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Increased Intracranial Pressure in Closed Head Injury

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1. Increased Intracranial Pressure in Closed Head Injury

Increased Intracranial Pressure in Closed Head Injury Increased Intracranial Pressure in Closed Head Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse (...) Cancer Administration 4 Increased Intracranial Pressure in Closed Head Injury Increased Intracranial Pressure in Closed Head Injury Aka: Increased Intracranial Pressure in Closed Head Injury , Increased Intracranial Pressure in Trauma , Severe Head Trauma Related Increased Intracranial Pressure From Related Chapters II. Differential Diagnosis III. Pathophysiology with secondary IV. Signs: Findings indicating management below >15 mm Severe (GCS 8 or less) Cerebral edema Severe Severe Hypopnea V

2018 FP Notebook

2. Increased Intracranial Pressure in Closed Head Injury

Increased Intracranial Pressure in Closed Head Injury Increased Intracranial Pressure in Closed Head Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse (...) Cancer Administration 4 Increased Intracranial Pressure in Closed Head Injury Increased Intracranial Pressure in Closed Head Injury Aka: Increased Intracranial Pressure in Closed Head Injury , Increased Intracranial Pressure in Trauma , Severe Head Trauma Related Increased Intracranial Pressure From Related Chapters II. Differential Diagnosis III. Pathophysiology with secondary IV. Signs: Findings indicating management below >15 mm Severe (GCS 8 or less) Cerebral edema Severe Severe Hypopnea V

2017 FP Notebook

3. Systematic Review - Relationship of Deployment-related Mild Traumatic Brain Injury to Posttraumatic Stress Disorder, Depressive Disorders, Substance Use Disorders, Suicidal Ideation, and Anxiety Disorders

Systematic Review - Relationship of Deployment-related Mild Traumatic Brain Injury to Posttraumatic Stress Disorder, Depressive Disorders, Substance Use Disorders, Suicidal Ideation, and Anxiety Disorders 4 March 2019 Prepared for: Department of Veterans Affairs Veterans Health Administration Health Services Research & Development Service Washington, DC 20420 Prepared by: Evidence Synthesis Program (ESP) Center Portland VA Medical Center Portland, OR Mark Helfand, MD, MPH, MS, Director (...) Relationship of Deployment-related Mild Traumatic Brain Injury to Posttraumatic Stress Disorder, Depressive Disorders, Substance Use Disorders, Suicidal Ideation, and Anxiety Disorders: A Systematic Review Authors: Principal Investigator: Nancy Greer, PhD Timothy J. Wilt, MD, MPH Co-Investigators: Princess Ackland, PhD, MSPH Roderick MacDonald, MS Nina Sayer, PhD Michele Spoont, PhD Brent Taylor, PhD Research Assistants: Lauren McKenzie, MPH Christina Rosebush, MPH Evidence Synthesis Program 4 Relationship

2019 Veterans Affairs Evidence-based Synthesis Program Reports

4. Assessment of traumatic brain injury, acute

include the following: Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008 Aug;7(8):728-41. http://www.ncbi.nlm.nih.gov/pubmed/18635021?tool=bestpractice.com Cerebral oedema Increased intracranial pressure (ICP) Haemorrhage Seizures Ischaemia Infection. Epidemiology of TBI TBI is a substantial cause of morbidity and mortality, leading to more than 2 million accident and emergency department visits annually in the US, Coronado VG, McGuire LC (...) /pubmed/11356436?tool=bestpractice.com After traumatic brain injury, there is an inverse relationship between the GCS score and the incidence of positive findings on CT; in fact, the rate of intracranial injury (ICI) and need for neurosurgical intervention doubles when the GCS drops from 15 to 14. Smits M, Dippel DW, Steyerberg EW, et al. Predicting intracranial traumatic findings on computed tomography in patients with minor head injury: the CHIP prediction rule. Ann Intern Med. 2007;146(6):397-405

