Traumatic Brain Injury 1st Edition by Stephen Honeybul, Angelos G Kolias ISBN 3030780740 9783030780746

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ISBN 10: 3030780740
ISBN 13: 9783030780746
Author: Stephen Honeybul, Angelos G Kolias

This book provides a comprehensive analysis of the contemporary management of all aspects of traumatic brain injury (TBI), combining the findings of several recent randomised controlled trials investigating the role of hypothermia, erythropoietin, intracranial pressure monitoring and decompressive craniectomy in the management of TBI.
The book is divided into four sections: the first section covers the epidemiology of TBI, the changing global patterns of presentation, and the basic pathophysiology and classification, while the second discusses contemporary management of TBI, from pre-hospital care, emergency assessment, and medical and surgical management to rehabilitation and social reintegration. The third section then examines the evidence gained from recent clinical trials that have investigated the efficacy of management strategies involving intracranial pressure monitoring, multimodal monitoring, hypothermia, erythropoietin, thromboembolic prophylaxis and decompressive craniectomy. Lastly, the fourth section explores the ethical issues, both at the societal level and on an individual basis.
Written by a broad range of experts, this book provides a valuable reference resource for neurosurgeons, intensivists, clinicians with ethical experience and pure bioethicists in their daily work.

Traumatic Brain Injury 1st Edition Table of contents:

