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93-441: PSH may refer to: Science and technology [ edit ] Paroxysmal sympathetic hyperactivity Past surgical history Petrograd Standard Hundred , a measure of timber PlayStation Home Plurisubharmonic function Polythematic structured-subject heading system , controlled vocabulary Portable Surgical Hospital Prebisch–Singer hypothesis , which argues that

186-438: A mass effect from a lesion, such as a hemorrhage. As a result, cerebral perfusion pressure (the pressure of blood flow in the brain) is reduced; ischemia results. When the pressure within the skull rises too high, it can cause brain death or brain herniation , in which parts of the brain are squeezed by structures in the skull. Diagnosis is suspected based on lesion circumstances and clinical evidence, most prominently

279-422: A multidisciplinary approach is key to optimizing outcome. Physiatrists or neurologists are likely to be the key medical staff involved, but depending on the person, doctors of other medical specialties may also be helpful. Allied health professions such as physiotherapy , speech and language therapy , cognitive rehabilitation therapy , and occupational therapy will be essential to assess function and design

372-412: A neurological examination , for example checking whether the pupils constrict normally in response to light and assigning a Glasgow Coma Score. Neuroimaging helps in determining the diagnosis and prognosis and in deciding what treatments to give. DSM-5 can be utilized to diagnose TBI and its psychiatric sequelae. The preferred radiologic test in the emergency setting is computed tomography (CT): it

465-401: A subacute rehabilitation unit of the medical center or to an independent rehabilitation hospital . Rehabilitation aims to improve independent functioning at home and in society, and to help adapt to disabilities. Rehabilitation has demonstrated its general effectiveness when conducted by a team of health professionals who specialize in head trauma. As for any person with neurologic deficits,

558-421: A TBI's auditory memory ability to above the control group's performance The type, direction, intensity, and duration of forces all contribute to the characteristics and severity of TBI. Forces that may contribute to TBI include angular, rotational , shear , and translational forces . Even in the absence of an impact, significant acceleration or deceleration of the head can cause TBI; however in most cases,

651-530: A TBI. Domestic violence is another cause of TBI, as are work-related and industrial accidents. Firearms and blast injuries from explosions are other causes of TBI, which is the leading cause of death and disability in war zones. According to Representative Bill Pascrell (Democrat, NJ), TBI is "the signature injury of the wars in Iraq and Afghanistan." There is a promising technology called activation database-guided EEG biofeedback, which has been documented to return

744-451: A combination of impact and acceleration is probably to blame. Forces involving the head striking or being struck by something, termed contact or impact loading , are the cause of most focal injuries, and movement of the brain within the skull, termed noncontact or inertial loading , usually causes diffuse injuries. The violent shaking of an infant that causes shaken baby syndrome commonly manifests as diffuse injury. In impact loading,

837-699: A consequence of a sudden acceleration or deceleration within the cranium or by a complex combination of both movement and sudden impact. In addition to the damage caused at the moment of injury, a variety of events following the injury may result in further injury. These processes may include alterations in cerebral blood flow and pressure within the skull . Some of the imaging techniques used for diagnosis of moderate to severe TBI include computed tomography (CT) and magnetic resonance imaging (MRIs). Prevention measures include use of seat belts and helmets , not drinking and driving , fall prevention efforts in older adults and safety measures for children. Depending on

930-792: A country producing mainly primary products will see its terms of trade deteriorate Psychosocial hypothesis Pumped-storage hydroelectricity Places [ edit ] Parma Senior High School Pershore railway station , England; National Rail station code PSH Primary State Highways (Washington) , major state highways in Washington State from 1905 to 1964 Public Service Hall - а Georgian government agency providing essential public services e.g. property registry, birth death and marriage registration, archive inquiries etc. People [ edit ] Philip Seymour Hoffman (1967–2014), American actor See also [ edit ] PSSH (disambiguation) Topics referred to by

1023-428: A decreasing level of consciousness. Traumatic brain injury may cause a range of serious coincidental complications that include cardiac arrhythmias and neurogenic pulmonary edema . These conditions must be adequately treated and stabilised as part of the core care. Surgery can be performed on mass lesions or to eliminate objects that have penetrated the brain. Mass lesions such as contusions or hematomas causing

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1116-515: A deficiency in identifying, understanding, processing, and describing emotions occurs in 60.9% of individuals with TBI. Cognitive and social deficits have long-term consequences for the daily lives of people with moderate to severe TBI, but can be improved with appropriate rehabilitation. When the pressure within the skull ( intracranial pressure , abbreviated ICP) rises too high, it can be deadly. Signs of increased ICP include decreasing level of consciousness , paralysis or weakness on one side of