2018 BMJ Best Practice

5. Assessment of traumatic brain injury, acute

include the following: Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008 Aug;7(8):728-41. http://www.ncbi.nlm.nih.gov/pubmed/18635021?tool=bestpractice.com Cerebral oedema Increased intracranial pressure (ICP) Haemorrhage Seizures Ischaemia Infection. Epidemiology of TBI TBI is a substantial cause of morbidity and mortality, leading to more than 2 million accident and emergency department visits annually in the US, Coronado VG, McGuire LC (...) /pubmed/11356436?tool=bestpractice.com After traumatic brain injury, there is an inverse relationship between the GCS score and the incidence of positive findings on CT; in fact, the rate of intracranial injury (ICI) and need for neurosurgical intervention doubles when the GCS drops from 15 to 14. Smits M, Dippel DW, Steyerberg EW, et al. Predicting intracranial traumatic findings on computed tomography in patients with minor head injury: the CHIP prediction rule. Ann Intern Med. 2007;146(6):397-405

2018 BMJ Best Practice

6. Prostacyclin Affects the Relation Between Brain Interstitial Glycerol and Cerebrovascular Pressure Reactivity in Severe Traumatic Brain Injury. Full Text available with Trip Pro

Prostacyclin Affects the Relation Between Brain Interstitial Glycerol and Cerebrovascular Pressure Reactivity in Severe Traumatic Brain Injury. Cerebral injury may alter the autoregulation of cerebral blood flow. One index for describing cerebrovascular state is the pressure reactivity (PR). Little is known of whether PR is associated with measures of brain metabolism and indicators of ischemia and cell damage. The aim of this investigation was to explore whether increased interstitial levels (...) of glycerol, a marker of cell membrane damage, are associated with PR, and if prostacyclin, a membrane stabilizer and regulator of the microcirculation, may affect this association in a beneficial way.Patients suffering severe traumatic brain injury (sTBI) were treated according to an intracranial pressure (ICP)-targeted therapy based on the Lund concept and randomized to an add-on treatment with prostacyclin or placebo. Inclusion criteria were verified blunt head trauma, Glasgow Coma Score ≤ 8, age 15-70

2019 Neurocritical care Controlled trial quality: uncertain

7. Management of Perceived Devastating Brain Injury After Hospital Admission

of DBI is not dependent on the underlying diagnosis. It can be used in patients with any primarily neurological diagnosis, most commonly traumatic brain injury, subarachnoid haemorrhage, intra-cerebral haemorrhage, stroke and hypoxic brain injury from a range of causes. The early limitation or WLST is usually considered in DBI because the presenting neurological insult is not thought to be compatible with survival and not amenable to active intervention. In practice this usually means that a short (...) for the diagnosis and confirmation of death. Academy of the Royal Colleges. 2010. 14 Management of Perceived Devastating Brain Injury after Hospital Admission 10. BARRIERS TO IMPLEMENTATION Resources ICU Capacity Even in countries with considerably higher ICU capacity than the UK the practical, moral and financial impacts of using increased ICU resources at the end of life are increasingly recognised 43 . The equitable and ethical management of scare ICU beds and resources is an everyday challenge for ICU

2018 Faculty of Intensive Care Medicine

8. Shaken baby syndrome or non-accidental head injury caused by shaking

/July 2017 14 ? Transcranial Doppler: it makes it possible to non-invasively indicate IH, and to guide a possible decision for emergency surgery. ? When a neurosurgical procedure is necessary, a macroscopic description (appearance/pressure) and a cytological analysis of the samples from the cerebrospinal fluid and haematoma must be carried out. 1.3 Differential diagnoses for NAHI caused by shaking The main differential diagnosis is accidental head injury, but in this case the clinical history must (...) . The following mechanisms and circumstances were examined: ? shaking without impact; ? mild head injury caused by a fall from a low height; ? play; ? childbirth; ? hypoxia or anoxia; ? resuscitation manoeuvres. The update looked at other mechanisms mentioned: vaccinations, dehydration, thrombosis of the intracranial venous sinuses and haemostasis disorders. 2.1 Shaking without impact Shaking is a highly violent action during which the cervical spine suffers brutal whiplash. Subdural bleeding and RH

