Biomechanical Basis of

Traumatic Brain Injury

Outline
Clinical classification of brain injuries
Mechanism of injury
Mechanistic cause of head injuries
Injuries and their mechanisms
Clinical classification of brain injuries
Skull fracture
May or may not involve damage to the underlying brain
Focal injury
Generally limited to a well-circumscribed region contusions to the
cortex and subdural, epidural, and intracerebral hematomas
Penetrating injury
Blast injury
Clinical classification of brain injuries
Diffuse brain injury
Mildest form : involve only alterations in neural excitability,
neurotransmission, or long-term changes in receptor
dysfunction and associated disabilities : concussion
Prolonged coma without a mass lesion and involves some
degree of structural derangement at the microscopic level
Diffuse axonal injury
Mechanism of injury
Static or quasi-static loading
Dynamic loading
Static or quasi-static loading
Uncommon
Slowly, over times longer than 200 msec
Squeezing or crushing (seen in earthquakes, building collapses, or
machinery accidents)
fractures at the vault or basilar skull region
common that consciousness is preserved
Dynamic loading
More common
Rapidly, duration less than 50 msec
Impulsive
the head is set into motion indirectly by a blow to another body region
inertial force,brain move within the skull
Impact
combination of contact force and inertial (head motion) force
Contact phenomena(head not moving)
> 2 inch localize skull bending
Shockwave localized change in pressure,distortion,injury
small hemorrhage and contusion
More common in children ; flexible, lower calcification
Distortion or strain
Distortion or strain
Compressive strain
Compressive
Book/cylinder/table
Tension strain
elongation
Shear strain
Force applied along surface
Playing card
Dilational strain(volumetric strain)
Pressure applied all exposed face
Mechanistic causes of head injuries
Contact injuries
Head motion(inertial) injuries
Blast induced brain injuries
Contact injuries
Local contact effect
Skull : Linear and depressed skull fracture,Basilar skull fracture,
EDH : associated with skull fracture or without skull fracture
Coup lesion : beneath the side of lesion
Direct injury to the brain,surface vessel
High negative pressure from skull rapid snaps back to place
Contact injuries
Remote contact effects
Vault fracture away from the impact site, basilar skull fracture, contrecoup
Thick portion of the skull, relatively broad object
Stress wave radiate in 3D
Formation of intermediate coup contusion
Scatterd ICH, traumatic intracerbral hematoma
Global change in skull shape(infant and developing children) :
localized change in pressure small petechiae
fluctuation in intracranial volume brain herniation
Head motion(inertial injuries)
Acceleration-deceleration injuries
Brain tissue strain
Differential movement of the skull and
brain localized strain of surface
Strain within the brain parenchyma
widespread disturbances in brain function
and structure cerebral concussion and
DAI
Type of head acceleration
 Type of head acceleration
Translational acceleration
Uncommon
Center gravity of brain move in straight line
Focal injuries(contrecoup, intracerebral, subdural hematoma )
Rotational acceleration
Brain rotation without center gravity of brain moving
Highly injuries
High surface strain,deep surface strain
Angular acceleration
Most common,compound translational and rotational
Neck anatomy
Most damaging (except : skull fracture and EDH)
Determinants of Acceleration injury
Not only on the type of acceleration
The magnitude of acceleration propagational to the
amount of strain delivered to the brain
First : Brief acceleration c extremely high acceleration
Second : Slightly longer
Strain restricted to periphery
skull, dura surface, brain periphery and vessel
Third : Increase even more
Strain propagate to deeper
DAI
 Blast-induced brain injuries
Temporary altermental status or confusion immediately
after blast
Primary bTBI
Rapidly expanding wave,rapid rise and fall
Secondary bTBI
Penetrating and non-penetrating injuries that occur when high
velocity projectile/fragment impact the head
Tertiary bTBI
Primary bTBI cause the victim to collide with fixed or mobile
object
 Injuries and their mechanisms
Skull fracture
Linear fracture
Contact effect secondary to impact
Depressed fracture
Small(< 2 inch), hard, impact
Basilar fracture
Impact or propagation of stress wave
 Injuries and their mechanisms
Focal injury
Epidural hematoma
More complex case of linear skull fracture
Head motion and inertial do not cause
Coup contusion
Under impact point
Skull rebounding
Contrecoup contusion
Cavitation effect : negative pressure at opposite loading
point cause damage + small bubble turn to normal
pressure,
small bubble rupture
Injuries and their mechanisms
Intermediate coup contusion
Impact generate shock wave
Intracerebral hematoma
Impact
acceleration
Tissue tear hemorrhage(microhemorrhage)
Inertial or head motion
Superior frontoparietal white matter, corpus callosum,
centrum semiovale, periventricular white and gray matter,
internal capsule, basal ganglia
 Injuries and their mechanisms
Diffuse brain injury
Cerebral concussion
Inertial loading,not form contact phenomena effect
Angular rotation
Diffuse axonal injury
Angular rotation