Various intrinsic mechanisms exist to prevent increases in ICP after trauma. Once there is no more space to accommodate the extra volume of the mass, blood, or fluid, increased ICP will ensue. The intracranial space is a fixed volume. In addition to the direct parenchymal damage, the mechanical forces can lead to hemorrhage. The ensuing cascade of cellular changes leads to the cerebral edema and the secondary injury, which occurs over hours to days after the traumatic event. 9 The initial insult occurs when force is transmitted to the brain tissue, which leads to cellular damage. Concussions, even without radiographic evidence of parenchymal damage, can lead to cerebral edema, increased intracranial pressure (ICP), and secondary ischemia. Trauma to the head results in mechanical damage to the parenchyma of the brain. 7 The rate of falls requiring hospitalization increases from 339 per 100,000 in people age 65-69 years old to 3637 per 100,000 in those age 85 years and older. 1 Most falls are from ground level and occur in or around the home. The leading causes of TBI in the elderly are falls (28%), motor vehicle crashes (20%), and struck by/against events, including pedestrians struck (19%). 6 A significant number of those deaths were from TBI. Unintentional death was the ninth leading cause of death among those over age 65 years in 2006. 3 Older age has been well recognized as an independent predictor of worse outcome after TBI, even with relatively minor head injuries. ![]() In 2006, over $2.8 billion was spent on treating TBI in those older than age 65 years. 2 As a result of this increase in the number of elderly persons, age-related TBI is expected to increase as well. The population of those over the age of 85 years is expected to increase in a similar fashion to greater than 20 million in the same time period. Between 20, the elderly population is projected to more than double. 1 As the baby boom generation ages, the number of people over the age of 65 will reach 71 million by 2030 and represent 20% of the U.S. In the elderly, defined as persons age 65 years and older, trauma is the seventh leading cause of death, and TBI is responsible for over 80,000 Emergency Department (ED) visits annually. Traumatic brain injury (TBI) is a leading cause of mortality and disability in the United States. Authors include skilled experts in the trauma field representing various specialties at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center and the University of Maryland School of Medicine. The series discusses the growing problem of trauma in the elderly, including its causes and possible ways to prevent it, care in the acute stages, and manifestations and treatment strategies when trauma involves the torso, spine, brain, and hip. Scopolamine Transdermal Patch.This article is the fourth in a continuing series on trauma care and the older adult. Automated pupillometer for monitoring the critically ill patient: a critical appraisal. Episodic unilateral mydriasis and recurrent headache: Not necessarily an ominous combination. Lasting bilateral mydriasis after traumatic brain injury may not always be a lost case. Traumatic Brain Injury.Īthanasiou A, Balogiannis I, Magras I. doi:10.3758/s1342-2Īmerican Association of Neurological Surgeons. Safe and sensible preprocessing and baseline correction of pupil-size data. Mathôt S, Fabius J, Van Heusden E, Van der Stigchel S. doi: 10.2147/IJGM.S18613.Īmerican Academy of Ophthalmology. Migraine with benign episodic unilateral mydriasis. "Don't Believe Your Eyes" Ipratropium Induced Mydriasis: A Case Report and Review of the Literature. Traumatic brain injury.Īthanasiou A, Balogiannis I, Magras I. ![]() ![]()
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