2017 HAS Guidelines

9. Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury

For the purposes of this CPG, the term concussion is used synonymously with mild traumatic brain injury (mTBI) and is defined as a traumatic injury that affects the brain, induced by biomechanical forces transmitted to the head by a direct blow to, or forces exerted on, the body, 141,153,159 but that does not result in an extended period of unconsciousness, amnesia, or other significant neurological signs indicative of a more severe brain injury. Concussions occur via many dif- ferent mechanisms (...) Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury Clinical Practice Guidelines CATHERINE C. QUATMAN-YATES, PT , DPT , PhD • AIRELLE HUNTER-GIORDANO, PT , DPT KATHY K. SHIMAMURA, PT , DPT , NCS, OCS, CSCS, FAAOMPT • ROB LANDEL, PT , DPT , FAPTA BARA A. ALSALAHEEN, PT , PhD • TIMOTHY A. HANKE, PT , PhD • KAREN L. McCULLOCH, PT , PhD, FAPTA Physical Therapy Evaluation and Treatment After Concussion/ Mild Traumatic Brain Injury Clinical Practice Guidelines

2020 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

10. Guidelines for the Management of Severe Traumatic Brain Injury (4th edition)

for management decisions, may be considered to reduce mortality and improve outcomes at 3 and 6 mo post-injury. a AVDO 2 , arteriovenous oxygen content difference; CPP, cerebral perfusion pressure; CT, computed tomography; GCS, Glasgow Coma Scale; ICP, intracranial pressure; SBP, systolic blood pressure; TBI, traumatic brain injury. b Bold: New or revised recommendations. TABLE 2. Updated Monitoring Recommendations , Topic Recommendations Intracranial pressure monitoring Level IIB • Management of severe TBI (...) mortality. Advanced cerebral monitoring Level III • Jugular bulb monitoring of AVDO 2 , as a source of information for management decisions, may be considered to reduce mortality and improve outcomes at 3 and 6 mo post-injury. a AVDO 2 , arteriovenous oxygen content difference; CPP, cerebral perfusion pressure; CT, computed tomography; GCS, Glasgow Coma Scale; ICP, intracranial pressure; SBP, systolic blood pressure; TBI, traumatic brain injury. b Bold: New or revised recommendations. TABLE 3. Updated

2016 Congress of Neurological Surgeons

11. Management of Concussion-mild Traumatic Brain Injury (mTBI)

) • Any alteration in mental state at the time of the injury (e.g., confusion, disorientation, slowed thinking, alteration of consciousness/mental state) • Neurological deficits (e.g., weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia) that may or may not be transient • Intracranial lesion External forces may include any of the following events: the head being struck by an object, the head striking an object, the brain undergoing an acceleration/deceleration (...) movement without direct external trauma to the head, a foreign body penetrating the brain, forces generated from events such as a blast or explosion, or other forces. The above criteria define the event of a TBI. Not all individuals exposed to an external force will sustain a TBI, but any person who has a history of such an event with immediate manifestation of any of the above signs and symptoms can be said to have had a TBI. For more details about mechanisms of brain injury, see Appendix C: Mechanism

2016 VA/DoD Clinical Practice Guidelines

12. Management of Traumatic Brain Injury

may be helpful in identifying a more individualized approach to treatment. We have recommended a “tiered” approach to ICP management that utilizes various treatments to target different mechanisms. The higher tiers reflect more intensive management that is also associated with increased complications. 9THREE-TIERED MANAGEMENT OF INTRACRANIAL PRESSURE TIER 1 z Head of bed elevated at 30 degrees (reverse Trendelenburg) to improve cerebral venous outflow z Sedation and analgesia using recommended (...) . Further, cerebral autoregulation and pressure reactivity indices are known to decrease over time. These changes can be complicated by comorbid conditions and medications that are more common in the elderly patient sustaining TBI. Well- studied recommendations for optimal CPP thresholds in the elderly are lacking. It is clear that as age advances, the risks of mortality and poor functional outcome from TBI increase. This is true for all types of brain injury, but most striking with a GCS 8000 patients