1209-420: A few minutes or as long as ten hours, and they can occur multiple times a day. Episode duration has been seen to average 30.8 minutes and occur five to six times a day. Episodes can occur naturally or arise from external triggers. Common triggers include pain or stimulation, body turning or movements, and bladder distention. Bladder distention has been observed in patients being treated in intensive care units with

1302-413: A head injury decreases the risk of death. Certain facilities are equipped to handle TBI better than others; initial measures include transporting patients to an appropriate treatment center. Both during transport and in hospital the primary concerns are ensuring proper oxygen supply, maintaining adequate blood flow to the brain, and controlling raised intracranial pressure (ICP), since high ICP deprives

1395-641: A moderate or severe TBI may have a headache that does not go away, repeated vomiting or nausea, convulsions, an inability to awaken, dilation of one or both pupils, slurred speech, aphasia (word-finding difficulties), dysarthria (muscle weakness that causes disordered speech), weakness or numbness in the limbs, loss of coordination, confusion, restlessness, or agitation. Common long-term symptoms of moderate to severe TBI are changes in appropriate social behavior, deficits in social judgment, and cognitive changes, especially problems with sustained attention, processing speed, and executive functioning. Alexithymia ,

1488-399: A result of secondary injury, potentially killing those neurons. Other factors in secondary injury are changes in the blood flow to the brain ; ischemia (insufficient blood flow); cerebral hypoxia (insufficient oxygen in the brain); cerebral edema (swelling of the brain); and raised intracranial pressure (the pressure within the skull). Intracranial pressure may rise due to swelling or

1581-464: A result of sports and recreation activities in the US. In children aged two to four, falls are the most common cause of TBI, while in older children traffic accidents compete with falls for this position. TBI is the third most common injury to result from child abuse . Abuse causes 19% of cases of pediatric brain trauma , and the death rate is higher among these cases. Although men are twice as likely to have

1674-413: A scan. Various methods are used to treat PSH. Medications are used to end episodes or prevent their occurrence. Hyperbaric oxygen therapy has been explored as well. Other treatments have been used, but their success is measured on a case-by-case basis. Successful treatments with qualitative results or efficacy for wider ranges of patients have not been developed. The two most common medications used in

1767-505: A secure airway. Hypotension (low blood pressure), which has a devastating outcome in TBI, can be prevented by giving intravenous fluids to maintain a normal blood pressure. Failing to maintain blood pressure can result in inadequate blood flow to the brain. Blood pressure may be kept at an artificially high level under controlled conditions by infusion of norepinephrine or similar drugs; this helps maintain cerebral perfusion . Body temperature

1860-456: A significant mass effect ( shift of intracranial structures ) are considered emergencies and are removed surgically. For intracranial hematomas, the collected blood may be removed using suction or forceps or it may be floated off with water. Surgeons look for hemorrhaging blood vessels and seek to control bleeding. In penetrating brain injury, damaged tissue is surgically debrided , and craniotomy may be needed. Craniotomy, in which part of

1953-420: A slower recovery of some abilities). Other influences that may affect recovery include pre-injury intellectual ability, coping strategies, personality traits, family environment, social support systems and financial circumstances. Life satisfaction has been known to decrease for individuals with TBI immediately following the trauma, but evidence has shown that life roles, age, and depressive symptoms influence

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2046-409: A specific location or over a widespread area). Head injury is a broader category that may involve damage to other structures such as the scalp and skull . TBI can result in physical, cognitive, social, emotional and behavioral symptoms, and outcomes can range from complete recovery to permanent disability or death. Causes include falls , vehicle collisions and violence. Brain trauma occurs as

2139-553: A universal system has not been embraced. One example of a proposed system of diagnosis requires observation confirmation for four of the six following symptoms: fever greater than 38.3 degrees Celsius, tachycardia classified as a heart rate of 120 bpm or higher, hypertension classified as a systolic pressure higher than 160 mmHg or a pulse pressure higher than 80 mmHg, tachypnea classified as respiration rate higher than 30 breaths per minute, excess sweating, and severe dystonia. Ruling out other diseases or syndromes that show similar symptoms

2232-457: A way that it achieves the effectiveness of the necessary levers, matching the gait pattern, in order to support the proprioceptive approaches of physiotherapy. The orthotic concepts of the treatment are based on the concepts for the patients with cerebral palsy . The characteristics of the stiffness of the orthosis shells and the adjustable dynamics in the ankle joint are important elements of the orthosis to be considered. The orthotic concepts of