Part I: Scientific Background
1: Epidemiology of Traumatic Brain Injury
1.1 Introduction
1.2 Defining Traumatic Brain Injury
1.3 Classifying Traumatic Brain Injury
1.4 The Incidence of Traumatic Brain Injury
1.5 The Severity of Traumatic Brain Injury
1.6 Financial Perspective
1.7 Risk Factors for TBI
1.8 Traumatic Brain Injury in HICs
1.9 Traumatic Brain Injury in LMICs
1.10 Traumatic Brain Injury in the Military
1.11 Preventive Strategies
1.12 Conclusions
References
2: Pathophysiology of Traumatic Brain Injury
2.1 Introduction
2.2 Acute Pathophysiology
2.2.1 Consequences of Mechanical Force and Deformation
2.2.2 Ionic and Metabolic Disruption
2.2.3 Diffuse Axonal Injury
2.2.4 Vascular Disruption and Dysfunction
2.2.5 Inflammation
2.2.6 Altered Neural Circuitry
2.3 Chronic Pathophysiology
2.4 Conclusion
References
3: Mechanics of Brain Tissue Deformation and Damage Following Trauma
3.1 Introduction
3.2 Overview of Healthy Brain Mechanics
3.2.1 Material Modelling of Brain Tissue
3.2.2 Macroscale Modelling of the Brain
3.3 Microscale Tissue Damage Induced by TBI
3.3.1 Direct Observations of Tissue Damage from Experiments
3.3.2 Inferring Tissue Damage from Experiments Combined with Modelling
3.3.3 Predicting and Modelling Tissue Damage
3.4 Macroscale Deformation in the Brain Induced by TBI
3.5 Future Directions
3.6 Conclusions
References
4: Evidence Pyramid, Comparative Effectiveness Research, and Randomised Trials
4.1 Introduction: What Constitutes ‘Evidence’?
4.2 Background Information: Pros and Cons of Different Paradigms of Evidence
4.3 Illustrative Cases: The Story of Decompressive Craniectomy
4.4 Recent Developments: Comparative Effective Research
4.5 Future Directions
4.6 Conclusions
References
5: Big Data Collection and Traumatic Brain Injury
5.1 Introduction
5.2 What Is Big Data in TBI?
5.3 Collection of Big Data
5.4 Use of Big Data in TBI
5.4.1 Classification of TBI
5.4.2 Acute TBI Management
5.4.3 ICP Monitoring
5.4.4 Intravenous (IV) Fluids and Medication Adjustments
5.4.5 Supportive Information to Guide Management
5.4.6 Management of Chronic TBI
5.4.7 Research Applications
5.5 Strengths and Limitations
5.6 Future Directions
References
Part II: Current Clinical Practice
6: Prehospital and Emergency Department Management of TBI
6.1 Introduction
6.2 Background Information and Pathophysiology
6.3 Current Evidence and Contemporary Practice
6.4 Pitfalls
6.5 Future Directions
6.6 Conclusions
References
7: Monitoring the Injured Brain
7.1 Introduction
7.2 Current Evidence and Contemporary Practice
7.2.1 Clinical Evaluation
7.3 Intracranial Pressure Monitoring
7.3.1 Prediction: ICP Prediction of Poor Outcome and Threshold for Intervention
7.3.2 Perfusion: Optimal Cerebral Perfusion Pressure
7.3.3 Pathology: Early Detection of Mass Lesions
7.3.3.1 ICP Monitoring: Current Evidence
7.3.3.2 Cerebral Oxygenation Monitoring
Jugular Bulb Venous Oxygen Saturation Monitoring (SjvO2)
Brain Tissue Oxygen Tension Monitoring (PbtO2)
7.4 Near-Infrared Spectroscopy (NIRS)
7.5 Microdialysis (MD)
7.6 Brain Ultrasonography: B-Mode Transcranial ­Color-Coded Duplex (TCCD) and Transcranial Doppler (TCD) Sonography
7.7 Thermal Diffusion Flowmetry
7.8 Ultrasound of Optic Nerve Sheath Diameter
7.9 Neurophysiological Monitoring
7.10 Conclusions
References
8: Contemporary Medical Management of Traumatic Brain Injury: High-Income Countries
8.1 Introduction
8.1.1 Neuroprotective Therapy
8.1.2 Multimodal Monitoring
8.1.3 Monro-Kellie Doctrine
8.2 Contemporary Medical Management of Severe Traumatic Brain Injury
8.2.1 Initial Medical Management in the ICU
8.3 Tier 1
8.3.1 Hyperosmolar Therapy
8.4 Tier 2
8.4.1 Hyperventilation
8.4.2 Neuromuscular Blocking Agents
8.4.3 Assessment of Autoregulation and Optimizing Cerebral Perfusion Pressure (CPP)
8.5 Tier 3
8.5.1 Hypothermia
8.5.2 Barbiturate Coma
8.5.3 Decompressive Craniectomy
8.6 Conclusions
References
9: Contemporary Management of Traumatic Brain Injury: Low and Middle-Income Countries
