Traumatic Brain Injury Case Studies

Zagazig University

Faculty of Medicine

Department of Anesthesiology and Surgical Critical Care

Predictive value of combining Middle Cerebral Artery Pulsatile Index and Glasgow Coma Scale on outcomes of Traumatic Brain Injury Patients in Zagazig University Hospital

Protocol of thesis submitted in partial fulfillment of MD degree in Anesthesiology and Surgical Critical Care

By

Dr. Naglaa Fathy Abdelhaleem Abdelhaleem

(M.B.B.Ch, M.Sc.)

Under supervision of

Faculty of Medicine

Zagazig University

-2015-

1. Introduction

Traumatic brain injury (TBI), defined as an alteration in brain functions caused by an external force, is responsible for high morbidity and mortality around the world. It is important to identify and treat TBI victims as early as possible, Reis et al. (2015).

(2004), Vigué et al. (2011)]. As the physiologic mechanisms against ischemia in cerebral tissue are impaired, the traumatized brain become highly vulnerable to ischemic injuries, these ischemic injuries, even for a few minutes, have a dramatic negative impact on long-term outcomes. Thus, prediction of outcomes is urgently needed.

The primary aim of managing patients with acute brain injury is to minimize secondary injury by maintaining cerebral perfusion and oxygenation. The pathophysiology of secondary brain injury, i.e., the cascade of deleterious events that occur in the early phase following initial cerebral insult is complex, involving a subtle interplay between cerebral blood flow, (CBF) oxygen delivery and utilization, and supply of main cerebral energy substrates (glucose) to the injured brain. Regulation of this interplay depends on the type of injury and may vary individually and overtime, Bouzat et al.