penetrating brain injury

• 穿通性頭部外傷、脳穿通外傷

関

penetrating cranial trauma、penetrating head injury、penetrating head trauma

WordNet

1. any physical damage to the body caused by violence or accident or fracture etc. (同)hurt, harm, trauma
2. an act that causes someone or something to receive physical damage
3. wrongdoing that violates anothers rights and is unjustly inflicted
4. an accident that results in physical damage or hurt (同)accidental injury
5. kill by smashing someones skull
6. mental ability; "hes got plenty of brains but no common sense" (同)brainpower, learning_ability, mental capacity, mentality, wit
7. that part of the central nervous system that includes all the higher nervous centers; enclosed within the skull; continuous with the spinal cord (同)encephalon
8. the brain of certain animals used as meat
9. hit on the head

PrepTutorEJDIC

1. 『負傷』,『損害』,損傷 / (名誉などを)傷つけること,侮辱《+『to』+『名』》
2. 『脳』,脳髄 / 《しばしば複数形で》『頭脳』,『知力』 / 《話》秀才,知的指導者 / …‘の'頭を打ち砕く
3. (寒さなど)突き刺すような / 見抜く,洞察力のある / (声などが)よく通る
4. =brassiere,　brassiere

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/22 08:08:55」(JST)

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[Wiki en表示]

Penetrating head injury
Classification and external resources
An 1868 illustration of the injury suffered by Phineas Gage, a railroad worker who had a tamping iron driven through his skull in an 1848 accident.
ICD-10	S01.9
eMedicine	med/2888
MeSH	D020197

A penetrating head injury, or open head injury, is a head injury in which the dura mater, the outer layer of the meninges, is breached. Penetrating injury can be caused by high-velocity projectiles or objects of lower velocity such as knives, or bone fragments from a skull fracture that are driven into the brain. A perforating head injury is one in which the object passes through the head and leaves an exit wound. Head injuries caused by penetrating trauma are serious medical emergencies and may cause permanent disability or death.

Mechanisms

An illustration of a brain after an "encircling" gunshot wound, showing the pattern of injury caused by the bullet's path

In penetrating injury from high-velocity missiles, injuries may occur not only from initial laceration and crushing of brain tissue by the projectile but also from the subsequent cavitation. High-velocity objects create rotations and can create a shock wave that cause stretch injuries, forming a cavity that is three to four times greater in diameter than the missile itself. A pulsating temporary cavity is also formed by a high-speed missile and can have a diameter thirty times greater than that of the missile. Though this cavity is reduced in size once the force is over, the tissue that was compressed during cavitation remains injured. Destroyed brain tissue may either be ejected from entrance or exit wounds or packed up against the sides of the cavity formed by the missile.

Low-velocity objects usually cause penetrating injuries in the regions of the skull's temporal bones or orbital surfaces, where the bones are thinner and thus more likely to break. Damage from lower-velocity penetrating injuries is restricted to the tract of the stab wound, because the lower-velocity object does not create as much cavitation. However, low-velocity penetrating objects such as slow bullets may ricochet inside the skull, continuing to cause damage until they stop moving.

Pathophysiology

Though it is more likely to cause infection, penetrating trauma is similar to closed head injury such as cerebral contusion or intracranial hemorrhage in a number of ways. As in closed head injury, intracranial pressure is likely to increase due to swelling or bleeding, potentially crushing delicate brain tissue. Most deaths from penetrating trauma are caused by damage to blood vessels, which can lead to intracranial hematomas and ischemia, which can in turn lead to a biochemical cascade called the ischemic cascade. The injury in penetrating brain trauma is mostly focal (that is, it affects a specific area of tissue).

Studies with PET scanning and transcranial Doppler imaging have shown that changes in cerebral blood flow, such as hypoperfusion and vasospasm, can follow penetrating head injury. These changes can last for two weeks. An ischemic cascade similar to the course of cellular and metabolic events that follow other head injuries may follow penetrating head injuries. Sometimes in penetrating injuries, the brain releases thromboplastin, which can lead to problems with blood clotting.