9.1 Introduction
9.2 Background Information and Historical Aspects
9.3 Current Evidence, Contemporary Practice, and Ethical Issues
9.4 Future Directions
9.5 Addressing the Training Deficit in Neurotrauma Care
9.6 Societal Considerations
9.7 Conclusions
References
10: Contemporary Surgical Management of Traumatic Brain Injury
10.1 Introduction
10.2 Assessment of Conscious Level
10.3 Surgical Procedures
10.3.1 Skull Fractures
10.3.1.1 Types of Fractures
10.3.1.2 Diagnostic Exams
10.3.1.3 Surgical Treatment
10.3.2 Posttraumatic Intracerebral Hematoma
10.3.2.1 Acute Extradural Hematoma
Surgical Treatment
Hyperacute Decompression
10.3.2.2 Acute Subdural Hematoma
Surgical Treatment
10.3.2.3 Cerebral Contusions
Surgical Treatment
10.3.3 Penetrating Brain injury
10.3.3.1 Radiological Evaluation
10.3.4 Traumatic Cerebrospinal Fistula
10.3.4.1 CSF Fistula: Presentation
10.3.4.2 CSF Fistula: Localization
10.3.4.3 Nonsurgical Treatment
10.3.4.4 Surgical Treatment
Intracranial Surgical Approaches
Endoscopic Endonasal Approaches
10.4 Conclusion
References
11: Military Management of Traumatic Brain Injury
11.1 Introduction
11.2 History of Military Approach to TBI
11.2.1 Severe and Penetrating TBI
11.2.2 Mild TBI
11.3 Contemporary Practice
11.3.1 TBI Grading
11.3.2 Roles of Care
11.3.3 Severe and Penetrating TBI
11.3.4 Mild TBI
11.4 Future Directions
11.5 Conclusions
References
12: Contemporary Management of Paediatric Head Injuries
12.1 Introduction
12.2 Anatomical and Pathophysiological Differences in Children Relevant to TBI
12.3 Characteristics of Primary TBI in Children
12.3.1 Skull Fractures
12.3.2 Intracranial Haematomas
12.3.3 Diffuse Axonal Injury (DAI)
12.4 Secondary TBI in Children
12.5 Non-Accidental Injury (NAI)
12.6 Birth Injuries
12.7 Management of Traumatic Brain Injury
12.7.1 Mild TBI
12.7.2 Moderate and Severe TBI
12.7.2.1 Initial Management of Paediatric Patients in the ICU
12.7.3 Tier 1
12.7.4 Tier 2
12.7.5 Tier 3 Therapies
12.7.5.1 Hypothermia
12.7.5.2 Barbiturate Coma
12.7.5.3 Decompressive Craniectomy
12.8 Future Directions
12.9 Conclusions
References
13: Sports-Related Traumatic Brain Injury
13.1 Introduction
13.2 Background Information and History
13.3 Management and Long-Term Consequences of SRC
13.3.1 SRC Recognition and Diagnosis
13.3.2 Early Removal from Play and Graduated Return-to-Play (or School) Protocol
13.3.3 Concussion Recovery and the “Post-Concussion Syndrome”
13.3.4 Long-Term Consequences
13.4 Future Directions
13.4.1 Controversies
13.4.2 Prevention
13.4.3 Fluid Biomarkers
13.4.4 Acute Treatment
13.4.5 Neuroimaging
13.4.5.1 Magnetic Resonance Imaging (MRI)
13.4.5.2 Positron Emission Tomography
13.4.6 When Should a Career Be Terminated?
13.5 Conclusions
References
14: Rehabilitation After Traumatic Brain Injury
14.1 Introduction
14.1.1 Historical Perspective of TBI Rehabilitation
14.2 Classification of Disability and Health
14.3 Rehabilitation Pathways and Services
14.3.1 Rehabilitation Prescriptions
14.4 The Multidisciplinary Approach
14.4.1 Physiotherapy
14.4.2 Occupational Therapy
14.4.3 Speech and Language Therapy
14.4.4 Neuropsychology
14.4.5 Rehabilitation Medicine Physicians
14.4.6 Goal Setting
14.4.7 Brain Injury and the Mental Capacity Act
14.4.8 Cognitive Impairment and Recovery After Traumatic Brain Injury
14.4.9 Vocational Rehabilitation After Brain Injury
14.5 Emerging Trends in Rehabilitation
14.5.1 Deep Brain Stimulation
14.5.2 Augmented Reality
14.5.3 Brain-Computer Interface
14.6 Conclusion
References
Part III: Evidence
15: Predicting Outcome Following Traumatic Brain Injury
15.1 Introduction
15.2 Background Information on Prognostic Factors of TBI
15.3 Recent Developments
15.4 Future Directions
15.5 Conclusions
References
16: Biomarkers in Traumatic Brain Injury
16.1 Introduction: The Need for Biomarkers in TBI Medicine
16.2 Challenges in Developing Biomarkers for Clinical Use in TBI
16.3 The Role of Biomarkers in Specific Clinical Situations
16.3.1 Identifying Patients with Mild Traumatic Brain Injury
16.3.2 Assessing the Need for Imaging After Mild Traumatic Brain Injury
16.3.3 Outcome Prediction
16.3.4 Monitoring the Injured Brain