2325-419: Is a rather serious side effect. Gabapentin inhibits neurotransmitter release in the dorsal horn of the spinal cord and various areas of the central nervous system. It helps treat mild symptoms and can be tolerated for longer periods of time compared to other drug treatments. Dantrolene helps combat dystonia and fever by affecting muscle contraction and relaxation cycles. It hinders the release of calcium from

2418-427: Is administered in doses of twenty milligrams to sixty milligrams every four to six hours in the treatment of PSH. Clonidine is an alpha receptor agonist that helps reduces sympathetic activity leaving the hypothalamus and reduces circulating catecholamines. It is helpful in lowering blood pressure and heart rate, but it does not show much of an effect on other symptoms. It may also increase sympathetic inhibition in

2511-944: Is agreed that a TBI with a GCS of 13 or above is mild, 9–12 is moderate, and 8 or below is severe. Similar systems exist for young children; however, the GCS grading system has limited ability to predict outcomes. Because of this, other classification systems such as the one shown in the table are also used to help determine severity. A current model developed by the Department of Defense and Department of Veterans Affairs uses all three criteria of GCS after resuscitation , duration of post-traumatic amnesia (PTA), and loss of consciousness (LOC). It also has been proposed to use changes that are visible on neuroimaging , such as swelling , focal lesions, or diffuse injury as method of classification. Systems also exist to classify TBI by its pathological features. Lesions can be extra-axial, (occurring within

2604-426: Is also used to control post-traumatic epilepsy ; however the preventive use of anti-epileptics is not recommended. In those cases where the person is bedridden due to a reduction of consciousness, has to remain in a wheelchair because of mobility problems, or has any other problem heavily impacting self-caring capacities, caregiving and nursing are critical. The most effective research documented intervention approach

2697-441: Is an intra-axial lesion. Extra-axial lesions include epidural hematoma , subdural hematoma , subarachnoid hemorrhage , and intraventricular hemorrhage . Epidural hematoma involves bleeding into the area between the skull and the dura mater , the outermost of the three membranes surrounding the brain. In subdural hematoma, bleeding occurs between the dura and the arachnoid mater . Subarachnoid hemorrhage involves bleeding into

2790-612: Is an ominous sign. Small children with moderate to severe TBI may have some of these symptoms but have difficulty communicating them. Other signs seen in young children include persistent crying, inability to be consoled, listlessness, refusal to nurse or eat, and irritability. The most common causes of TBI in the U.S. include violence, transportation accidents, construction site mishaps, and sports. Motor bikes are major causes, increasing in significance in developing countries as other causes reduce. The estimates that between 1.6 and 3.8 million traumatic brain injuries each year are

2883-399: Is bent and the foot contact is complete. To improve the gait pattern, orthotics can be included in the therapy concept. An Orthosis can support physiotherapeutic treatment in setting the right motor impulses in order to create new cerebral connections. The orthosis must meet the requirements of the medical prescription. In addition, the orthosis must be designed by the orthotist in such

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2976-686: Is carefully regulated because increased temperature raises the brain's metabolic needs, potentially depriving it of nutrients. Seizures are common. While they can be treated with benzodiazepines , these drugs are used carefully because they can depress breathing and lower blood pressure. Anti-convulsant medications have only been found to be useful for reducing the risk of an early seizure. Phenytoin and Levetiracetam appear to have similar levels of effectiveness for preventing early seizures. People with TBI are more susceptible to side effects and may react adversely to some medications. During treatment monitoring continues for signs of deterioration such as

3069-532: Is closely related to severity, is a strong predictor of poor outcome. Prognosis differs depending on the severity and location of the lesion, and access to immediate, specialised acute management. Subarachnoid hemorrhage approximately doubles mortality. Subdural hematoma is associated with worse outcome and increased mortality, while people with epidural hematoma are expected to have a good outcome if they receive surgery quickly. Diffuse axonal injury may be associated with coma when severe, and poor outcome. Following

3162-400: Is defined as damage to the brain resulting from external mechanical force, such as rapid acceleration or deceleration, impact, blast waves, or penetration by a projectile. Brain function is temporarily or permanently impaired and structural damage may or may not be detectable with current technology. TBI is one of two subsets of acquired brain injury (brain damage that occur after birth);

3255-496: Is different from Wikidata All article disambiguation pages All disambiguation pages Paroxysmal sympathetic hyperactivity Characteristics of paroxysmal sympathetic hyperactivity include: In cases where PSH episodes develop post-injury, specifically traumatic brain injury, symptoms typically develop quickly, usually within a week. Symptom onset has been seen to average 5.9 days post-injury. Episodes vary in duration and occurrence. Episodes can last as little as

