Traumatic Brain Injury
Deadline for manuscript submissions: closed (30 November 2018) | Viewed by 62048
Traumatic Brain Injury (TBI) remains a major public health problem and is a major cause of death and disability in, predominately, the young male population, mostly as victims of traffic accidents or falls.
The incidence of all closed head injuries admitted to hospitals is, conservatively, estimated to be 200 per 100,000 population. Of these, 10% are generally classified at admission as severe (Glasgow Coma Scale (GCS) ≤ 8), another 10% as moderate (GCS 9–12), and the rest as mild (GCS 13–15). Mild traumatic brain injury (GCS 13–15) the most common form of TBI results mainly from concussion. Fortunately, there is full neurological recovery in most of these cases, although many of these subjects have short-term memory and concentration difficulties. However, some of them may even suffer from long term sequels.
Of the subjects who suffer a severe TBI, approximately one-third die, even in the best of centers. Of the survivors, a sizeable fraction demonstrates significant long-term disability. Mortality and long term disability are the consequences of primary and secondary brain injuries.
Primary brain injury (brain contusions, intracerebral bleeding, diffuse axonal injury) result from direct impact of biomechanical forces on skull and brain tissue and can be classified as focal, diffuse or a combination.
Delayed or secondary brain injuries result from various secondary insults leading to tissue ischemia predominantly but nor exclusively affecting vulnerable areas of the brain (i.e., penumbra zones). They include hemodynamic and respiratory instability, neuro-humoral and metabolic derangements, mass lesions among others due to progression of hematoma or new hematoma within the first 24 hours after injury. The presence of delayed brain injury is associated with higher mortality, slower recovery, and poorer outcome at six months.
Pathophysiology and mechanisms responsible for some of the deleterious effects of brain injuries in many subjects still not are fully understood. Involvement of structural and functional alterations in neurofilaments cell membranes and mitochondria, metabolic changes, disruption of blood–brain barrier and autoregulation among others resulting in brain edema, neuroinflammation, cytotoxic events, i.e., resulting from excitotoxicity, could be identified thus far. However, many other factors including genetic predisposition might be involved additionally.
To date standard management of traumatic brain injury comprises surgery if indicated, supportive therapy, (analgo-sedation, circulatory and respiratory support, body temperature management, nutrition) as well as therapies directed to neuroprotection (i.e., intracerebral pressure (ICP) and cerebral perfusion pressure (CPP) management, management of oxygen consumption and brain edema) in order to maintain/restore intracranial hemodynamic, sufficient tissue perfusion, and minimized cerebral oxygen consumption targeting prevention or at least limitation of secondary insults leading to secondary brain injury as there is no causal treatment for TBI. Interventions have to be started at the site of the accident and be maintained throughout emergency room, intensive care unit and patient ward. Moreover, specific neuro-rehabilitation in the post-acute care is a mainstay to reduce long term sequels after brain injury.
In order to provide an update on traumatic brain injury, we invite reviews, research articles, or short communications which include, but are not limited to the topics listed below.
We look forward to your contributions.
Prof. Dr. Reto Stocker
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- Epidemiology, pathology and pathophysiology of traumatic brain injury
- “Minor” head injury
- Pre-hospital Care in traumatic brain injury
- Diagnostic algorithms and treatment protocols in the emergency room
- Diagnostics and imaging in traumatic brain injury
- Intensive care in traumatic brain injury including multi-modal monitoring and neuroprotection
- Rehabilitation after traumatic brain injury
- Guidelines for traumatic brain injury management
- Ethical issues in traumatic brain injury
- Comorbidities in people with traumatic brain injury
- Animal models for traumatic brain injury