pressure (ICP) and its pathological response to TBI.

  • — Head injuries vary widely in their etiology, pathophysiology, clinical presentation, and optimal treatment strategies. TBI initiates many heterogeneous and interactive pathological, neurochemical, metabolic and functional changes. Even if the clinical sign expressing them is finite, we have to bear in mind the complexity and variability of the interactions behind them.

  • — In many cases, TBI occurs in polytrauma and, therefore, it is accompanied by derangements in some physiological variables important in ensuring a continuous blood supply and oxygenation to the brain. Hypoxia and hypotension are the principal factors leading to secondary insults and secondary brain damage.

Keywords

Traumatic Brain Injury Cerebral Blood Flow Head Injury Brain Edema Cerebral Perfusion Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bergsneider M, Hovda DA, Shalmon E et al (1997) Cerebral hyperglycolysis following severe traumatic brain injury in humans: a positron emission tomography study. J Neurosurg 86: 241–251PubMedCrossRefGoogle Scholar
  2. 2.
    Bouma GJ, Muizelaar JP (1995) Cerebral blood flow in severe clinical head injury. New Horiz 3: 384–394PubMedGoogle Scholar
  3. 3.
    Eisenberg HM, Gary HE, Aldrich EF et al (1990) Initial CT findings in 753 patients with severe head injury. J Neurosurg 73: 688–698PubMedCrossRefGoogle Scholar
  4. 4.
    Jaggi JL, Obrist WD, Gennarelli TA et al (1990) Relationship of early CBF and metabolism to outcome in acute head injury. J Neurosurg 72: 176–182PubMedCrossRefGoogle Scholar
  5. 5.
    Kelly DF, Martin N, Kordestani RK et al (1997) Cerebral blood flow as a predictor of outcome following traumatic brain injury. J Neurosurg 86: 633–664PubMedCrossRefGoogle Scholar
  6. 6.
    Marmarou A, Anderson RL, Ward JD et al (1991) Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 75: S59–S66Google Scholar
  7. 7.
    Marshall LF, Smith RW, Shapiro HM (1979) The outcome with aggressive treatment in severe head injuries. Part I: The significance of intracranial pressure monitoring. J Neurosurg 50: 20–25PubMedCrossRefGoogle Scholar
  8. 8.
    Obrist WD, Langfitt TW, Jaggi JL et al (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. J Neurosurg 61: 241–253PubMedCrossRefGoogle Scholar
  9. 9.
    Robertson CS, Cormio M (1995) Cerebral metabolic management. New Horiz 3: 410–422PubMedGoogle Scholar
  10. 10.
    Rosner MJ, Rosner SD, Johnson AH (1995) Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 83: 949–962PubMedCrossRefGoogle Scholar
  11. 11.
    Unterberg A, Andersen B, Clarke G et al (1988) Cerebral energy metabolism following fluid percussion brain injury in cats. J Neurosurg 68: 594–600PubMedCrossRefGoogle Scholar
  12. 12.
    Xiong Y, Gu Q, Peterson et al (1997) Mitochondrial dysfunction and calcium perturbation induced by traumatic brain injury. J Neurotrauma 14: 23–34PubMedCrossRefGoogle Scholar
  13. 13.
    Zimmerman R, Bilaniuk L, Bruce D et al (1978) Computed tomography of pediatric head trauma: acute general cerebral swelling. Radiology 126: 403–408PubMedGoogle Scholar
  14. 14.
    Zimmerman R, Bilaniuk L, Gennarelli T (1978) Computed tomography of shearing injuries of the cerebral white matter. Radiology 127: 393–396PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 1998

Authors and Affiliations

  • M. Cormio
  • G. Citerio

There are no affiliations available

Personalised recommendations