3348-469: Is imperative to diagnosis as well. Sepsis , encephalitis , neuroleptic malignant syndrome , malignant hyperthermia , lethal catatonia , spinal cord injury (not associated with PSH), seizures , and hydrocephalus (this can be associated with PSH) are examples of diagnoses that should be considered due to the manifestation of similar symptoms before confirming a diagnosis of PSH. PSH has no simple radiological features that can be observed or detected on

3441-428: Is necessary. Patients often are more vulnerable to infections and spend longer times on ventilators, which can lead to an increased risk of various lung diseases. PSH does not affect mortality rate, but it increases the amount of time it takes a patient to recover from injury, compared to patients with similar injuries who do not develop PSH episodes. It often takes patients who develop PSH longer to reach similar levels of

3534-409: Is quick, accurate, and widely available. Follow-up CT scans may be performed later to determine whether the injury has progressed. Magnetic resonance imaging (MRI) can show more detail than CT, and can add information about expected outcome in the long term. It is more useful than CT for detecting injury characteristics such as diffuse axonal injury in the longer term; however, MRI is not used in

3627-444: Is speculative. Morphine has been found to be effective in aborting episodes; sometimes it is the only medication that can combat the sympathetic response. Morphine helps lower respiration rates and hypertension. It is given in doses of two milligrams to eight milligrams but can be administered up to twenty milligrams. Nausea and vomiting are common side effects. Withdrawal is sometimes seen in patients. Non-selective beta-blockers are

3720-486: Is that it makes different gait patterns very recognizable and can be used in patients in whom only one leg and both legs are affected. The Amsterdam Gait Classification was developed for viewing patients with cerebral palsy ; however, it can be used just as well in patients with traumatic brain injuries. According to the Amsterdam Gait Classification, five gait types are described. To assess the gait pattern,

3813-431: Is the activation database guided EEG biofeedback approach, which has shown significant improvements in memory abilities of the TBI subject that are far superior than traditional approaches (strategies, computers, medication intervention). Gains of 2.61 standard deviations have been documented. The TBI's auditory memory ability was superior to the control group after the treatment. In patients who have developed paralysis of

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3906-419: The cortex . Focal injuries often produce symptoms related to the functions of the damaged area . Research shows that the most common areas to have focal lesions in non-penetrating traumatic brain injury are the orbitofrontal cortex (the lower surface of the frontal lobes) and the anterior temporal lobes , areas that are involved in social behavior, emotion regulation, olfaction, and decision-making, hence

3999-709: The TBI rehabilitation team. After discharge from the inpatient rehabilitation treatment unit, care may be given on an outpatient basis. Community-based rehabilitation will be required for a high proportion of people, including vocational rehabilitation; this supportive employment matches job demands to the worker's abilities. People with TBI who cannot live independently or with family may require care in supported living facilities such as group homes. Respite care , including day centers and leisure facilities for disabled people, offers time off for caregivers, and activities for people with TBI. Pharmacological treatment can help to manage psychiatric or behavioral problems. Medication

4092-458: The United States have been insufficient to determine their effectiveness preventing number of deaths or injuries. It is important to begin emergency treatment within the so-called " golden hour " following the injury. People with moderate to severe injuries are likely to receive treatment in an intensive care unit followed by a neurosurgical ward. Treatment depends on the recovery stage of

4185-867: The acute stage, prognosis is strongly influenced by the patient's involvement in activity that promote recovery, which for most patients requires access to a specialised, intensive rehabilitation service. The Functional Independence Measure is a way to track progress and degree of independence throughout rehabilitation. Medical complications are associated with a bad prognosis. Examples of such complications include: hypotension (low blood pressure), hypoxia (low blood oxygen saturation ), lower cerebral perfusion pressures , and longer times spent with high intracranial pressures. Patient characteristics also influence prognosis. Examples of factors thought to worsen it include: abuse of substances such as illicit drugs and alcohol and age over sixty or under two years (in children, younger age at time of injury may be associated with

4278-431: The body, and a blown pupil , one that fails to constrict in response to light or is slow to do so. Cushing's triad , a slow heart rate with high blood pressure and respiratory depression is a classic manifestation of significantly raised ICP. Anisocoria , unequal pupil size, is another sign of serious TBI. Abnormal posturing , a characteristic positioning of the limbs caused by severe diffuse injury or high ICP,