While blunt head trauma does not present a risk of shock due to hemorrhage, penetrating head trauma does.

Diagnosis and treatment

3-D CT scan showing a penetrating head injury by a screwdriver

A person with a penetrating head injury may be evaluated using X-ray, CT scan, or MRI (however MRI can only be used when the penetrating object would not be magnetic, because MRI uses magnetism and could move the object, causing further injury).

Surgery may be required to debride or repair the injury or to relieve excessive intracranial pressure. Intracranial pressure is monitored and attempts are made to maintain it within normal ranges. Intravenous fluids are given and efforts are taken to maintain high blood oxygen levels.

Prognosis

The highest-velocity injuries tend to have the worst associated damage. Penetrating injury from any missile such as a bullet has a mortality rate of 92%. Thus, firearms cause the most head injury-related deaths. Perforating injuries have an even worse prognosis.

Penetrating head trauma can cause impairment or loss of abilities controlled by parts of the brain that are damaged. A famous example is Phineas Gage, whose personality appears to have changed (though not as dramatically as usually described) after a penetrating injury to his frontal lobe(s).

People with subarachnoid hemorrhage, a blown pupil, respiratory distress, hypotension, or cerebral vasospasm are more likely to have worse outcomes.

People with penetrating head trauma may have complications such as acute respiratory distress syndrome, disseminated intravascular coagulation, and neurogenic pulmonary edema. Up to 50% of patients with penetrating brain injuries get late-onset post-traumatic epilepsy.

See also

• Brain herniation
• Intracranial hemorrhage
• Intracranial pressure
• Penetrating trauma
• Traumatic brain injury
• Head injury
• Skull fracture
• Phineas Gage

References

UpToDate Contents

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• 1. 急性重度外傷性脳損傷のマネージメント management of acute severe traumatic brain injury
• 2. Anesthesia for adults with acute spinal cord injury
• 3. Posterior cruciate ligament injury
• 4. 成人における確定診断を得られていない低血圧やショックの評価および初期アプローチ evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock
• 5. 外傷性脳損傷：疫学、分類、および病態生理 traumatic brain injury epidemiology classification and pathophysiology

English Journal

• Imaging of penetrating injuries of the head and neck:current practice at a level I trauma center in the United States.

• Saito N1, Hito R, Burke PA, Sakai O.
• The Keio journal of medicine.Keio J Med.2014 Jun 25;63(2):23-33. Epub 2014 Jun 10.
• Penetrating neck injuries are commonly related to stab wounds and gunshot wounds in the United States. The injuries are classified by penetration site in terms of the three anatomical zones of the neck. Based on this zonal classification system, penetrating injuries to the head and neck have traditi
• PMID 24965876

• Selective vulnerability of the cerebral vasculature to blast injury in a rat model of mild traumatic brain injury.

• Gama Sosa MA, De Gasperi R, Janssen PL, Yuk FJ, Anazodo PC, Pricop PE, Paulino AJ, Wicinski B, Shaughness MC, Maudlin-Jeronimo E, Hall AA, Dickstein DL, McCarron RM, Chavko M, Hof PR, Ahlers ST, Elder GA.
• Acta neuropathologica communications.Acta Neuropathol Commun.2014 Jun 17;2(1):67. [Epub ahead of print]
• BACKGROUND: Blast-related traumatic brain injury (TBI) is a common cause of injury in the military operations in Iraq and Afghanistan. How the primary blast wave affects the brain is not well understood. The aim of the present study was to examine whether blast exposure affects the cerebral vasculat
• PMID 24938728

• Using the Olfactory System as an In Vivo Model To Study Traumatic Brain Injury and Repair.

