AANN Core Curriculum, 7th Edition, Ch. 20 Craniocerebral Trauma: Digital Version-Chapter 20

Chapter 20

Pdf Summary

Craniocerebral trauma (traumatic brain injury, or TBI) affects the skull, brain, blood vessels, cranial nerves, and surrounding tissues. Injuries result from contact, acceleration–deceleration or rotational forces, and penetrating objects. Common causes include falls, motor vehicle collisions, sports, assaults, and blasts. Falls are especially common among young children and older adults. Safety restraints, airbags, helmets, fall-prevention measures, and concussion education can reduce risk.<br /><br />TBI severity is commonly classified using the Glasgow Coma Scale (GCS): mild, 13–15; moderate, 9–12; and severe, 8 or lower. Injury may be focal, such as a fracture, contusion, or hematoma, or diffuse, such as concussion or diffuse axonal injury.<br /><br />Primary injury is the immediate mechanical damage caused by impact and tissue movement within the skull. It cannot be reversed, making prevention essential. Secondary injury develops afterward and may cause further brain damage through impaired oxygen and blood delivery, ischemia, swelling, increased intracranial pressure (ICP), seizures, fever, infection, abnormal glucose, or expanding hemorrhage. Cellular processes—including excitotoxicity, oxidative stress, and mitochondrial dysfunction—contribute to tissue damage and cell death.<br /><br />Care focuses on preserving oxygenation and cerebral perfusion while limiting secondary injury. Assessment includes injury history and mechanism, serial neurological examinations, GCS, pupil and motor responses, vital signs, and imaging. Severe injuries may require advanced neuromonitoring. Key measures include avoiding hypoxia and hypotension, maintaining appropriate ventilation and blood pressure, elevating the head when appropriate, identifying and treating mass lesions, and managing elevated ICP. Steroids and routine prophylactic hyperventilation are not recommended for ICP control.<br /><br />Mild TBI may cause headache, dizziness, visual or cognitive difficulties, sleep disruption, and emotional changes; most patients recover within days or weeks, though some have persistent symptoms. Moderate and severe injuries can produce lasting cognitive, behavioral, motor, and functional impairment. Rehabilitation and individualized symptom management support recovery. After severe injury, clinicians also monitor for complications such as seizures, blood clots, infection, malnutrition, immobility, and autonomic instability.

Keywords

traumatic brain injury

craniocerebral trauma

Glasgow Coma Scale

secondary injury

intracranial pressure

concussion

diffuse axonal injury

hypoxia

neurological assessment

brain rehabilitation