4371-500: The brain activity seen in patients who do not develop PSH, although PSH patients do eventually reach these same levels. The first published case of paroxysmal sympathetic hyperactivity was Wilder Penfield's case report of a 41-year-old woman, JH, published in 1929. She had a third ventricle cholesteatoma . She displayed increased respiration, increased heart rate, diaphoresis, and increased blood pressure. She also displayed minor symptoms: pupillary dilation, hiccups, and lacrimation. At

4464-688: The brain and reduces ICP, but it potentially causes ischemia and is, therefore, used only in the short term. Giving corticosteroids is associated with an increased risk of death, and so their routine use is not recommended. There is no strong evidence that the following pharmaceutical interventions should be recommended to routinely treat TBI: magnesium , monoaminergic and dopamine agonists , progesterone , aminosteroids , excitatory amino acid reuptake inhibitors , beta-2 antagonists (bronchodilators), haemostatic and antifibrinolytic drugs. Endotracheal intubation and mechanical ventilation may be used to ensure proper oxygen supply and provide

4557-428: The brain of badly needed blood flow and can cause deadly brain herniation . Other methods to prevent damage include management of other injuries and prevention of seizures . Some data supports the use of hyperbaric oxygen therapy to improve outcomes. Further research is required to determine the effectiveness and clinical importance of positioning the head at different angles (degrees of head-of-bed elevation) while

4650-443: The brainstem. Bromocriptine is a dopamine agonist that helps lower blood pressure. Its effects are modest, but they are not well understood. Baclofen is a GABA agonist that helps control muscle spasms, proving to be helpful in treating dystonia. Benzodiazepines bind to GABA receptors and work as muscle relaxants. Benzodiazepines also combat high blood pressure and respiratory rates; however, they are associated with glaucoma, which

4743-428: The common social/emotional and judgment deficits following moderate-severe TBI. Symptoms such as hemiparesis or aphasia can also occur when less commonly affected areas such as motor or language areas are, respectively, damaged. One type of focal injury, cerebral laceration , occurs when the tissue is cut or torn. Such tearing is common in orbitofrontal cortex in particular, because of bony protrusions on

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4836-531: The concurrent use of catheters. Symptoms of PSH can last from weeks to years following initial onset. As episodes persist over time, they have been found to become less frequent in occurrence but last for prolonged periods. The number of events that can lead to the development of PSH symptoms is many. The exact pathways or causes for the development of the syndrome are not known. Traumatic brain injury , hypoxia, stroke , anti-NMDA receptor encephalitis (although further associations are being explored), injury of

4929-408: The early 2000s, researchers discovered that diffusion tensor imaging (DTI), a way of processing MRI images that shows white matter tracts, was an effective tool for displaying the extent of diffuse axonal injury . Types of injuries considered diffuse include edema (swelling), concussion and diffuse axonal injury, which is widespread damage to axons including white matter tracts and projections to

5022-566: The emergency setting for reasons including its relative inefficacy in detecting bleeds and fractures, its lengthy acquisition of images, the inaccessibility of the patient in the machine, and its incompatibility with metal items used in emergency care. A variant of MRI since 2012 is high-definition fiber tracking (HDFT). Other techniques may be used to confirm a particular diagnosis. X-rays are still used for head trauma, but evidence suggests they are not useful; head injuries are either so mild that they do not need imaging or severe enough to merit

5115-420: The force sends shock waves through the skull and brain, resulting in tissue damage. Shock waves caused by penetrating injuries can also destroy tissue along the path of a projectile, compounding the damage caused by the missile itself. Damage may occur directly under the site of impact, or it may occur on the side opposite the impact ( coup and contrecoup injury , respectively). When a moving object impacts

5208-603: The gait pattern is useful. J. Rodda and H. K. Graham already described in 2001 how gait patterns of CP patients can be more easily recognized and defined gait types which they compared in a classification. They also described that gait patterns can vary with age. Building on this, the Amsterdam Gait Classification was developed at the free university in Amsterdam, the VU medisch centrum. A special feature of this classification

5301-447: The greatest number of TBI deaths occurring in hospitals. Secondary injury events include damage to the blood–brain barrier , release of factors that cause inflammation , free radical overload, excessive release of the neurotransmitter glutamate ( excitotoxicity ), influx of calcium and sodium ions into neurons , and dysfunction of mitochondria . Injured axons in the brain's white matter may separate from their cell bodies as

5394-527: The head to promote blood flow through the veins of the neck. Sedatives , analgesics and paralytic agents are often used. Propofol and midazolam are equally effective as sedatives. Hypertonic saline can improve ICP by reducing the amount of cerebral water (swelling), though it is used with caution to avoid electrolyte imbalances or heart failure. Mannitol , an osmotic diuretic , appears to be as effective as hypertonic saline at reducing ICP; however, some concerns have been raised regarding some of

