graded in order of increasing severity.Imaging often underestimate the full extent of axonal injury present May be associated with restricted diffusion. corpus callosum, internal capsule, dorsal midbrain or pons) or the grey-white matter interface (particularly in the frontal lobes) results from axonal stretch or shear stress, usually affecting organized white matter tracts (e.g.commonly at the inferior frontal lobes and anterior-inferior temporal lobes due to the ridged morphology of the inner table.in the setting of trauma, this may occur from a ruptured subependymal vein, extension from intra-parenchymal hemorrhage or retrograde distribution from the subarachnoid space.isolated SAH in the basilar cisterns may require investigation for underlying vascular aneurysm.SAH in the interpeduncular cisterns may indicate brainstem injury midline traumatic SAH in the inter-hemispheric fissure or perimesencephalic cisterns may be a marker of diffuse axonal injury.usually small volume sulcal SAH occurring at the site of impact (coup) or opposite the site of impact (contrecoup).can occur in the first day of trauma, but mean time to appearance is 9 days after injury 8.caused by tearing of the arachnoid membrane with CSF accumulation in the subdural space.mixed-attenuation SDH is not necessarily acute on chronic other causes of hypoattenuating portions of subdural hematomas include hyperacute hemorrhage and unclotted chronic blood products (particularly in patients with coagulopathy) 8.compression from an extra-axial hematoma and/or thrombosis) fractures traversing the dural venous sinus or jugular bulb are often associated with injuries to the venous structures (e.g.anterior cranial fossa fractures are often associated with CSF leak.may be associated with tearing of the underlying meninges and extra-axial hemorrhage.Potential indications for performing CT in the acute setting for patients with concussion (to exclude more serious forms of traumatic brain injury such as intracranial hemorrhage) may include the following: loss of consciousness, post-traumatic amnesia, persistent altered mental status, focal neurology, signs of skull fractures or evidence of clinical deterioration 8. Various clinical tools exist which help to screen for patients who require acute neuro-imaging, including: the Canadian Head CT Rule, the National Emergency X-Radiography Utilization study II (NEXUS-II) criteria, and the American College of Radiology Appropriateness Criteria for head trauma. The decision to perform imaging in the setting of head trauma will depend on multiple factors, including local department guidelines and access to imaging. cervical spine injury: patients with GCS hydrocephalus: can also be a chronic non-mass effect related complication.cerebral herniation: often requires urgent treatment.midline shift: associated with worse prognosis.increased risk of schizophrenia, bipolar disorder and organic mental disorders 6.depression, anxiety and alcohol excess 5.chronic subdural hematomas / CSF hygromas.Long-term sequelae of head trauma include: ischemic stroke from traumatic arterial dissection. ![]() ![]() Secondary brain damage can also occur and manifests as 4: ![]() traumatic subarachnoid hemorrhage (tSAH).In the acute setting patients can present with primary brain damage 4: Chronic traumatic encephalopathy describes neurodegeneration associated with repetitive head injuries, and characterized microscopically by accumulation of hyperphosphorylated tau in neurons. The potential long term sequelae of repetitive traumatic brain injury is a current area of research. The term concussion refers to a clinical diagnosis which has overlap with the mild end of the spectrum of traumatic brain injury, and usually is used in reference to a transient brain injury 8. This scale has limitations as there are other causes for reduced GCS in trauma (alcohol, drugs, seizure, etc.). mild traumatic brain injury (TBI): GCS 14-15.The severity of the injury can be assessed with GCS 4: Patients typically present with a combination of reduced Glasgow Coma Scale (GCS), nausea/vomiting and/or amnesia 3. Although sport is a common cause of relatively mild repeated head injury potentially eventually leading to chronic traumatic encephalopathy, more severe injuries are most often due to motor vehicle accidents and assault. Traumatic brain injuries are more common in young patients, and men account for the majority (75%) of cases 4.
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