Traumatic brain injury

Traumatic brain injuries (TBI) are common and come with a large cost to both society and the individual. Imaging plays a key role in accurate diagnosis, classification and follow-up. 

TBI are more common in young patients, and men account for the majority (75%) of cases 4.

Patients typically present with a combination of reduced Glasgow Coma Scale (GCS), nausea/vomiting and/or amnesia 3. Severity of injury can be assessed with GCS 4:

  • mild TBI: GCS 14-15
  • moderate TBI: GCS 9-13
  • severe TBI: GCS 3-8

This has limitations as there are other causes for reduced GCS in trauma (alcohol, drugs, seizure, etc). 

In the acute setting patients can present with primary brain damage 4

Secondary brain damage can also occur and manifests as 4:

Long-term sequelae of head trauma includes:

TBI has been traditionally divided into closed and penetrating head injuries 4:

  • closed head injury
    • blunt trauma: motor vehicle collision, assault, sport, industrial/workplace accidents, etc
    • blast injuries
    • non-accidental injury in children
  • penetrating head injury

Severe mass effect can result in:

Other traumatic injuries are common:

CT is the workhorse of imaging in TBI, especially in the acute setting, and is used in most settings to classify the degree of injury using imaging (see main article: Marshall classification of traumatic brain injury). 

MRI has a supplementary role, especially in the evaluation of patients whose clinical condition do not match the CT findings (this can often occur in DAI) 1,2. Please see the relevant articles for imaging findings. 

A number of classifications have been described, variably using clinical or imaging parameters. These include: 

Large haematomas with significant mass effect require urgent neurosurgical evacuation. Hydrocephalus can develop and urgent ventricular drainage may be required. Intracranial pressure (ICP) monitor insertion is a common procedure used to help in the assessment of severe TBI. 

Ongoing follow-up with CT is often required. In patients with diffuse injuries ~15% will develop new lesions, and ~35% (range 25-45%) of cerebral contusions will increase in size with progression thought to typically occur 6-9 hours after injury 4

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Article information

rID: 46289
Synonyms or Alternate Spellings:
  • Closed head injury
  • Traumatic brain injuries
  • TBI
  • Penetrating head injury
  • Penetrating brain injury (PBI)
  • Closed brain injury (CBI)

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    Case 3: gun shot injury
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    Case 4: with ICP monitor
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    Case 5: diffuse axonal injury
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    Case 6: penetrating head injury (stabbing)
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