Severe Brain Injury Pathology

Understanding Severe Brain Injury Pathology – 301

Understanding Severe Brain Injury Pathology – 301

Part 1 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        Doctor, I’d now like to talk, begin the discussion about, neuropathology.  We’re still looking at the DTI image. And perhaps ,as I want to start with severe brain injury and then we’ll go on to mild. perhaps we should change our images or at least our conversation to discussions that are specific to(…)

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Understanding Intracranial Pressure 302

Understanding Intracranial Pressure 302

Part 2 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        Let’s talk a minute about the volume of the skull. We go back to the skull. And I always have a challenge putting these back together. There is a certain amount of volume of fluids that can held inside this skull, is that right? Dr. Erin Bigler:            That is correct. Gordon Johnson:        And(…)

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Epidural Hematoma and Epidural Hemorrhage 303

Epidural Hematoma and Epidural Hemorrhage 303

Part 3 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        Let’s see if we can take one of our brain models and sort of demonstrate the concept of first of the epidural bleed. Perhaps if we take one of the, the still intact brains. Dr. Erin Bigler:            So now this brain doesn’t have a cerebellum, but so an epidural hematoma is occurring on(…)

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Subdural Hematoma and Subdural Hemorrhage – 304

Subdural Hematoma and Subdural Hemorrhage – 304

Part 4 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        Now in contrast to that, what we can see of the epidural bleed there can also be a subdural bleed, is that right? Dr. Erin Bigler:            That’s correct. Gordon Johnson:        Any I images of that you can show us? Dr. Erin Bigler:            Well, what, what occurred here though, this was the first scan,(…)

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Skull Fracture Doesn’t Necessarily Mean Catastrophic Brain Injury – 305

Skull Fracture Doesn’t Necessarily Mean Catastrophic Brain Injury – 305

Part 5 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        Often times we think about a head injury as beginning with skull fracture. On our image we do have a skull fracture. But skull fracture is not necessarily a catastrophic injury. Dr. Erin Bigler:            No. Gordon Johnson:        Talk to me about skull fracture. Dr. Erin Bigler:            Well, skull fracture may actually absorb some(…)

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ICP Pressure Issues in Severe Brain Injury – 306

ICP Pressure Issues in Severe Brain Injury – 306

Part 6 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        Doctor, I now would like to talk about what happens with brain swelling, hematomas and the increase of pressure associated with these severe brain injury events. Dr. Erin Bigler:            Well, if we look at this case again, this patient has some severe intracranial pressure that’s occurring here, and this was a very significant(…)

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Vasculature Issues in Severe Brain Injury – 307

Vasculature Issues in Severe Brain Injury – 307

Part 7 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        Doctor, in order to understand the concepts of what’s really going on with brain swelling and the damage that occurs as a result of increased pressure in the brain, I think it’s helpful if we talk about blood flow in and out of the skull. To do that we’ve got a new model(…)

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Pathology of Brain Bleeds 308

Pathology of Brain Bleeds 308

Part 8 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        When there’s a bleed, and if we’re talking about just on the internal brain aspect of it, that blood, basically gets stuck there. There’s no more oxygen, and ultimately that becomes a toxin, is that right? Dr. Erin Bigler:            That’s correct. Gordon Johnson:        Also, it starts to pool and create one of these(…)

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Goals of Neurosurgery After Severe Brain Injury – 309

Goals of Neurosurgery After Severe Brain Injury – 309

Part 9 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        Let’s talk about the realistic objectives and goals of neurosurgery. What is the surgeon able to do to reverse hemorrhages, hematomas, brain swelling? Dr. Erin Bigler:            Well neurosurgical advances in my lifetime have completely revolutionized the ability to care for acute brain injury. When I finished my Ph.D., a large majority of those(…)

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Demonstrating Mechanism of Diffuse Axonal Injury – 310

Demonstrating Mechanism of Diffuse Axonal Injury – 310

Part 10 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        I want to turn now to a topic that probably is under discussed when we talk about brain injury as a whole, but especially, severe brain injury. because most people associate this topic with mild brain injury. The topic is axonal injury, injury to our axonal tracts, the kind of tracts that we(…)

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Diffuse Axonal Injury is Injury to Axonal Tracts – 311

Diffuse Axonal Injury is Injury to Axonal Tracts – 311

Part 11 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        Are there different levels of severity of axonal injury? Dr. Erin Bigler:            Well, there are and basically how one should view this is sort of an umbrella classification. So the umbrella classification is traumatic axonal injury. So that encompasses all kinds of changes that may happen at the level of the axon. A(…)

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Problems in Diagnosing Axonal Injury – 312

Problems in Diagnosing Axonal Injury – 312

Part 12 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        We also see diffuse axonal injury ranked in severity by DAI 1, DAI 2 and DAI 3 or mild, moderate and severe. Is that correct? Dr. Erin Bigler:            Well that is correct. But the thing is that’s based on post-mortem, analyses. And so that’s not very helpful when you’re trying to use predictions on somebody who(…)

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Brainstem Injury – 313

Brainstem Injury – 313

Part 13 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        A close corollary to the severe diffuse accidental injury is brainstem injury. Tell us about brainstem injury. Dr. Erin Bigler:            Well brainstem injury typically has a pretty devastating outcome. We published a study a number of years ago wherein the hospital that the university’s affiliated with, we examined 244 patients who came in.(…)

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CT, Helicopter and Controlling Brain Swelling Save TBI Lives – 314

CT, Helicopter and Controlling Brain Swelling Save TBI Lives – 314

Part 14 of 14 in the series Severe Brain Injury Pathology

Gordon Johnson:        One of the reasons for the advancement in people surviving brain injury in your career is the fact that we are able to image where the pathology is now, is that true? Dr. Erin Bigler:            Image where the pathology is and better ways to control brain swelling. Those, those two things are the(…)

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