TY - CHAP M1 - Book, Section TI - Brain A1 - Yang, Likun A1 - Opalak, Charles F. A1 - Valadka, Alex B. A2 - Feliciano, David V. A2 - Mattox, Kenneth L. A2 - Moore, Ernest E. PY - 2020 T2 - Trauma, 9e AB - KEY POINTSOf the approximately 1.4 million individuals who are evaluated for traumatic brain injuries in emergency departments in the United States each year, 1.1 million are treated and released, 240,000 are hospitalized, and 50,000 die.In patients with gunshot wounds to the head, the mortality rate is greater than 50% among those who are alive upon presentation to a hospital.When calculating a Glasgow Coma Scale score, confounding factors include alcohol and other drugs, hypotension, hypoxia, sepsis, hypothermia, and other systemic factors.Magnetic resonance imaging (MRI) scans provide higher resolution images of the brain, spinal cord, and other soft tissues than computed tomography scans.In patients with diffuse axonal injury, T2-weighted MRI scans may show multifocal hyperintense lesions at gray matter/white matter interfaces.As many as 90% of patients with a concussion do not exhibit loss of consciousness; however, when this does occur, it is usually brief.The modified Monro-Kellie hypothesis states that an increase in the volume of one component inside the skull (brain, intravascular blood, cerebrospinal fluid) or addition of a new component (hemorrhage, tumor) mandates a compensatory decrease in other components to maintain constant intracranial pressure.Relative indications for surgical elevation of a depressed skull fracture include depression of greater than 8 to 10 mm or greater than the thickness of the adjacent skull, a focal neurologic deficit due to compression of underlying brain, significant inward intrusion of bone fragments, and persistence of cosmetic deformity after overlying scalp swelling has subsided.An acute subdural hematoma with a thickness of greater than 1 cm or a midline shift of greater than 5 mm should usually be evacuated regardless of Glasgow Coma Scale score.When intracranial hypertension cannot be controlled by routine measures, hypothermia, barbiturate coma, and unilateral hemispheric decompressive craniectomy should be considered. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=1175132799 ER -