Neuroprotective Strategies during Management of Traumatic Brain Injuries

Abstract

The brain is composed of 2 cerebral hemispheres each has 4 lobes, basal ganglia, diencephalon, brain stem, cranial nerves, and the cerebellum. Covered with 3 layers of meninges (the dura, the arachnoid, and the pia). The brain has 4 ventricles filled with the cerebrospinal fluid. The brain tissue is separated from the blood milieu by the blood brain barrier. The brain is supplied by the internal carotid and the vertebral arteries and drained into the internal jugular veins. Due to the high metabolic rate, the brain receives 15% of the cardiac output, consumes 20% of total body oxygen, and 25% of total body glucose utilization. Traumatic Brain Injury is a major cause of death and disability worldwide, especially in children and young adults below 40 years. Males sustain traumatic brain injuries more frequently than do females. Causes include falls, vehicle accidents, and violence. Traumatic Brain injuries can be classified as primary injuries such as (brain concussion, cerebral contusions, intracranial hematomas and diffuse axonal injury) which occur at the time of impact. Secondary brain injuries are inflammatory process due to hypoxia and ischemia leading to a cascade of cellular and biochemical changes leading to cell damage. This will lead to increase the intracranial pressure and cerebral edema. Other systemic insults could happen include (hypotension, hypoxia, hyperpyrexia, anemia and seizures).