Traumatic Brain Injury-2

28/07/2022
What is a concussion?
• Alteration of consciousness caused by closed head injury
• Mild head injury, +/- LOC
• Most common
• Key features: Confusion and Amnesia
• Others: Lethargy, ditractable, forgetful, emotional lability, slow
interaction
• Rare: gait disturbance, incoordination
• At risk: high contact sports, RTA, fall from height, p/h/o concussion,
old age
Management of concussion
• Brain imaging- not vey useful
• Physical and mental rest
• No alcohol
• Avoiding bright lights and loud noises
• Analgesia, ice packs
• Follow up with doctor prior to resuming full activity
Complications
• Second impact syndrome- brain edema resulting due to a second
concussion, blood flow regulation of brain is lost, refractory to
treatment
• Post concussion syndrome- “shell shock”, series of symptoms lasting
for months post concussion, features of headache, dizziness, hearing
and vision difficulty, neurocognitive and neuropsychological
disturbances like emotional lability, insomnia, depression, poor
concentration and recall, personality change.
Diffuse Axonal Injury
• Shearing of the axons due to rotational shifting of the brain matter
inside the bony skull along with resultig hypoxia
• Variably seen in mild, moderate and severe head injury
• Process takes 12-24 hours to develop
• One of the major causes for LOC and persistent vegetative state after
head injury
Clinical features of DAI
• Mild to severe, temporary or permanent
• Immediately seen, or may take weeks to months
• LOC, ICP increased, decerebration or decortication, global cerebral
edema
Investigations
• CT- only 20% detected as these are hemorrhagic
• MRI- more sensitive
• Angiography- to detect blood vessel pathology
Treatment
• Mild- gradual resolution within 7-10 days
• Gradual return to work