Brain injury. Ricardo

Traumatic brain injury continues to be an enormous public health problem, even with modern medicine in the 21st century. Most patients with TBI (75-80%) have mild head injuries; the remaining injuries are divided equally between moderate and severe categories.

Head injuries include both injuries to the brain and those to other parts of the head, such as the scalp and skull.

Cerebral contusion, is a bruise of the brain tissue. The injury can cause a decline in mental function in the long term and in the emergency setting may result in brain herniation, a life-threatening condition in which parts of the brain are squeezed past parts of the skull. Contusions are likely to heal on their own without medical intervention. It is possible to relieve symptoms by way of neurotherapies such as Neurofeedback.

Numerous small contusions from broken capillaries that occur in grey matter under the cortex are called multiple petechial hemorrhagesor multifocal hemorrhagic contusion.Caused by shearing injuries at the time of impact, these contusions occur especially at the junction between grey and white matter and in the upper brain stem, basal ganglia, thalamus and areas near the third ventricle. The hemorrhages can occur as the result of brain herniation, which can cause arteries to tear and bleed. A type of diffuse brain injury, multiple petechial hemorrhages are not always visible using current imaging techniques like CT and MRI scans. This may be the case even if the injury is quite severe, though these may show up days after the injury. Hemorrhages may be larger than in normal contusions if the injury is quite severe. This type of injury has a poor prognosis if the patient is comatose, even with no apparent causes for the coma.

Contusions, which are frequently associated with edema, are especially likely to cause increases in intracranial pressure and concomitant crushing of delicate brain tissue.

Contusions typically form in a wedge-shape with the widest part in the outermost part of the brain.

The distinction between contusion and intracerebral hemorrhage is blurry because both involve bleeding within the brain tissue; however, an arbitrary cutoff exists that the injury is a contusion if two thirds or less of the tissue involved is blood and a hemorrhage otherwise.

The contusion may cause swelling of the surrounding brain tissue, which may be irritated by toxins released in the contusion. The swelling is worst at around four to six days after the injury.

Extensive contusion associated with subdural hematoma is called burst lobe. Cases of a burst frontal or temporal lobe are associated with high mortality and morbidity.

Old or remote contusions are associated with resorption of the injured tissue, resulting in various degrees of cavitation, in addition to the presence of a golden-yellow discoloration due to residual hemosiderin. These remote contusions are often referred to as plaque jaune oryellow plaque.