2015 American College of Surgeons

13. CRACKCast E041 – Head Injury

and Cerebral Edema Congestive brain swelling Increased intracranial blood volume due to hyperemia caused by vasodilation needed to maintain increased metabolic needs of damaged brain tissue after head injury Cerebral edema Absolute increase in cerebral water content Diffuse cerebral edema may occur with a head injury, but does NOT correlate with the severity of head injury 3 findings: loss of sulci, loss of grey-white interface and collapsed ventricles Vasogenic edema Failure of the BBB endothelial (...) pressure of CSF is 6-20 cm H20 Blood in the ventricles can cause traumatic hydrocephalus Blood brain barrier When intact it serves to balance ion and neurotransmitters. Post-traumatic cerebral edema affects the permeability of the BBB which can last for hours. This can lead to vasogenic edema Brain cellular damage and death – Primary and Secondary Brain Injuries Primary: Mechanical damage occurring at the time of head injury Brain lacerations, hemorrhages, contusions, tissue avulsions. Permanent

2016 CandiEM

14. Early Management of Head Injury in Adults

head injury: GCS 3 - 8 The MHI group can be subdivided into two types as shown in Table 1. 10 - 11, level III Table 1. Classification of MHI Refer to Appendix 3 on Glasgow Coma Scale. Cerebral concussion Should only be used if there is no imaging evidence of brain injury With or without history of LOC Can be further subdivided into: GCS 15 Mild head injury GCS 13 - 15 With or without imaging evidence of brain injury Requires a LOC (=30 minutes) or post- traumatic amnesia (=24 hours) Can be further (...) , alcohol consumption and/or drug misuse, age =65 years old, previous cranial surgery and history of pre-trauma epilepsy6 Early Management of Head Injury in Adults 4. DIFFERENTIAL DIAGNOSES The differential diagnoses of adult head injury include the following: • primary anoxic, inflammatory, infectious, toxic or metabolic encephalopathies, which are not complications of head trauma • neoplasm • brain infarction (ischaemic stroke) and intracranial haemorrhage (haemorrhagic stroke) without associated

2015 Ministry of Health, Malaysia

15. Relationship of mechanical impact magnitude to neurologic dysfunction severity in a rat traumatic brain injury model. Full Text available with Trip Pro

Relationship of mechanical impact magnitude to neurologic dysfunction severity in a rat traumatic brain injury model. Traumatic brain injury (TBI) is a major brain injury type commonly caused by traffic accidents, falls, violence, or sports injuries. To obtain mechanistic insights about TBI, experimental animal models such as weight-drop-induced TBI in rats have been developed to mimic closed-head injury in humans. However, the relationship between the mechanical impact level and neurological (...) markers were increased at 1 and 7 days post-impact injury when compared to the sham control rats. The severity of neurologic dysfunction and induction in inflammatory markers strongly correlated with the graded mechanical impact levels.We conclude that the weight-drop-induced TBI model can produce graded brain injury and induction of neurobehavioral deficits and may have translational relevance to developing therapeutic strategies for TBI.

2017 PLoS ONE

16. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition

. of Medicine University of Toronto UHN Toronto Rehabilitation Institute Lyndhurst Center, Brain and Spinal Cord Program Department of Physical Medicine and Rehabilitation Consultant and Staff Physician Toronto, Ontario22 REGISTERED NURSES’ ASSOCIATION OF ONTARIO BACKGROUND Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition Kim-Marie Meeker, RN, BScN, CETN(C), CON(C) Staff Nurse Mount Sinai Hospital Toronto, Ontario Deborah Mings, RN, MHSc, IIWCC Clinical Manager (...) Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition Clinical Best Practice Guidelines MAY 2016 Assessment and Management of Pressure Injuries for the Interprofessional T eam Third EditionDisclaimer Th ese guidelines are not binding on nurses, other health care professionals, or the organizations that employ them. Th e use of these guidelines should be fl exible, and based on individual needs and local circumstances. Th ey neither constitute a liability

