![]() TBI may also induce changes in the magnitude and duration of glucose metabolism, with a temporary increase in glucose uptake followed by glucose depression ipsilateral to the injury. ![]() The Na+-K+-ATPase pump attempts to re-establish balance and depletes ATP. This release leads to an influx of sodium and calcium and an efflux of potassium. Calcium and sodium shifts, mitochondrial damage, and production of free radicals occurs, which may lead to the expansion of the initial injury. There is a release of presynaptic neurotransmitters such as glutamate, which activate NMDA receptors. In the hours, days, and weeks that follow the primary injury, the initial damage triggers numerous secondary effects - secondary injury results from multiple factors. ![]() There may also be coup-contrecoup injuries coup injury occurs at the site of impact, whereas contrecoup injury occurs on the opposite side of the impact from rapid brain movement. Diffuse axonal injury often impacts the junction between gray and white matter. Diffuse axonal injury results from shearing forces and can cause neuronal axon stretching and tearing, leading to secondary damage. There are multiple types of traumatic intracranial hemorrhage, including epidural hematomas, subdural hematomas, intraparenchymal hemorrhage, intraventricular hemorrhage, and subarachnoid hemorrhage. There may be no visible injury on imaging, and imaging is not always indicated to assess the primary injury. Primary insult occurs due to the initial injury and may result in contusions, intracranial hemorrhage, and diffuse axonal injury. īrain trauma has both primary and secondary effects. Patients who have experienced recurrent TBI are an area of active research, some of which have demonstrated that the cumulative effects of TBI put patients at risk for permanent damage. Patients who have suffered any degree of TBI are at risk for long-term post-concussive symptoms, including changes in personality, emotional lability or depression, impairment in memory or ability to concentrate, or changes in sensation (visual or hearing changes). Factors that are often used to classify severity include changes in structural imaging, length of loss of consciousness, duration of altered mental status, post-traumatic amnesia, and GCS within the first 24 hours. Patients with mild TBI may have transient changes in consciousness or mentation, while those with severe TBI may experience prolonged periods of unconsciousness, coma, or death. Symptoms vary greatly and may range from mild to severe depending on the degree of damage imaging may or may not reveal changes. ![]() A cerebral contusion D.Brain trauma or traumatic brain injury (TBI) results from a blow, bump, jolt, or penetrating injury to the head that disrupts the normal function of the brain. With the provided information, on which field diagnosis would you base your treatment plan? A. She states that the object did not hurt very much, so she figured it was unimportant and forgot about it. When asked, she remembers that she was struck on the left side of the head by an object that she thought was thrown by a lawn mower as she walked past it three days ago while walking her dog. As you perform your examination, you notice that she winces when you touch the left parietal area of her head. When she awoke this morning, she noticed the dizziness and vision change in her eye and decided not to drive herself to the doctor. When you question her, she tells you that the headache began the previous day and got worse as the day went on, forcing her to leave work early. As you follow her, you notice that she appears to be relying on the wall to assist her balance. When you arrive at the scene, she meets you at the door and leads you toward the kitchen. You are dispatched to a residence for a 32-year-old woman who is complaining of a severe headache and blurry vision in her left eye.
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