Traumatic brain injury classification
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Traumatic brain injury may be classified into several subtypes including focal or diffuse, open or close, and mild, moderate or severe.
- Focal vs. Diffuse
- The damage from TBI can be focal, confined to one area of the brain, or diffuse, involving more than one area.
- Diffuse trauma to the brain is frequently associated with concussion (a shaking of the brain in response to sudden motion of the head), diffuse axonal injury, or coma.
- Localized injuries may be associated with neurobehavioral manifestations, hemiparesis or other focal neurologic deficits.
- Types of focal brain injury include bruising of brain tissue called a contusion and intracranial hemorrhage or hematoma, heavy bleeding in the skull.
- Hemorrhage, due to rupture of a blood vessel in the head, can be extra-axial, meaning it occurs within the skull but outside of the brain, or intra-axial, occurring within the brain.
- Extra-axial hemorrhages can be further divided into subdural hematoma, epidural hematoma, and subarachnoid hemorrhage.
- An epidural hematoma involves bleeding into the area between the skull and the dura.
- With a subdural hematoma, bleeding is confined to the area between the dura and the arachnoid membrane.
- A subarachnoid hemorrhage involves bleeding into the space between the surface of the brain and the arachnoid membrane that lies just above the surface of the brain, usually resulting from a tear in a blood vessel on the surface of the brain.
- Bleeding within the brain itself is called an intracerebral hematoma.
- Intra-axial bleeds are further divided into intraparenchymal hemorrhage which occurs within the brain tissue itself and intraventricular hemorrhage which occurs into the ventricular system.
- Open vs. Closed
- TBI can result from a closed or penetrating head injury.
- A closed injury occurs when the skull is not breached, while a penetrating injury occurs when an object pierces the skull and enters brain tissue.
- As the first line of defense, the skull is particularly vulnerable to injury.
- Skull fractures occur when a bone in the skull cracks or breaks.
- A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain.
- A penetrating skull fracture occurs when something pierces the skull, such as a bullet, leaving a distinct and localized traumatic injury to brain tissue.
- Skull fractures can cause cerebral contusion.
- Head injuries can be subdivided into mild, moderate, and severe TBI to help predict outcome.
- One common classification system determines severity based on the Glasgow Coma Scale (GCS) and duration of post-traumatic amnesia (PTA) and loss of consciousness (LOC) according to the table at right.
- Other classification systems use GCS alone or PTA or LOC alone or together.
- Prognosis worsens with the severity of injury, but mild TBI is more poorly defined and prognosis is not as clear with it.
- Mild TBI is also commonly called concussion.
- Though prognosis for concussion is usually very good, a portion of people may suffer lasting problems associated with the injury, such as post-concussion syndrome.
- A patient who receives a second concussion before symptoms from another one have healed is at risk for developing a very rare but deadly condition called second-impact syndrome, in which the brain swells catastrophically after even a mild blow.
|Mild||13 to 15||<1
|Moderate||9 to 12||30 minutes
to 24 hours
|1 to 24|
|Severe||<8||>1 day||>24 |
- Saatman KE, Duhaime AC, Bullock R, Maas AI, Valadka A, Manley GT; et al. (2008). "Classification of traumatic brain injury for targeted therapies". J Neurotrauma. 25 (7): 719–38. doi:10.1089/neu.2008.0586. PMC 2721779. PMID 18627252.
- O'Neil ME, Carlson K, Storzbach D, et al. Complications of Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review [Internet]. Washington (DC): Department of Veterans Affairs (US); 2013 Jan. Table A-1, Classification of TBI Severity. Available from: https://www.ncbi.nlm.nih.gov/books/NBK189784/table/appc.t1/