A Clinician’s Guide to the Pathophysiology of Traumatic Brain Injury

Abstract

Traumatic brain injury induces a complex pathophysiological cascade of cellular events. Central components of this response include increases in cerebral glucose uptake, reductions in cerebral blood flow, indiscriminate excitatory neurotransmitter release, ionic disequilibrium, and intracellular calcium accumulation. Acute glutamate release and nonspecific neuronal depolarization induce threatening perturbations in neuronal function. Restoration of homeostasis requires significant increases in glucose metabolism; however, there is often a concomitant reduction in cerebral blood flow, resulting in an uncoupling of supply and demand. Understanding the nature and timing of these processes provides the practicing clinician with a mechanistic rationale for acute physiological monitoring, aggressive interventions to address and minimize secondary injuries, implementation of advanced neuroimaging techniques, and careful monitoring return to normal activity in head injured patients.

Keywords

cerebral blood flow - glucose metabolism - glutamate - monitoring - positron emission tomography (pet)

• References

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