The role of a neurosurgeon in caring for patients with traumatic brain injury Kevin Yoo M.D.

Traumatic brain injury Major cause of disability and death Is head injury = traumatic brain injury?

Acute care Surgery Monitoring Subdural Hematoma Epidural Hematoma Cerebral Contusions Cerebral Edema Monitoring Intracranial Monitors Can you change this picture to one of surgery for TBI?

Glasgow Coma Score Eye Verbal Motor Perfect score: 15 1: Does not open eyes 2: Opens eyes to pain 3: Opens eyes to voice 4: Spontaneously opens eyes Verbal 1: No speech 2: Incomprehensible noise 3: Incomprehensible words 4: Confused 5: Normal Motor 1: No movement 2: Decorticate posturing 3: Decerebrate posturing 4: Withdraws to pain 5: Moves spontaneously 6: Moves purposefully Perfect score: 15 Most PI patients will be 14 Even at 14 or 15, have TBI

Why does normal patient have tbi? Why does normal patient have tbi?--- What does this mean it does not make sense

In Hospital care For severe TBI For mild to moderate TBI Monitor for brain swelling Medications and CSF Drainage May need additional surgery such as decompressive craniectomy Eventually to rehab. For mild to moderate TBI Discharge soon or after patient has controlled or no symptoms Please add appropriate picture here.

Outpatient care Post-concussive syndrome Care: Self-limiting Time Pain medications Rest Physical Therapy Cognitive Therapy Occipital Nerve Stimulator

Post concussive syndrome These are not post concussive syndrome. Can you make me a slide of that?

How does a neurosurgeon help with PI tbi? Evaluation and Report Diagnose TBI and PCS MRI Brain with Brain Injury Protocol THIS IS KEY! Objective evidence of brain injury

MRI with TBI Protocol Imaging Healthcare Specialist Advanced neuroimaging techniques Diffusion Tensor Imaging (DTI) Looks at fiber tracks Susceptibility weighted Imaging (SWI) Looks for micro-bleeds MRI Spectroscopy (MRS) Looks for chemical composition of brain issue