Neurology

Traumatic Brain Injury & Concussion song

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Traumatic Brain Injury & Concussion

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Concussion is a mild TBI defined by transient neurological dysfunction after biomechanical force, with GCS 13–15 and no structural abnormality on CT; loss of consciousness is not required for diagnosis.
The most common cause of death in TBI is diffuse axonal injury (DAI), resulting from rotational acceleration-deceleration forces that shear axons at the gray-white matter junction, corpus callosum, and brainstem.
Epidural hematoma classically presents with a lucid interval followed by rapid deterioration, caused by rupture of the middle meningeal artery, and appears as a biconvex (lens-shaped) hyperdensity on CT that does not cross suture lines.
Subdural hematoma results from tearing of bridging veins, appears as a crescent-shaped hyperdensity on CT that crosses suture lines, and is most common in elderly patients and alcoholics due to cortical atrophy stretching bridging veins.
Second impact syndrome occurs when a second concussion is sustained before full recovery from the first, causing rapid cerebral edema and herniation; it disproportionately affects adolescent athletes and can be fatal.
Post-concussive syndrome presents with headache, cognitive slowing, sleep disturbance, and emotional lability persisting beyond 4 weeks; symptoms are more prolonged in females, younger patients, and those with prior concussion history.
CT head without contrast is the first-line imaging in TBI; MRI is preferred for detecting DAI and subtle parenchymal injury when CT is unrevealing but neurological deficits persist.
Cushing's triad — hypertension, bradycardia, and irregular respirations — indicates severely elevated intracranial pressure with impending brainstem herniation and requires immediate intervention.
Management of elevated ICP in severe TBI includes head-of-bed elevation to 30 degrees, osmotic therapy with mannitol or hypertonic saline, and targeting a cerebral perfusion pressure of 60–70 mmHg; prophylactic hyperventilation is avoided except as a bridge measure.
Chronic traumatic encephalopathy (CTE) is a tau-protein tauopathy associated with repetitive subconcussive head trauma in contact sport athletes, presenting with progressive neuropsychiatric symptoms, dementia, and parkinsonism; diagnosis is confirmed only at autopsy.