Anatomy is the study of the structure of

Anatomy is the study of the structure of the human body.
Physiology, in contrast, focuses on how these body parts function together.
The human body is composed of several major organ systems that work in concert.
The circulatory system is responsible for transporting blood, oxygen, and nutrients throughout the body.

1. Traumatic Brain Injury By- Niyati Nilesh Vaidya Sem-11 | MDE2002 University Geomedi

2. Traumatic brain injury is an alteration in brain function, or other evidence of brain pathology, caused by an external force, Head injury accounts for 3-4% of emergency department attendances. Epidemiology: Leading cause of death & disability in young adults Common causes: Road traffic accidents, falls, assaults, sports injuries

3. Classification & Severity The GCS score, and in particular the motor score is the best predictor of neurological outcome. In broad terms, significantly obtunded patients have moderate injuries and comatose patients have severe injuries; alcohol and drug effects often complicate the classification.

4. Types Closed Brain Injury- without the skull being broken or penetrated and the brain has not been exposed. Open Brain Injury- open or penetrating head injury. • A TBI can be focal or diffuse, meaning damage may be isolated to one specific area of the brain in focal injuries or wide spread in the case of diffuse injuries.

5. Non-penetrating (Closed) TBI is caused by a forceful external impact that moves the brain inside the skull, leading to injury without a break in the skull. Common causes include falls, motor vehicle accidents, and sports injuries. Specific types include: Concussion: A transient alteration in mental status, often without loss of consciousness, caused by a blow to the head. Contusion: Bruising of the brain tissue that can cause variable neurological dysfunction. Diffuse Axonal Injury (DAI): Damage that occurs when the brain is shaken or rotated violently, causing widespread microscopic damage.

6. Intracranial hematoma is the most common cause of death and clinical deterioration after TBI. Hematomas are categorized as follows: Epidural hematomas - These are usually caused by fracture of the temporal bone and rupture of the middle meningeal artery. Subdural hematomas - Such hematomas are usually caused by rupture of the bridging veins in the subdural space. Subarachnoid hematomas - These result from damage to blood vessels in the posterior fossa stalk. Extracranial hematoma: scalp lacerations nasal injuries injuries to the face and neck can lead to significant blood loss

7. Pathophysiology Primary Injury- Occurs at the moment of trauma -Caused by direct mechanical forces: impact, acceleration-deceleration, rotation -Examples: contusions, lacerations, hematomas, diffuse axonal injury, skull fractures -Irreversible Secondary Injury- Develops hours to days after trauma -Result of biochemical and physiological responses to primary injury -Mechanisms: cerebral edema, ischemia, hypoxia, increased ICP, inflammation -Potentially preventable or treatable

8. Signs & Symptoms Altered consciousness headache vomiting seizures Focal deficits anisocoria Cushing’s triad. (Consider associated cervical spine trauma)

9. Management Mild TBI, sometimes called concussion, may not require specific treatment other than rest. instructions for complete rest and slow return to normal activities after a mild TBI In addition, alcohol and other drugs can slow recovery and increase the chances of re-injury. Re-injury during recovery can slow healing and increase the chances of long-term problems, including permanent brain damage and even death.2

10. Initial Approach (ABCDE): Airway protection with cervical spine control Breathing: ensure adequate oxygenation, control CO₂ Circulation: maintain systolic BP >100–110 mmHg Disability: rapid neurological assessment (GCS) Exposure: identify other injuries Neurosurgical Involvement: Begins after stabilization and CT evaluation.

11. Investigations CT head (non-contrast) – gold standard MRI – DAI/posterior fossa ICP monitoring if severe TBI Baseline labs & coagulation Intracranial pressure monitor- Tissue swelling from a traumatic brain injury can increase pressure inside the skull and cause additional damage to the brain.

12. ICP Control Measures: Head elevation 30° Osmotic therapy (Mannitol 0.25–1 g/kg IV or Hypertonic saline 3%) Sedation, analgesia, normothermia Avoid Hypoxia & Hypotension (key causes of secondary injury) Seizure Prophylaxis: IV levetiracetam or phenytoin for 7 days

13. Indications for Neurosurgical intervention E pidural Hematoma (EDH): 30 mL or any symptomatic → Emergency craniotomy Acute Subdural Hematoma (ASDH): Thickness >10 mm or midline shift >5 mm → Craniotomy Depressed Skull Fracture: thickness of skull, contamination, or dural breach → Elevation & debridement Intracerebral Hematoma/Contusion: Large or causing mass effect → Evacuation Decompressive Craniectomy: For refractory intracranial hypertension (>25 mmHg despite maximal therapy)

14. Neurosurgical Procedures Craniotomy: Bone flap temporarily removed for hematoma evacuation or repair. Decompressive Craniectomy: Bone flap left off to allow brain swelling; duraplasty performed. External Ventricular Drain (EVD): Monitors ICP, drains CSF to reduce pressure. Burr Holes: Rapid decompression (EDH/SDH) in emergency settings.

15. Postoperative & Rehabilitation Care I CU Monitoring: ICP, CPP, fluid balance, sodium levels. Complications: Rebleeding, infection, hydrocephalus, seizures. Rehabilitation: Early physiotherapy, cognitive therapy, neuropsychological support. Outcome Assessment: Glasgow Outcome Scale (GOS) at follow-up.

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