oa CME : Your SA Journal of CPD - Targeted treatment of severe head injury - : main article

Volume 29, Issue 1
  • ISSN : 0256-2170



It has been increasingly appreciated in recent times that head injury is not a homogeneous concept and is poorly classified for the purposes of treatment. The separation of patients into 3 categories of severity (mild, moderate and severe) remains a blunt measure used to guide therapy in individual patients. Patients with severe traumatic brain injury (TBI), i.e. a Glasgow Coma Score (GCS) ≤8, may have different pathologies, including an extradural haematoma, subdural haematoma, cerebral ischaemia, cerebral hyperaemia, vasospasm, diffuse axonal injury, and / or focal haemorrhagic contusions. Moreover, autoregulation of the links between cerebral blood flow (CBF) and blood pressure, carbon dioxide tension, and cerebral metabolic requirements may be variably impaired in individuals - all of which have major implications for treatment. Yet traditional management tends to treat all individuals similarly. For example, intracranial pressure (ICP) is usually treated in a standardised stepwise approach. Yet in individual patients, elevated ICP may be associated with cerebral hyperaemia or cerebral ischaemia, subclinical seizures, or impaired autoregulation (where it is the elevated blood pressure that is the underlying problem). To target these appropriately would require accurate diagnosis and a different approach to management.

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