This document discusses traumatic brain injury (TBI), including its definition, causes, classification, types of head injuries, severity scoring systems, management, and monitoring of intracranial pressure (ICP). TBI is caused by external forces and characterized by decreased consciousness, memory loss, neurological deficits, or mental state changes. Common causes are road accidents, falls, and sports injuries. TBI is classified as primary or secondary injury. ICP is monitored to maintain levels below 22 mmHg to prevent herniation and maintain adequate cerebral perfusion pressure. Treatment focuses on reducing ICP through medications, surgery, ventilation management, and other modalities.

1. TRAUMATIC BRAIN INJURY
DR VISHAL JAINTH

2. DEFINITION
ALTERATION IN BRAIN FUNCTION OR OTHER EVIDENCE OF BRAIN
PATHOLOGY CAUSED BY AN EXTERNAL FORCE,AND CHARACTERISE BY
FOLLOWING.
1.ANY PERIOD OF DECREASED LEVEL OF CONSCIOUSNESS.
2.ANY LOSS OF MEMORY FOR EVENT IMMEDIATELY BEFORE AND AFTER
THE INJURY.
3.ANY NEUROLOGICAL DEFICIT.
4.ANY ALTERATION IN MENTAL STATE AT THE TIME OF INJURY.

3. CLASSIFICATION

4. CAUSES OF BRAIN INJURY
• ROAD TRAFFIC ACCIDENT (39%).
• FALLS(10%).
• SPORTS INJURY.
• FIRE ARM INJURY.
• EXPLOSION INJURY.

5. CLASSIFICATION OF TRAUMATIC BRAIN
INJURY
• PRIMARY BRAIN INJURY.
• SECONDARY BRAIN INJURY

6. PRIMARY BRAIN INJURY

7. SECONDARY BRAIN INJURY

8. SECONDARY BRAIN INJURY

9. TYPES OF HEAD INJURY

10. CEREBRAL CONTUSION

11. SURGERY FOR CEREBRAL CONTUSION

12. SKULL FRACTURE

13. EPIDURAL HAEMATOMA

14. EPIDURAL HAEMATOMA

15. SUB DURAL HAEMATOMA

16. SUB DURAL HAEMATOMA

17. SUB DURAL HAEMATOMA

18. TRAUMATIC SUB ARACHNOID
HAEMORRAHAGE

19. INTRA PARENCHYMAL HAEMORHAGE

20. DIFFUSE AXONAL INJURY

21. DIFFUSE AXONAL INJURY

22. SEVERITY SCORING SYSTEM USED IN TBI
• GLASGOW COMA SCALE.
• THE FOUR SCORE.
• THE MARSHALL CT CLASSIFICATION.
• THE ROTTERDAM CT SCORE.

23. GLASGOW COMA SCALE
• 3 COMPONENTS IN THIS.
1.EYE OPENING(1-4).
2.VERBAL RESPONSE(1-5).
3.MOTOR RESPONSE(1-6).

24. GLASGOW COMA SCALE

25. THE FOUR SCORE(FOUR LINE OF
UNRESPONSIVENESS)

26. MARSHALL COMPUTED TOMOGRAPHY
CLASSIFICATION

27. THE ROTTERDAM COMPUTED TOMOGRAPHY
SCORE

28. MANAGEMENT OF PATIENT WITH TRAUMATIC
BRAIN INJURY
• DECISION TO INTUBATE:
1.GCS<9.
2.PERIPHERAL OXYGEN SATURATION LESS THAN 92% DESPITE
OXYGEN SUPPLEMENTATION.
3.SIGN ON CEREBRAL HERNIATION,
4.SIGNS OF ASPIRATION.
5.COMPROMISED AIRWAY.

29. INTRA CRANIAL PRESSURE

30. CEREBRAL PERFUSION PRESSURE

31. CEREBRAL BLOOD FLOW

32. MONRO KELLIE DOCTRINE

33. ETIOLOGY

34. MECHANISM OF ELEVATED INTRA CRANIAL
PRESSURE

36. CLINICAL INDICATOR OF INCREASED ICP

37. CHANGE IN VITAL SIGN

38. OCULAR SIGN

39. DECREASE IN MOTOR FUNCTION

40. SIGNS OF HERNIATION

41. INTRACRANIAL PRESSURE MONITORING
• INDICATIONS:
1.GCS<8 WITH CT SHOWING MASS EFFECT DUE TO INTRACRANIAL
BLEED.
2.GCS<8 WITH A NORMAL CT SCAN IF ANY OF THE FOLLOWING SIGN
AGE>40 YEARS,MOTOR POSTURING AND SBP<90 MMHG.
AN ICP TARGET OF <22 MMHG IS GENERALLY RECOMMENDED.

42. CONTRAINDICATION
• AWAKE PATIENT.
• COAGULOPATHY.
• SCALP INFECTION.
• BRAIN ABSCESS.

43. INTRACRANIAL PRESSURE MONITORING
TECHNIQUES

45. VARIOUS MONITORS

46. EXTERNAL VENTRICULAR DRAIN

49. WHEN TO PULL THE EVD OUT

52. FIBEROPTIC INTRA CRANIAL PRESSURE
MONITOR

54. THE SUBARACHNOID SCREW(BOLT)

56. SPIEGELBERG PARENCHYMAL TRANSDUCER

57. NONINVASIVE INTRACRANIAL PRESSURE
MONITORING

58. VENOUS OPHTHALMODYNAMOMETRY

59. TYMPANIC MEMBRANE DISPLACEMENT

60. TRANSCRANIAL DOPPLER

61. PUPILLOMETER

62. ADVANCED NEUROMONITORING

63. JUGULAR VENOUS OXIMETRY

64. BRAIN TISSUE OXYGEN TENSION
MONITORING

65. CEREBRAL MICRODIALYSIS

66. GOAL OF THERAPY
• MAINTAIN ICP AT LESS THAN 20-25 MMHG.
• MAINTAIN CPP AT> THAN 60 MMHG BY MAINTAINING ADEQUATE
MAP.
• AVOID FACTORS THAT AGGRAVATE OR PRECIPITATE ELEVATED ICP.

67. IMMEDIATE MEASURES

68. MODALITIES OF REDUCTION OF ICP

69. MANNITOL

71. HYPERTONIC SALINE

74. SURGICAL TREATMENT