Intracranial Compliance, Traumatic Brain Injury and Management
Traditionally, head injury has been categorized into the primary injury and the secondary injury. The initial injury once inflicted is hard to reverse. Thus, the major goal is to prevent secondary injury which ensues within minutes to days after the initi
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Intracranial Compliance, Traumatic Brain Injury and Management Zahid Hussain Khan and Pooya Kalani
1.1
Introduction
Traumatic brain injury (TBI) has been reported to be 50,000 annually in the mean age group of 35 year in the United States alone [1]. Survivors live with the TBI related disabilities. In the contemporary literature, a 20% reduction in mortality has been reported, and this could be attributed to an improvement of our knowledge of pathophysiology of TBI and an advancement in our management strategies. The last decade has witnessed giant strides in monitoring, critical care techniques, indications and timing of surgery, which had an overall favorable impact on the mortality. The brain is an organ that is exquisitely sensitive to hypoxemia, episodes of hypotension and alterations in the blood pH. TBI ushers in a cascade of events that bring in a change in the body hemostasis which if not corrected urgently can end up in more profound damage to the brain that would be difficult to treat. The major causes of head injury include road vehicle accidents, falls from heights and sports, etc. Traditionally, head injury has been divided into the primary injury and the secondary injury. Z.H. Khan, MD, FCCM (*) Department of Anesthesiology and Intensive Care, Tehran University of Medical Sciences, Tehran, Iran e-mail: [email protected] P. Kalani, MD Department of Anesthesiology and Intensive Care, Hamedan University of Medical Sciences, Hamedan, Iran
The initial assault or impact damage once inflicted is hard to reverse, that, it causes inevitable destruction depending upon the severity of the injury but is preventable if safety measures are adopted and rules of driving and other sports abided. The impact damage can appear in the form of contusions or lacerations, or else appear as epidural, subdural or intracerebral hematomas when bleeding occurs in the contusions or else several contusions coalesce together because of bleeding occurring within them. The secondary brain damage occurs within minutes to days after the initial insult in the form of hypoxia, hypercarbia, brain edema, brain shift, ischemia and infection which are preventable to some extent, and this aspect is the cornerstone in the management of TBI.
1.2
Intracranial Compliance/ Elastance
The brain is besieged by the rigid skull and an increase in intracranial pressure (ICP) may reduce cerebral perfusion pressure (CPP), and demolish cerebral blood flow (CBF) leading to cerebral ischemia. The craniospinal axis is essentially a partially closed box containing both viscous and elastic elements. The elastic or its inverse the compliant properties of the container will ascertain as to how much volume can be added to it before the ICP shows a rise.
© Springer International Publishing Switzerland 2017 Z.H. Khan (ed.), Challenging Topics in Neuroanesthesia and Neurocritical Care, DOI 10.1007/978-3-319-41445-4_1
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Z.H. Khan and P. Kalani Maximum constriction Maximum dilatation
Fig. 1.1 Autoregulatory relationship between vascular resistance (CV
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