• Steuer E1, Schaefer ML, Belluscio L.
• Journal of neurotrauma.J Neurotrauma.2014 Jun 17. [Epub ahead of print]
• Abstract Loss of olfactory function is an early indicator of traumatic brain injury (TBI). The regenerative capacity and well-defined neural maps of the mammalian olfactory system enable investigations into the degeneration and recovery of neural circuits after injury. Here, we introduce a unique ol
• PMID 24694002

Japanese Journal

• 穿通性頭部外傷 : 銃創,穿通創への対処 (特集 Seamlessな頭部外傷診療を目指して) -- (特殊な病態・特殊な患者への対応)

• 下田 健太郎,前田 剛,吉野 篤緒 [他]
• 救急医学 = The Japanese journal of acute medicine 38(7), 845-848, 2014-07
• NAID 40020153289

• The blood cell flow and the vascular responses in arterioles and capillaries after subarachnoid hemorrhage

• Ishikawa Mami,Kajimura Mayumi,Morikawa Takayuki,Nakamura Tomomi,Tanaka Yuichi,Watanabe Eiju,Suematsu Makoto
• Microvascular Reviews and Communications 7(1), 35-35, 2014
• … Purpose: Immediately after subarachnoid hemorrhage (SAH), brain injury begins and determines the acute phase mortality and the long-term prognosis, but its mechanism is not well understood. … Immediately and one hour after SAH, blood cell velocities were measured with a line scan method in precapillary and capillary using two-photon laser scanning microscopy.Results: A penetrating arteriole branched into a precapillary arteriole at the depth of 85.9 +/- 21.0µm (n=7). …
• NAID 130004678473

• 脳小血管病におけるNeurovascular Unitの障害

• 伊藤 義彰,鳥海 春樹,海老根 妙子,畝川 美悠紀,山田 哲,此枝 史恵,小泉 健三,冨田 裕,鈴木 則宏
• 臨床神経学 52(11), 1365-1368, 2012
• … Lipohyalinosis affects penetrating arteries distally than microatheroma. … In contrast, fibrinoid necrosis of smooth muscle cells in the media may weaken the vascular constriction, increasing the perfusion pressure in the capillary and damaging the blood brain barrier which can induce white matter lesion. … NVU is involved in the maintenance of synapse, transmitter, energy metabolism, blood-brain barrier, and blood flow. …
• NAID 130004505164

Related Links

• Management of penetrating brain injury - National Center for ...

Penetrating brain injury (PBI), though less prevalent than closed head trauma, carries a worse prognosis. The publication of Guidelines for the Management of Penetrating Brain Injury in 2001, attempted to standardize the ...

• Penetrating Brain Injury - Trident Health System | Charleston, SC

Learn more about Penetrating Brain Injury at Trident Health System This type of traumatic injury occurs when an object penetrates the skull and damages the brain... ... Initial Treatment The hospital staff will first attempt to stabilize ...

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★リンクテーブル★

リンク元	「穿通性頭部外傷」「脳穿通外傷」「penetrating cranial trauma」「penetrating head injury」「penetrating head trauma」
関連記事	「injury」「penetrating」「brain」

「穿通性頭部外傷」

　　[★]

英

penetrating brain injury、penetrating head trauma、penetrating cranial trauma、penetrating head injury

関

脳穿通外傷、穿通性頭蓋外傷

「脳穿通外傷」

　　[★]

英

penetrating brain injury、penetrating head trauma、penetrating head injury

関

穿通性頭蓋外傷、穿通性頭部外傷

「penetrating cranial trauma」

　　[★]

• 穿通性頭部外傷、穿通性頭蓋外傷

関

penetrating brain injury、penetrating head injury、penetrating head trauma

「penetrating head injury」

　　[★]

• 穿通性頭部外傷、脳穿通外傷

関

penetrating brain injury、penetrating cranial trauma、penetrating head trauma

「penetrating head trauma」

　　[★]

• 穿通性頭部外傷、脳穿通外傷

関

penetrating brain injury、penetrating cranial trauma、penetrating head injury

「injury」

　　[★]

• n.

• 傷害、損傷、外傷、受傷
• wound or trauma; harm or hurt; usually applied to damage inflicted on the body by an external force.

関

damage、injure、insult、lesion、spoilage、trauma、traumatic、traumatic injury、wound

　 　 　 　 　

「penetrating」

　　[★]

• 穿通性の、貫通性の、浸透性の

関

impregnated、penetrability、penetrant、permeability、permeable、permeant

　

「brain」

　　[★] 脳