chapter  1
48 Pages

The Epidemiology and Pathophysiology of Traumatic Brain Injury

Traumatic brain injury has been recognized as an affliction of humankind since the Stone Age. Anthropological evidence from mass graves of ancient battle fields has demonstrated trephination holes across fracture lines of skulls.1 It is postulated that these drill holes were perhaps for release of pressure from hematoma following head injury. In the eighteenth century, Pott, LeBran, and Heister related altered mental status and severity of head injury to pressure on the brain rather than damage to the skull itself.2 By the turn of the twentieth century, neurosurgery had progressed to the point that it was conclusively known that intracranial pressure increased in head injury, and Jaboulay in France emphasized the need for opening the skull to release intracranial pressure.3 Jefferson introduced us to uncal herniation as a consequence of sustained intracranial hypertension.4 Continuous intracerebral pressure monitoring was introduced in the late 1950s and early 1960s.5 In the three decades from the 1970s to the 1990s, studies revealed that there were two major components to traumatic brain injury (TBI): primary injury and secondary injury.6-9 From the early 1990s onward, the neurosurgical profession has made significant strides in improving survivability following TBI.