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Severe TBI

Last modified by XWikiGuest on 2025/06/09 13:52

 

FACTS

Punchline

CONSULT

HPI 

  •  

FOCUSED EXAM

 

IMG 

CT without contrast: 
- loss-of gray-white differentiation (indicates severe swelling / hypoxic injury)
- effacement of sulci
- slit vents 
- scattered petechial hemorrhage in corpus callosum indicative of 

MRI Brain without contrast
- evaluate SWAN hits based on Adams DAI classificaiton

Adams Diffuse Axonal Injury Classification

  • Grade 1: A mild diffuse axonal injury with microscopic white matter changes in the cerebral cortex, corpus callosum, and brainstem
  • Grade 2: A moderate diffuse axonal injury with gross focal lesions in the corpus callosum
  • Grade 3: A severe diffuse axonal injury with finding as Grade 2 and additional focal lesions in the brainstem

A/P

- pituitary labs (endocrinopathy common) 

[ ] box 1

Pedatric TBI

  • after moderate-severe TBI, GH deficiency most common in children (10-40% dysfunction)

Cerebral Perfusion Pressure

  • Brain Trauma Foundation guidelines currently recommend 60-70 mmHg 
  • > 70 increases ARDs risk 

Oxygenation

  • PbO2 < 20 is hypoxia 

Prognostication

MRI Brain without contrast

SSEPs

  • N20 = negative deflection of signal recorded from scalp in area of central sulcus approximately 20 ms after each stimulus, averaged
    • represnts post-synaptic activity related to sensory stimulation
    • absence = poor prognosticator

Figure 1: Sea