This document discusses traumatic brain injury (TBI) epidemiology and pathophysiology. It notes that TBI is a leading cause of death in polytrauma patients and that over 35% present with secondary injury lesions. The pathophysiology involves the Monroe-Kellie doctrine where intracranial pressure (ICP) equals mean arterial pressure minus intracranial volume. Initial management involves a thorough history and Glasgow Coma Scale assessment. Continuous multimodal monitoring of ICP, brain tissue oxygen, and other biomarkers may help manage severe TBI patients and observe disease changes over time.

1. TRAUMA
CRANEOENCEFALICO
Vanessa Borrero M.
Neurocirujano
CLINICA UNIVERSIDAD DE LA SABANA

2. EPIDEMIOLOGIA
 TCE PRIMERA CAUSA DE MORTALIDAD EN
PACIENTE POLITRAUMATIZADO
 18% DE LOS Dx. DE INGRESO EN URGENCIAS
 20% CON LESIONES ASOCIADAS SISTÉMICAS
 MÁS DEL 35% PRESENTAN LESIONES POR DAÑO
SECUNDARIO

3. EPIDEMIOLOGIA
 PREDOMINIO EN POBLACIÓN JOVEN
 IMPACTO DE DX. TEMPRANO, TTO. OPORTUNO Y
REHABILITACIÓN PRECOZ:
 MAXIMIZAR CALIDAD DE VIDA
 REDUCIR DISCAPACIDAD
 MINIMIZAR COSTOS

4. EPIDEMIOLOGIA
25
24
20
8
3 10 Accidentes de tránsito
Caídas
Armas de fuego
Arma
cortocontundente
Otras
Desconocido

5. FISIOPATOLOGÍA
 TEORIA DE MONROE - KELLIE  PPC= PAM - PIC

6. LESIONES EN TCE

7. DAÑO AXONAL DIFUSO
 LESION SEVERA
 ACELERACION-DESACELERACION
 DAÑO DE VASOS PENETRANTES:
HEMORRAGIAS PETEQUIALES
 80% NO SE VEN EN TC
 RM CON TRACTOGRAFIA

8. EDEMA
CEREBRA
L DIFUSO

9. HERNIAS CEREBRALES

11. ABORDAJE INICIAL
1. HISTORIA CLÍNICA
 Tiempo de evolución desde el momento del trauma hasta el ingreso,
 Mecanismo de trauma
 Progresión del estado de conciencia
 Amnesia del evento traumático y lo acontecido antes y después del
mismo.
 Evaluación rápida de antecedentes: AMPLIA

12. ESCALA DE
COMA DE
GLASGOW

19. Based on the previous observation and current study, it can be concluded
that ICP monitoring cannot be considered as a standard for the
management of severe TBI. The question should not be whether to monitor
ICP, but in whom to monitor ICP. Unless a lot of studies that globally
replicate the results of studies showing benefit of ICP monitoring in
improving outcomes in severe TBI, the ICP monitoring will not be
incorporated in the management of severe TBI protocols, particularly in
resource-limited settings.

22. • On a selected cohort of severe TBI patients with
abnormal head CT lesions and predominantly focal
cerebral injury, elevated ICP episodes correlated with
a concomitant decrease of NPi.
• Sustained abnormal NPi was in turn associated with
a more complicated ICP course and worse outcome.

25. By continuously monitoring patients with severe TBI, the use of multimodal
monitoring technologies, will be crucial for observing disease changes such
as ICP and brain tissue oxygen partial pressure
• Computed tomography
• Cerebral microdialysis
• Near-infrared spectroscopy
• Magnetic resonance spectroscopy
• High-performance liquid chromatography
• Magnetic induction phase

27. Gracias!