5487-567: The idea of introducing protective headgear for players has been proposed. Improved equipment design can enhance safety; softer baseballs reduce head injury risk. Rules against dangerous types of contact, such as "spear tackling" in American football , when one player tackles another head first, may also reduce head injury rates. Falls can be avoided by installing grab bars in bathrooms and handrails on stairways; removing tripping hazards such as throw rugs; or installing window guards and safety gates at

5580-634: The injury's severity. With mild TBI, the patient may remain conscious or may lose consciousness for a few seconds or minutes. Other symptoms of mild TBI include headache, vomiting, nausea, lack of motor coordination , dizziness, difficulty balancing, lightheadedness, blurred vision or tired eyes, ringing in the ears , bad taste in the mouth, fatigue or lethargy, and changes in sleep patterns. Cognitive and emotional symptoms include behavioral or mood changes, confusion, and trouble with memory, concentration, attention, or thinking. Mild TBI symptoms may also be present in moderate and severe injuries. A person with

5673-682: The injury, treatment required may be minimal or may include interventions such as medications, emergency surgery or surgery years later. Physical therapy , speech therapy , recreation therapy , occupational therapy and vision therapy may be employed for rehabilitation. Counseling , supported employment and community support services may also be useful. TBI is a major cause of death and disability worldwide, especially in children and young adults. Males sustain traumatic brain injuries around twice as often as females. The 20th century saw developments in diagnosis and treatment that decreased death rates and improved outcomes. Traumatic brain injury

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5766-416: The interior skull ridge above the eyes. In a similar injury, cerebral contusion (bruising of brain tissue), blood is mixed among tissue. In contrast, intracranial hemorrhage involves bleeding that is not mixed with tissue. Hematomas, also focal lesions, are collections of blood in or around the brain that can result from hemorrhage. Intracerebral hemorrhage , with bleeding in the brain tissue itself,

5859-420: The jobs they had before the injury, although a small portion have mild cognitive and social impairments. Over 90% of people with moderate TBI are able to live independently, although some require assistance in areas such as physical abilities, employment, and financial managing. Most people with severe closed head injury either die or recover enough to live independently; middle ground is less common. Coma, as it

5952-406: The knee angle is normal and the foot contact is complete. In gait type 2, the knee angle is hyperextended and the foot contact is complete. In gait type 3, the knee angle is hyperextended and foot contact is incomplete (only on the forefoot). In gait type 4, the knee angle is bent and foot contact is incomplete (only on the forefoot). With gait type 5, which is also known as crouch gait, the knee angle

6045-407: The legs in the form of spastic hemiplegia or diplegia as a result of the traumatic brain injury, various gait patterns can be observed, the exact extent of which can only be described with the help of complex gait analysis systems. In order to facilitate interdisciplinary communication in the interdisciplinary team between those affected, doctors, physiotherapists and orthotists, a simple description of

6138-400: The moment of trauma when tissues and blood vessels are stretched, compressed, and torn) is not adequate to explain this deterioration; rather, it is caused by secondary injury, a complex set of cellular processes and biochemical cascades that occur in the minutes to days following the trauma. These secondary processes can dramatically worsen the damage caused by primary injury and account for

6231-419: The more accurate CT. Angiography may be used to detect blood vessel pathology when risk factors such as penetrating head trauma are involved. Functional imaging can measure cerebral blood flow or metabolism, inferring neuronal activity in specific regions and potentially helping to predict outcome. Neuropsychological assessment can be performed to evaluate the long-term cognitive sequelae and to aid in

6324-436: The most effective in reducing the frequency and severity of PSH episodes. They help decrease the effect of circulating catecholamines and lower metabolic rates, which are high in patients during PSH episodes. Beta-blockers also help in reducing fever, diaphoresis, and in some cases dystonia. Propranolol is a common beta-blocker administered due to the fact that it penetrates the blood-brain barrier relatively well. Typically it

6417-421: The number of crashes. In addition, changes to public policy and safety laws can be made; these include speed limits, seat belt and helmet laws, and road engineering practices. Changes to common practices in sports have also been discussed. An increase in use of helmets could reduce the incidence of TBI. Due to the possibility that repeatedly "heading" a ball practicing soccer could cause cumulative brain injury,

