Traumatic brain injury: Pathology review
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Traumatic brain injury: Pathology review
Pathology
Central and peripheral nervous system disorders
Amyotrophic lateral sclerosis
Neurofibromatosis
Sturge-Weber syndrome
Tuberous sclerosis
von Hippel-Lindau disease
Central nervous system disorders
Brain herniation
Broca aphasia
Kluver-Bucy syndrome
Wernicke aphasia
Wernicke-Korsakoff syndrome
Acoustic neuroma (schwannoma)
Adult brain tumors
Pediatric brain tumors
Pituitary adenoma
Ischemic stroke
Transient ischemic attack
Brain abscess
Cavernous sinus thrombosis
Creutzfeldt-Jakob disease
Encephalitis
Epidural abscess
Meningitis
Neonatal meningitis
Aqueductal stenosis
Cerebral palsy
Chiari malformation
Dandy-Walker malformation
Septo-optic dysplasia
Spina bifida
Spinocerebellar ataxia (NORD)
Syringomyelia
Tethered spinal cord syndrome
Alzheimer disease
Creutzfeldt-Jakob disease
Delirium
Frontotemporal dementia
Lewy body dementia
Normal pressure hydrocephalus
Vascular dementia
Acute disseminated encephalomyelitis
Central pontine myelinolysis
JC virus (Progressive multifocal leukoencephalopathy)
Multiple sclerosis
Transverse myelitis
Cavernous sinus thrombosis
Cluster headache
Idiopathic intracranial hypertension
Migraine
Tension headache
Trigeminal neuralgia
Arteriovenous malformation
Epidural hematoma
Intracerebral hemorrhage
Saccular aneurysm
Subarachnoid hemorrhage
Subdural hematoma
Essential tremor
Huntington disease
Opsoclonus myoclonus syndrome (NORD)
Parkinson disease
Restless legs syndrome
Torticollis
Early infantile epileptic encephalopathy (NORD)
Epilepsy
Febrile seizure
Brown-Sequard Syndrome
Cauda equina syndrome
Friedreich ataxia
Neurogenic bladder
Syringomyelia
Treponema pallidum (Syphilis)
Vitamin B12 deficiency
Concussion and traumatic brain injury
Peripheral nervous system disorders
Poliovirus
Spinal muscular atrophy
Charcot-Marie-Tooth disease
Guillain-Barre syndrome
Bell palsy
Trigeminal neuralgia
Carpal tunnel syndrome
Erb-Duchenne palsy
Klumpke paralysis
Sciatica
Thoracic outlet syndrome
Ulnar claw
Winged scapula
Lambert-Eaton myasthenic syndrome
Myasthenia gravis
Nervous system pathology review
Adult brain tumors: Pathology review
Central nervous system infections: Pathology review
Cerebral vascular disease: Pathology review
Congenital neurological disorders: Pathology review
Dementia: Pathology review
Demyelinating disorders: Pathology review
Headaches: Pathology review
Movement disorders: Pathology review
Neurocutaneous disorders: Pathology review
Neuromuscular junction disorders: Pathology review
Pediatric brain tumors: Pathology review
Seizures: Pathology review
Spinal cord disorders: Pathology review
Traumatic brain injury: Pathology review
Assessments
Traumatic brain injury: Pathology review
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Transcript
At the emergency department, 65-year-old Christian came in complaining of headaches, vision problems, and memory loss. These symptoms have gradually progressed over the past couple of weeks. On examination, there’s slurred speech, and his gait is unsteady. He has a history of chronic alcohol abuse. Head CT shows a “crescent-shaped” hyperdense mass that crosses the suture lines. Later that day, 33-year-old Max is brought in after a fight. They reported being knocked unconscious, but regained consciousness after an unknown period of time. Head CT is ordered and shows a “lens-shaped” hyperdense mass that doesn’t cross the suture lines. Max was very agitated and said they felt fine. They then left the hospital against medical advice. Later that day, Max lost consciousness again and died at home.
Okay, so Christian and Max had some form of traumatic brain injury. When an external force damages the head resulting in temporary or permanent brain dysfunction, we call it a traumatic brain injury, or TBI. Now, as a direct result of the external force, TBIs can cause extra-axial and intra-axial injuries. Extra-axial injuries are within the skull but don’t involve the brain parenchyma. The most high yield ones are epidural and subdural hematomas, as well as a subarachnoid hemorrhage. Intra-axial injuries - on the other hand - do involve the brain parenchyma, and the most high yield one for your exams is diffuse axonal injury. Now, the initial brain injury can impair the normal functioning of the cerebral metabolism and result in complications, such as tissue hypoxia, cognitive impairment, and seizures. Additionally, if the brain injury is associated with intracranial bleeding or severe inflammation followed by edema, the pressure within the skull may rise and result in severe complications. For your exams, it’s important to note that the most important complication of increased intracranial pressure is brain herniation. Trauma initiates a series of molecular events along with the primary brain injury, which can persist for hours, or even days. These are referred to as “secondary brain injury”, and eventually can result in increased intracranial pressure, which in turn, has numerous consequences, and for the exams, the most important is brain herniation.
Summary
Traumatic brain injury (TBI) is a type of injury that occurs when an external force blows or jolts the head, resulting in temporary or permanent brain dysfunction. Sometimes, TBI can lead to increased intracranial pressure, which can have various consequences, like brain herniations that are life-threatening.
TBI can range from mild to severe and can result in a wide range of physical, cognitive, and emotional symptoms. Symptoms can include headaches, confusion, memory loss, difficulty concentrating, mood changes, and more.
Diagnosis can be made based on clinical presentation, imaging tests of the brain, like CT or MRI, or other techniques such as a lumbar puncture. TBIs usually require surgery. Treatment for TBI typically involves drugs such as mannitol to control intracranial pressure, antiseizure medications like phenobarbital to control seizures, and neurosurgical interventions like when there is a need for hematoma evacuation.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Brain Injury" Springer Science & Business Media (2001)
- "Adams and Victor's Principles of Neurology, Ninth Edition" McGraw Hill Professional (2009)
- "Neuropsychiatric Sequelae of Traumatic Brain Injury" Psychosomatics (2000)
- "Classification of Traumatic Brain Injury for Targeted Therapies" Journal of Neurotrauma (2008)
- "Communication Disorders Following Traumatic Brain Injury" NA (1999)
- "Pathophysiology of traumatic brain injury" British Journal of Anaesthesia (2007)
- "Pioglitazone Therapy and Fractures: Systematic Review and Meta- Analysis" Endocrine, Metabolic & Immune Disorders - Drug Targets (2018)
- "Brain Herniation and Intracranial Hypertension" Neurologic Clinics (2021)
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