16.4 Current Evidence
16.5 Protein Biomarkers
16.6 Neuronal Cell Body Biomarkers
16.6.1 Neuron-Specific Enolase (NSE)
16.6.2 Ubiquitin C-Terminal Hydrolase-L1 (UCH-L1)
16.7 Axonal and Axon Terminal Biomarkers
16.7.1 Neurofilament Light Polypeptide (NF-L)
16.7.2 Tau
16.8 Astroglial Biomarkers
16.8.1 Glial Fibrillary Acidic Protein (GFAP)
16.8.2 S100 Calcium-Binding Protein B (S100B)
16.9 Metabolomic and Lipidomic Biomarkers
16.10 Future Directions and Conclusions
References
17: Erythropoietin, Progesterone, and Amantadine in the Management of Traumatic Brain Injury: Current Evidence
17.1 Introduction
17.2 Erythropoietin
17.3 Progesterone
17.4 Amantadine
17.5 Future Directions
References
18: Tranexamic Acid in the Management of Traumatic Brain Injury
18.1 Introduction
18.2 Coagulation and Coagulopathy in Traumatic Brain Injury
18.3 Tranexamic Acid
18.4 Tranexamic Acid: Current Evidence for Efficacy
18.5 The CRASH-3 Trial
18.6 The Subgroup Analysis
18.7 CRASH-3 Trial Interpretation
18.8 Future Directions
18.9 Conclusions
References
19: Hypothermia in the Management of Traumatic Brain Injury
19.1 Introduction
19.2 History of Therapeutic Hypothermia
19.3 The Pathophysiology of Traumatic Brain Injury
19.3.1 The Monro-Kellie Doctrine
19.3.2 Neuroprotection and the Heterogeneity Paradox
19.4 Hypothermia: Clinical Evidence
19.5 Future Directions
19.5.1 Management Strategies
19.5.2 Complications
References
20: Decompressive Craniectomy in the Management of Traumatic Brain Injury
20.1 Introduction
20.2 Background Information
20.2.1 History
20.2.2 Pathophysiology
20.3 Practical Aspects: Surgical Techniques, Indications and Patient Selection
20.3.1 Hemicraniectomy
20.3.2 Bifrontal Decompressive Craniectomy
20.3.3 Indications
20.3.4 Patient Selection
20.4 After Decompressive Craniectomy
20.4.1 Specific Aspects of Care After Decompressive Craniectomy
20.4.2 Complications
20.4.3 Cranial Reconstruction
20.5 Current Evidence Base
20.5.1 DECRA Trial
20.5.2 RESCUEicp Trial
20.5.3 Other Trials of Decompressive Craniectomy
20.5.4 Summarising the Current Evidence Base and Its Limitations
20.5.4.1 Patient Values and Preference
20.6 Conclusions
References
21: Cranioplasty Following Traumatic Brain Injury
21.1 Introduction
21.2 Cranioplasty: Clinical Indications
21.2.1 Restoration of Cosmesis
21.2.2 Regaining Protection of the Cerebral Tissue
21.2.3 Re-establishment of Normal Cerebral Hydrodynamics
21.3 Cranioplasty: Surgical Technique
21.3.1 Surgical Timing
21.3.2 Management of Temporal Muscle
21.3.3 Materials Used for Reconstruction
21.3.3.1 Autologous Bone
21.3.3.2 Titanium
21.3.4 Methyl Methacrylate
21.3.5 Ceramics and Others
21.4 Current Evidence
21.5 Complications of Cranioplasty
21.5.1 Sudden Death
21.5.2 Postoperative Collections
21.5.3 Infection
21.5.4 Bone Resorption
21.6 Future Directions
21.7 Conclusions
References
22: Thromboembolic Prophylaxis in Traumatic Brain Injury
22.1 Introduction
22.2 Background Information and Pathophysiology
22.3 Current Evidence and Recommendations
22.4 Future Directions
22.5 Conclusions
References
23: Long-Term Neurological Consequences of Traumatic Brain Injury
23.1 Introduction
23.2 Long-Term Behavioral Issues
23.2.1 Long-Term Physical Symptoms Following TBI
23.2.2 Long-Term Cognitive Symptoms Following TBI
23.2.3 Long-Term Emotional Symptoms Following TBI
23.3 Long-Term Neurodegenerative Problems
23.3.1 Dementia Following TBI: Historical Evidence and Case Studies
23.3.2 Chronic Traumatic Encephalopathy
23.3.3 Impaired Cognition in Later Life: Epidemiological Evidence
23.3.4 Cognitive Decline of TBI: Future Developments
23.3.5 Conclusion
References
24: Post-Traumatic Epilepsy
24.1 Introduction
24.2 Epidemiology
24.3 Pathophysiology
24.3.1 Oxidative Stress
24.3.1.1 Excitotoxic Mechanism
24.3.2 History and Examination
24.3.3 Investigations
24.3.4 Magnetic Resonance Imaging
24.4 Current Evidence
24.4.1 Specific Antiepileptic Medications
24.4.2 Non-pharmacological Interventions
24.5 Future Directions
24.6 Conclusion
References
25: Brain Death: Current Evidence and Guidelines
25.1 Introduction
25.2 Definition of Death