6510-513: The other subset is non-traumatic brain injury, which does not involve external mechanical force (examples include stroke and infection). All traumatic brain injuries are head injuries, but the latter term may also refer to injury to other parts of the head; however, the terms head injury and brain injury are often used interchangeably. Similarly, brain injuries fall under the classification of central nervous system injuries and neurotrauma. In neuropsychology research literature, in general

6603-455: The pathophysiology: There are many theories dealing with the pathophysiology of paroxysmal sympathetic hyperactivity. It is possible that none or multiple of these theories are correct. Research that is being conducted on PSH is focused on figuring out these pathways. Diagnosing PSH can be very difficult due to the lack of common terminology in circulation and a lack of diagnostic criteria. Different systems for diagnosis have been proposed, but

6696-477: The patient is viewed visually or via a video recording from the side of the leg to be assessed. At the point in time at which the leg to be viewed is in mid stance and the leg not to be viewed is in mid swing, the knee angle and the contact of the foot with the ground are assessed on the one hand. Classification of the gait pattern according to the Amsterdam Gait Classification: In gait type 1,

6789-497: The patient. In the acute stage, the primary aim is to stabilize the patient and focus on preventing further injury. This is done because the initial damage caused by trauma cannot be reversed. Rehabilitation is the main treatment for the subacute and chronic stages of recovery. International clinical guidelines have been proposed with the aim of guiding decisions in TBI treatment, as defined by an authoritative examination of current evidence . Tranexamic acid within three hours of

6882-403: The person is being treated in intensive care. Neuroimaging is helpful but not flawless in detecting raised ICP. A more accurate way to measure ICP is to place a catheter into a ventricle of the brain , which has the added benefit of allowing cerebrospinal fluid to drain, releasing pressure in the skull. Treatment of raised ICP may be as simple as tilting the person's bed and straightening

6975-515: The planning of the rehabilitation . Instruments range from short measures of general mental functioning to complete batteries formed of different domain-specific tests . Since a major cause of TBI are vehicle accidents, their prevention or the amelioration of their consequences can both reduce the incidence and gravity of TBI. In accidents, damage can be reduced by use of seat belts, child safety seats and motorcycle helmets, and presence of roll bars and airbags. Education programs exist to lower

7068-464: The rehabilitation activities for each person. Treatment of neuropsychiatric symptoms such as emotional distress and clinical depression may involve mental health professionals such as therapists , psychologists , and psychiatrists , while neuropsychologists can help to evaluate and manage cognitive deficits . Social workers, rehabilitation support personnel, nutritionists, therapeutic recreationists, and pharmacists are also important members of

7161-469: The rigidity to be specifically adapted to the requirements that fits to the gait pattern of the patient. The adjustment of the stiffness has a decisive influence on the gait pattern and on the energy cost of walking. It is of great advantage if the stiffness of the orthosis can be adjusted separately from one another via resistances of the two functional elements in the two directions of movement, dorsiflexion and plantar flexion . Prognosis worsens with

7254-403: The same term [REDACTED] This disambiguation page lists articles associated with the title PSH . If an internal link led you here, you may wish to change the link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=PSH&oldid=1063493261 " Category : Disambiguation pages Hidden categories: Short description

7347-469: The sarcoplasmic reticulum, inhibiting muscle contraction. It causes decreases in respiration, but it can be very dangerous for the liver. Again, these treatments are seen case by case and treat symptoms well. They do not treat the syndrome as a whole or preventatively. Efficacy varies patient to patient, as symptoms do. Patients who develop PSH after traumatic injury have longer hospitalization and longer durations in intensive care in cases where ICU treatment

7440-459: The severity of injury. Most TBIs are mild and do not cause permanent or long-term disability; however, all severity levels of TBI have the potential to cause significant, long-lasting disability. Permanent disability is thought to occur in 10% of mild injuries, 66% of moderate injuries, and 100% of severe injuries. Most mild TBI is completely resolved within three weeks. Almost all people with mild TBI are able to live independently and return to

7533-404: The skull and breaches the dura mater , the outermost membrane surrounding the brain . Brain injuries can be classified into mild , moderate, and severe categories. The Glasgow Coma Scale (GCS), the most commonly used system for classifying TBI severity, grades a person's level of consciousness on a scale of 3–15 based on verbal, motor, and eye-opening reactions to stimuli. In general, it

7626-443: The skull but outside of the brain) or intra-axial (occurring within the brain tissue). Damage from TBI can be focal or diffuse , confined to specific areas or distributed in a more general manner, respectively; however, it is common for both types of injury to exist in a given case. Diffuse injury manifests with little apparent damage in neuroimaging studies, but lesions can be seen with microscopy techniques post-mortem , and in

