Traumatic Brain Injury: Diagnosis

by Roy Strowd, MD

My Notes
  • Required.
Save Cancel
    Learning Material 2
    • PDF
      Slides Head Trauma Traumatic Brain Injury.pdf
    • PDF
      Download Lecture Overview
    Report mistake

    00:01 What's the mechanism of a traumatic brain injury where we can see closed head injuries where the head has been struck by something, the head strikes something that is fixed.

    00:12 This can result in an acceleration-decelerate deceleration injury or injury as a result of rotational mechanisms.

    00:19 And each of these mechanisms can contribute to a traumatic brain injury.

    00:24 We can also see traumatic brain injuries from penetrating trauma or blast trauma.

    00:30 One of the important things to think about is how the brain is injured.

    00:34 And an acceleration-deceleration mechanisms, we can see two injuries to the brain.

    00:40 Both a coup injury that occurs at the site of the direct impact of the brain on surrounding structures, including the skull.

    00:49 And a secondary contrecoup injury which occurs at the area of the brain opposite the site of impact.

    00:57 And this contrecoup injury can actually often result in more severe injuries to the brain.

    01:02 And so we may see frontal and occipital injuries, we may see bitemporal and parietal injuries as a result of this coup and contrecoup injury.

    01:14 We grade and scale traumatic brain injuries based on the severity of the patient's symptoms.

    01:20 And we can categorize TBI as mild, moderate or severe.

    01:24 And there are a number of things that I want you to think about as you're evaluating whether a patient may have suffered a mild, moderate or severe traumatic brain injury.

    01:32 First we use the Glasgow Coma Scale.

    01:35 Mild TBI is defined as a GCS of 13 to 15.

    01:39 Moderate TBI is 9 to 12 and severe TBI as less than 8.

    01:45 We also think about loss of consciousness.

    01:47 With mild TBI, there is often a brief period of loss of consciousness or none at all.

    01:52 The patient may maintain consciousness throughout the entirety of the traumatic event.

    01:58 With moderate TBI there is frequently loss of consciousness in the range of 30 minutes with impaired a consciousness, sometimes extending out to several days.

    02:09 And then with more severe TBI, patients can remain in a coma for a prolonged period of time requiring hospitalization during that.

    02:17 Post-traumatic amnesia is a differentiating factor.

    02:21 Amnesia after the traumatic event is typically very short or not at all.

    02:24 With a mild TBI, it can last 1 to 7 days.

    02:28 With moderate TBI, it may last for a prolonged period of time with severe TBI.

    02:34 And we can often see some other key factors that help differentiate these three categories.

    02:39 Non-severe mechanisms may be in place for mild TBI, such as a fall or an injury during practice in a sporting event.

    02:47 With moderate TBI, patients may have headache, severe vomiting that may be refractory to medication interventions or alterations in their mental status at the time of the injury.

    02:57 And then severe long term and even persistent neurologic deficits can result from severe TBI.

    03:04 What about diagnosis? How do we diagnose a TBI or traumatic brain injury? Well, first the Glasgow Coma Scale is critical.

    03:12 We often perform a pupillary examination looking for unequal pupils or anisocoria.

    03:18 Anisocoria is a concerning finding and should prompt immediate workup for cause of of that abnormal pupil exam.

    03:26 In particular, we think about herniation, either transtentorial herniation, uncal herniation or brainstem herniation, which could be compressing the third cranial nerves or other important structures.

    03:39 In addition, in patients with neck injury, your injury to the carotid artery can result in a Horner syndrome which may lead to abnormal pupil exam, ptosis, meiosis and anhidrosis which requires imaging evaluation for possible dissection.

    03:58 In addition to the physical exam, imaging is critical in patients presenting with TBI particularly moderate to severe TBI.

    04:05 A CT of the head without contrast is the first line modality of choice.

    04:09 We're looking for skull fractures, intracranial hemorrhage or cerebral edema.

    04:12 And here we see a noncontrast head CT demonstrating an open skull fracture with underlying cerebral edema.

    04:19 MRI has better diagnostic sensitivity for underlying brain pathology.

    04:24 And here we see an associated MRI demonstrating a significant area of broad temporal contusion.

    About the Lecture

    The lecture Traumatic Brain Injury: Diagnosis by Roy Strowd, MD is from the course Head Trauma.

    Included Quiz Questions

    1. Closed head injury
    2. Penetrating injury
    3. Rotational injury
    4. Ischemic injury
    5. Blast trauma
    1. Occipital area
    2. Parietal area
    3. Temporal area
    4. Prefrontal area
    5. Motor cortex
    1. Severe
    2. Moderate
    3. Mild
    4. Progressive
    5. Regressive
    1. Moderate
    2. Mild
    3. Severe
    4. Comatose
    5. Normal

    Author of lecture Traumatic Brain Injury: Diagnosis

     Roy Strowd, MD

    Roy Strowd, MD

    Customer reviews

    5,0 of 5 stars
    5 Stars
    4 Stars
    3 Stars
    2 Stars
    1  Star