2016 Registered Nurses' Association of Ontario

17. Assessing the Accuracy and the Impact of Standard-practice Ventricular Drainage on Intracranial Pressure Measurements Following Traumatic Brain Injury

Measures Go to Primary Outcome Measures : Evaluate the need for an optimized device that can simultaneously measure intracranial pressure and drain CSF without requiring potentially harmful clamping. [ Time Frame: 6 months ] Investigators want to find a better device that can measure pressure in the head after a traumatic brain without causing an increase in pressure inside of the head. Secondary Outcome Measures : Compare clinical practices regarding intermittent versus continuous monitoring during (...) Assessing the Accuracy and the Impact of Standard-practice Ventricular Drainage on Intracranial Pressure Measurements Following Traumatic Brain Injury Assessing the Accuracy and the Impact of Standard-practice Ventricular Drainage on Intracranial Pressure Measurements Following Traumatic Brain Injury - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved

2016 Clinical Trials

18. Multidisciplinary Postacute Rehabilitation for Moderate to Severe Traumatic Brain Injury in Adults

. 5 Different injury types and severity levels are associated with specific impairments. For example, penetrating head injuries can result in cognitive decline related to the location of the injury and the amount of tissue lost. 7 Deficits resulting from penetrating head injuries may be similar to those observed in stroke patients. 8 Closed head injuries are more common and can cause diffuse brain damage that leads to a variety of impairments unique to each individual. 8 Evidence suggests (...) ranged from 36 to 366. Six studies were conducted in the United States and two in other countries (United Kingdom and Finland). Subjects were predominantly male (85 percent) and young relative to the adult population of the United States (mean age, 31). Other demographic statistics were less often reported. Studies restricted to TBI populations often included only closed head injuries. Median time since injury varied widely among studies, from 1 to 45 months with a median of 19 months. Two studies

2012 Effective Health Care Program (AHRQ)

19. Multimodal Neuroimaging Analysis After Mild Traumatic Brain Injury

terms: Layout table for MeSH terms Wounds and Injuries Brain Injuries Brain Injuries, Traumatic Brain Concussion Brain Diseases Central Nervous System Diseases Nervous System Diseases Craniocerebral Trauma Trauma, Nervous System Head Injuries, Closed Wounds, Nonpenetrating (...) , 2017 Last Update Posted : February 26, 2019 Sponsor: University Hospital, Bordeaux Information provided by (Responsible Party): University Hospital, Bordeaux Study Details Study Description Go to Brief Summary: Mild Traumatic Brain Injury (mTBI), including concussion, is a real public health problem. Indeed mTBI might induce long-term brain disorders with increased risk of neurodegenerative diseases and the healthcare costs can be significant for both the individual and the society. However mTBI

2017 Clinical Trials

20. Usability and Tolerability of Novel Protection Device Against Potential Brain Injury During Competitive Sport

/professional sports of football or rugby Exclusion Criteria: Unable to provide written consent History of neurological deficits, previous cerebral infarction, or severe head trauma as indicated through pre-season screening: Medical contraindications to restriction of venous outflow via the internal jugular veins (known increased intracerebral pressure, metabolic acidosis or alkalosis) Glaucoma (Narrow Angle or Normal Tension) Hydrocephalus Recent penetrating brain trauma (within 6 months) Known carotid (...) by Children's Hospital Medical Center, Cincinnati: brain injury Additional relevant MeSH terms: Layout table for MeSH terms Wounds and Injuries Brain Injuries Brain Injuries, Traumatic Brain Concussion Brain Diseases Central Nervous System Diseases Nervous System Diseases Craniocerebral Trauma Trauma, Nervous System Head Injuries, Closed Wounds, Nonpenetrating

2017 Clinical Trials

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