7719-761: The skull is removed, may be needed to remove pieces of fractured skull or objects embedded in the brain. Decompressive craniectomy (DC) is performed routinely in the very short period following TBI during operations to treat hematomas; part of the skull is removed temporarily (primary DC). DC performed hours or days after TBI in order to control persistently high intracranial pressures (secondary DC), although can reduce intracranial pressure and length of stay in ICU, but have worse Glasgow Coma Scale (GCS) scores, and high chances of death, vegetative state , or severe disability when compared to those receiving standard medical therapies. Once medically stable, people may be transferred to

7812-417: The space between the arachnoid membrane and the pia mater . Intraventricular hemorrhage occurs when there is bleeding in the ventricles . Symptoms are dependent on the type of TBI (diffuse or focal) and the part of the brain that is affected. Unconsciousness tends to last longer for people with injuries on the left side of the brain than for those with injuries on the right. Symptoms are also dependent on

7905-451: The spinal cord , and many other forms of brain injury can cause onset of PSH. Even more obscure diseases such as intracranial tuberculoma have been seen to cause onset of paroxysmal sympathetic hyperactivity. It is observed that these injuries lead to the development of PSH or are seen in conjunction with PSH, but the pathophysiology behind these diseases and the syndrome is not well understood. A considerable number of theories exist as to

7998-406: The stationary head, coup injuries are typical, while contrecoup injuries are usually produced when the moving head strikes a stationary object. A large percentage of the people killed by brain trauma do not die right away but rather days to weeks after the event; rather than improving after being hospitalized, some 40% of TBI patients deteriorate. Primary brain injury (the damage that occurs at

8091-452: The studies performed. Hyertonic saline is also suitable in children with severe traumatic brain injury. Diuretics , drugs that increase urine output to reduce excessive fluid in the system, may be used to treat high intracranial pressures, but may cause hypovolemia (insufficient blood volume). Hyperventilation (larger and/or faster breaths) reduces carbon dioxide levels and causes blood vessels to constrict; this decreases blood flow to

8184-472: The term "traumatic brain injury" is used to refer to non-penetrating traumatic brain injuries. TBI is usually classified based on severity, anatomical features of the injury, and the mechanism (the causative forces). Mechanism-related classification divides TBI into closed and penetrating head injury . A closed (also called nonpenetrating, or blunt) injury occurs when the brain is not exposed. A penetrating, or open, head injury occurs when an object pierces

8277-698: The time, her episodes were termed 'diencephalic autonomic epilepsy'. It was believed that both her sympathetic and parasympathetic nervous systems were showing overactivity. The future may hold non-pharmacologic solutions such as renal sympathetic denervation. Traumatic brain injury A traumatic brain injury ( TBI ), also known as an intracranial injury , is an injury to the brain caused by an external force. TBI can be classified based on severity ranging from mild traumatic brain injury (mTBI/concussion) to severe traumatic brain injury. TBI can also be characterized based on mechanism ( closed or penetrating head injury ) or other features (e.g., occurring in

8370-447: The top and bottom of stairs around young children. Playgrounds with shock-absorbing surfaces such as mulch or sand also prevent head injuries. Child abuse prevention is another tactic; programs exist to prevent shaken baby syndrome by educating about the dangers of shaking children. Gun safety, including keeping guns unloaded and locked, is another preventative measure. Studies on the effect of laws that aim to control access to guns in

8463-405: The trajectory of life satisfaction as time passes. Many people with traumatic brain injuries have poor physical fitness following their acute injury and this may result with difficulties in day-to-day activities and increased levels of fatigue. Improvement of neurological function usually occurs for two or more years after the trauma. For many years it was believed that recovery was fastest during

8556-405: The treatment are based on the concepts for the patients with cerebral palsy. Due to these requirements, the development of orthoses has changed significantly in recent years, especially since around 2010. At about the same time, care concepts were developed that deal intensively with the orthotic treatment of the lower extremities in cerebral palsy. Modern materials and new functional elements enable

8649-627: The treatment of paroxysmal sympathetic hyperactivity are morphine sulfate and beta-blockers . Morphine is useful in helping halt episodes that have started to occur. Beta-blockers are helpful in preventing the occurrence of 'sympathetic storms'. Other drugs that have been used and have in some cases been helpful are dopamine agonists , other various opiates , benzodiazepines , clonidine , and baclofen . Chlorpromazine and haloperidol , both dopamine antagonists, in some cases have worsened PSH symptoms. These drugs are in use currently for treatment; exact pathways are not known and wide-range helpfulness

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