25.3 Pathophysiology and Mechanisms of Brain Death
25.4 Essential Prerequisites for the Diagnosis of BD/DNC
25.5 BD/DNC: The Clinical Diagnosis
25.6 Ancillary Tests
25.7 Pediatric Considerations
25.8 The Role of Communication and of Education and Training
25.9 Conclusions
References
Part IV: Ethical Considerations
26: Introduction to Bioethics
26.1 Introduction
26.2 The History of Bioethics
26.2.1 Virtue Ethics: Greek
26.2.2 Virtue Ethics: Christian
26.2.3 Natural Law
26.2.4 Deontology and Kantian Ethics
26.2.5 Utilitarianism and Consequentialism
26.2.6 Feminist Ethics
26.2.7 Contemporary Ethical Frameworks
26.3 Conclusion
References
27: Consent for Neurosurgery in Cases of Traumatic Brain Injury
27.1 Introduction
27.2 Consent
27.2.1 Capacity to Consent to Treatment
27.2.2 Consent Must Be Voluntary and Free from Undue Influence
27.2.3 Consent Should Be Accompanied by the Provision of Information Regarding Material Risks
27.2.4 The Ethical and Legal Limits of Consent
27.2.5 Disputes over Treatment
27.2.6 A Clinical Example
27.3 Discussion
27.4 Conclusion
References
28: Team-Based Decision-Making in Traumatic Brain Injury
28.1 Introduction
28.2 History of Shared Decision-Making
28.3 Agency for Healthcare Research and Quality (AHRQ) SHARE Approach to SDM
28.4 SDM Foundation
28.5 SDM Challenges
28.6 SDM Conflicts
28.6.1 Conflicts for Physicians
28.6.2 Conflicts for Family Members
28.7 SDM Drivers
28.8 SDM Types
28.9 Conclusion
References
29: Traumatic Brain Injury and Resource Allocation
29.1 Introduction
29.2 Contextual Considerations on Resource Limits
29.3 How Do Limited Resources Apply to Traumatic Brain Injury (TBI)?
29.4 Framework for Priority Setting in Clinical Care
29.5 How Does Resource Allocation Affect TBI?
References
30: Research Ethics in Clinical Trials
30.1 Introduction
30.2 Clinical Trials in Neurotrauma
30.2.1 The Role of Corticosteroids in the Management of TBI
30.2.2 The Role of Therapeutic Hypothermia in the Management of Traumatic Brain Injury
30.3 Hypothermia: Clinical Studies
30.3.1 The Role of Decompressive Craniectomy in Severe Traumatic Brain Injury
30.3.1.1 The DECompressive CRAniectomy (DECRA) Trial
30.3.1.2 The Randomised Evaluation of Surgery with Elevation of Intracranial Pressure (RESCUEicp) Trial
30.3.2 The Role of ICP Monitoring in the Management of TBI
30.3.3 The Role of Tranexamic Acid in TBI
30.4 Conclusion
References
31: Artificial Intelligence and Healthcare Ethics
31.1 Introduction
31.2 Background
31.3 Ethical Outlook
31.4 Pathway for Ethical Healthcare
31.4.1 Transparency, Responsibility, and Reproducibility
31.4.2 Autonomy in AI (Scope of Human Intervention)
31.4.3 Privacy and Security
31.4.4 Social Impact
31.4.5 Machines with Morality
31.4.6 Deployment and AI Safety
31.5 Conclusions
References
32: Ethical Issues in Paediatric Traumatic Brain Injury
32.1 Introduction
32.2 Background Information
32.3 Current Evidence
32.4 Communication and Consent in Paediatric Neurotrauma
32.5 Brain Death
32.6 Conclusions
References
33: Withholding and Withdrawing Treatment
33.1 Introduction
33.2 Withdrawing Medical Therapy: Historical Aspects
33.3 Withdrawing and Withholding Medical Therapy: Traumatic Brain Injury
33.4 Treatment Decisions for Incapacitated Patients
33.4.1 Consent
33.4.2 Medical Futility
33.4.3 Medical Futility: An Alternative Approach
33.4.4 Medical Futility: Does Life Have Intrinsic Value?
33.5 Withholding and Withdrawing Life-Sustaining Treatment: Is There a Difference?
33.5.1 Acts and Omissions
33.6 The Equivalence Test
33.7 Practical Decision-Making
33.8 Mitigating Conflict
33.9 Conclusion
References
34: Long-Term Outcome Following Traumatic Brain Injury
34.1 Introduction
34.2 Favorable Outcome but Not Necessarily Acceptable
34.3 Unfavorable Outcome but Not Necessarily Unacceptable
34.3.1 The Disability Paradox
34.3.2 The Salutogenic Model
34.4 Unfavorable and Unknown
34.4.1 Disorders of Consciousness: Diagnosis
34.4.2 Disorders of Consciousness: Experimental Intervention
34.4.3 The Rule of Rescue
34.4.4 Disorders of Consciousness: Surgical Intervention
34.5 Conclusions
References

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