34:(TBI), primary brain injury occurs during the initial insult, and results from displacement of the physical structures of the brain. Secondary brain injury occurs gradually and may involve an array of cellular processes. Secondary injury, which is not caused by mechanical damage, can result from the primary injury or be independent of it. The fact that people sometimes deteriorate after brain injury was originally taken to mean that secondary injury was occurring. It is not well understood how much of a contribution primary and secondary injuries respectively have to the clinical manifestations of TBI.
187:
not die right away but rather days to weeks after the event. In addition, rather than improving after being hospitalized as most patients with other types of injuries do, about 40% of people with TBI deteriorate. This is often a result of secondary injury, which can damage neurons that were unharmed in the primary injury. It occurs after a variety of brain injury including
313:(oxygen deficiency). Furthermore, secondary injury presents opportunities for researchers to find drug therapies to limit or prevent the damage. Since a variety of processes occur in secondary injury, any treatments that are developed to halt or mitigate it will need to address more than one of these mechanisms.
186:
result of the injury. It results from processes initiated by the trauma. It occurs in the hours and days following the primary injury and plays a large role in the brain damage and death that results from TBI. Unlike in most forms of trauma a large percentage of the people killed by brain trauma do
169:
may be damaged in the primary injury, and neurons may die. Cells are killed in a nonspecific manner in primary injury. Tissues have a deformation threshold: if they are deformed past this threshold they are injured. Different regions in the brain may be more sensitive to mechanical loading due to
312:
Since primary injury occurs at the moment of trauma and is over so rapidly, little can be done to interfere with it other than prevention of the trauma itself. However, since secondary injury occurs over time, it can be prevented in part by taking measures to prevent complications such as hypoxia
174:
tissues may have different properties than other tissues. Thus some tissues may experience more force and be more injured in the primary injury. The primary injury leads to the secondary injury.
690:
Sullivan PG, Rabchevsky AG, Hicks RR, Gibson TR, Fletcher-Turner A, Scheff SW (2000). "Dose-response curve and optimal dosing regimen of cyclosporin A after traumatic brain injury in rats".
296:
after head trauma. Similar mechanisms are involved in secondary injury after ischemia, trauma, and injuries resulting when a person does not get enough oxygen. After stroke, an
316:
Thus efforts to reduce disability and death from TBI are thought to be best aimed at secondary injury, because the primary injury is thought to be irreversible.
945:
Armin SS, Colohan AR, Zhang JH (June 2006). "Traumatic subarachnoid hemorrhage: Our current understanding and its evolution over the past half century".
540:
260:(the chemicals used by brain cells to communicate) can cause secondary injury. Imbalances in some neurotransmitters can lead to
141:
In TBI, primary injuries result immediately from the initial trauma. Primary injury occurs at the moment of trauma and includes
655:
464:
502:
284:. Another factor in secondary injury is loss of cerebral autoregulation, the ability of the brain's blood vessels to regulate
665:
629:
550:
474:
870:
837:
514:
441:
364:
893:
355:
Scalea TM (2005). "Does it matter how head injured patients are resuscitated?". In
Valadka AB, Andrews BT (eds.).
429:
617:
657:
Traumatic Brain Injury: Methods for
Clinical & Forensic Neuropsychiatric Assessment, Second Edition
466:
Traumatic Brain Injury: Methods for
Clinical & Forensic Neuropsychiatric Assessment, Second Edition
826:
Marion DW (2003). "Pathophysiology and treatment of intracranial hypertention". In
Andrews BT (ed.).
998:
860:
827:
69:
289:
188:
79:
325:
233:(the pressure within the skull). If intracranial pressure gets too high, it can lead to deadly
192:
31:
380:
Ortega-PĂ©rez, Stefany; Amaya-Rey, Maria (2018). "Secondary Brain Injury: A Concept
Analysis".
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230:
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differences in their properties that result from differences in their makeup; for example,
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276:). Excitotoxicity can cause a variety of negative effects, including damage to cells by
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292:, edema, ischemia and hypoxia. Ischemia is one of the leading causes of secondary
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108:
987:
958:
898:"Posttraumatic epilepsy: A major problem in desperate need of major advances"
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Pitkänen A, McIntosh TK (2006). "Animal models of post-traumatic epilepsy".
