TRAUMATIC BRAIN INJURY:

A Life Threatening Condition

Priandana A
Brain Injury is a leading cause of death and disability
worldwide.
Brain Injury is the leading cause of death and
Injuries to the braindisability
are among worldwide.
the most likely to result in
deathInjuries to the braindisability
and permanent are among the most likely to result
in death andthan
TBI is more common permanent
breastdisability
cancer, spinal cord
injury, HIV/AIDS International
and Brain Injury Association
multiple sclerosis combined

Estimated prevalence, 2% of population

International Brain Injury Association
 Definition of TBI

An alteration in brain function, or other evidence of

brain pathology, caused by an external force…”
Brain Injury Association of America
 Acquired Brain Injury
TRAUMATIC NON-TRAUMATIC
 Open  Asphyxia
 Closed  Aneurysmal Rupture
 Brain Tumors
 Encephalitis
 Meningitis
 Metabolic
Encephalopathy
 Stroke with
Cognitive Disabilities
 Causes of TBI CDC 2006

Suicide, 1% Unknown,
9%
Other Transport, Other, 7%
2%
Falls, 28%
Pedal Cycle
(non MV), 3%

Assault, 11%

Motor Vehicle-
Traffic, 20%
Struck
By/Against, 19%
Who is at the Highest Risk of
TBI?

 Males 1.5 times as likely as females to sustain a

TBI
 Two age groups most at risk are 0-4 year olds and
15-19 year olds
 The elderly, 75 and older from falls
Skull
Brain and
Ventricles
Spine and
Spinal
Cord
 Demographics

 Account for most trauma hospitalizations

 Domestic falls, MVA’s, recreational injuries and abuse
account for majority of them.
TBIs are common….
Pathophysiology of Brain Injury

Brain Injury

Primary Secondary

3.Ischemia systemic
2.Intracranial hypertension 1.Delayed cell death hypoxia,hypercarbia and
and mass lesion hypotension
 Primary Brain Injury

Coup
Focal
Contra-
Primary coup

Diffuse DAI
Primary Injury
Secondary Injury
 Monro-Kellie Doctrine
Venous Art. Brain CSF
Volume Vol.

Ven. Art.
Brain Mass CSF
Vol. Vol.

75 mL Arterial 75 mL
Brain Mass CSF
Volume
Volume – Pressure Curve

60- Herniation
55- ICP
50- (mm Hg)
45-
40-
35- Point of
30- Decompensation
25-
20-
15-
10-
5- Compensation
Volume of Mass
 Intracranial Pressure (ICP) a.k.a.
Tekanan Intrakranial
 10 mm Hg = Normal
 > 20 mm Hg = Abnormal
 > 40 mm Hg = Severe
Cerebral Perfusion Pressure*

MBP – ICP = CPP

Normal 90 10 80
Cushing’s
Response 100 20 80

Hypotension 50 20 30

* CPP  Cerebral Blood Flow

Brain Herniation

• brain death
• respiratory or cardiac
arrest
• permanent brain damage
• coma
• death
 Take Home Messages

TBI is a silent epidemic

Life – threatening (as in

morbidity and mortality)