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for excitatory neurotransmitters (those that increase the likelihood that a
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Secondary injury can result from complications of the injury. These include
37:
Primary and secondary injuries occur in instances other than a TBI, such as
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150:
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125:
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241:
237:, in which parts of the brain are squeezed past structures in the skull.
214:
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196:
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142:
436:. Washington, DC: American Psychiatric Association. pp. 27–33.
509:. Hagerstown, MD: Lippincott Williams & Wilkins. p. 1150.
245:
206:
166:
859:
Andrews BT (2003). "Head injury management". In
Andrews BT (ed.).
545:. Hagerstown, MD: Lippincott Williams & Wilkins. p. 838.
542:
269:
171:
158:
42:
689:
264:, damage to brain cells that results from overactivation of
733:
Sauaia A, Moore FA, Moore EE, et al. (February 1995).
154:
774:
Narayan RK, Michel ME, Ansell B, et al. (May 2002).
288:. Other factors in secondary damage are breakdown of the
26:
are ways to classify the injury processes that occur in
832:. New York: Thieme Medical Publishers. pp. 52–53.
615:
357:
Neurotrauma: Evidence-Based
Answers To Common Questions
891:
622:
Neurotrauma: New
Insights Into Pathology and Treatment
379:
865:. New York: Thieme Medical Publishers. p. 125.
773:
432:. In Silver JM, McAllister TW, Yudofsky SC (eds.).
616:LaPlaca MC, Simon CM, Prado GR, Cullen DR (2007).
944:
618:"CNS injury biomechanics and experimental models"
500:
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244:(excessive carbon dioxide levels in the blood),
735:"Epidemiology of trauma deaths: A reassessment"
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256:. In addition, alterations in the release of
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213:(insufficient oxygen in the brain);
209:(insufficient blood flow); cerebral
660:. Boca Raton: CRC. pp. 26–32.
469:. Boca Raton: CRC. pp. 26–32.
54:Examples in traumatic brain injury
13:
501:Hammeke TA, Gennarelli TA (2003).
434:Textbook Of Traumatic Brain Injury
14:
1010:
428:Gennarelli GA, Graham DI (2005).
914:10.1111/j.1535-7511.2005.00083.x
776:"Clinical trials in head injury"
752:10.1097/00005373-199502000-00006
382:Journal of Neuroscience Nursing
240:Other secondary injury include
862:Intensive Care in Neurosurgery
829:Intensive Care in Neurosurgery
373:
1:
704:10.1016/S0306-4522(00)00380-8
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248:(excessively acidic blood),
624:. Elsevier. pp. 13–19.
394:10.1097/JNN.0000000000000384
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161:are stretched and torn. The
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280:, potentially leading to
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503:"Traumatic brain injury"
359:. Thieme. pp. 3–4.
70:Intracerebral hemorrhage
586:10.1089/neu.2006.23.241
227:blood flow to the brain
189:subarachnoid hemorrhage
182:Secondary injury is an
80:Subarachnoid hemorrhage
574:Journal of Neurotrauma
326:Wallerian degeneration
193:traumatic brain injury
32:traumatic brain injury
24:secondary brain injury
654:Granacher RP (2007).
620:. In Weber JT (ed.).
539:Porth, Carol (2007).
463:Granacher RP (2007).
266:biochemical receptors
231:intracranial pressure
100:Axonal stretch injury
302:biochemical cascades
290:blood–brain barrier
286:cerebral blood flow
163:blood brain barrier
121:cerebral blood flow
95:Cerebral laceration
85:Epidural hemorrhage
75:Subdural hemorrhage
55:
90:Cerebral contusion
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39:spinal cord injury
667:978-0-8493-8138-6
631:978-0-444-53017-2
552:978-0-7817-7087-3
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282:neurodegeneration
258:neurotransmitters
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300:, a set of
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215:hypotension
988:Categories
908:(1): 1–5.
878:2008-06-08
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673:2008-07-06
637:2008-06-10
558:2008-07-03
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449:2008-06-10
332:References
308:Prevention
250:meningitis
172:myelinated
115:metabolism
62:Secondary
892:Garga N,
197:metabolic
178:Secondary
143:contusion
128:formation
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246:acidosis
207:ischemia
200:cascades
184:indirect
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151:shearing
119:Altered
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