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Abstract
ABSTRACT
Background: Traumatic brain injury constitutes a major health and socioeconomic problem throught the world .It is one of the major causes of disability and death. Traumatic brain injury may be divided into primary injury and secondary injury: Primary injury is induced by mechanical force and occurs at the moment of injury. Secondary injury is not mechanically induced. It may be delayed from the moment of impact, and it may superimpose injury on a brain already affected by a mechanical injury. The brain receives 15-20 % of the resting cardiac output (700 ml/min in the adult).The central nervous system has high CMRO2 and use glucose predominantly as the substrate for its energy needs.Mean resting CBF in young adults is about 50 ml/100 g brain/min. Glascow coma scale has become the most widely used clinical measure of the severity of traumatic brain injury. It permits a repetitive and moderately reliable standardized method of reporting and recording the ongoing neurologic evaluations even when performed by a variety of health care providers. Evidence suggests that initial assessment of GCS at the site of injury by the health care worker serves as an important marker in the assessment of the progress, prognosis and outcome. The pupil examination is an important component of the prehospital evaluation of patients with head trauma. Pupillary light reflex and size reflect an indirect evidence of the pathology inside the cranial vault. Imaging is a cornerstone of neurologically directed intensive care, identifying critical changes in cerebral structure and function and also yielding valuable insight into the causative mechanisms of acute brain dysfunction. CT is the modality of choice because it is fast, widely available, and highly accurate in the detection of skull fractures and intracranial hemorrhage. Life-support and monitoring equipment can be more easily accommodated in the CT scanner suite than in the Magnetic Resonance (MR) suite. In addition, CT is superior to Magnetic Rsonance Imaging (MRI) in revealing skull fractures and radio-opaque foreign bodies. Continuous ICP monitoring has been used to guide the management of patients with TBI and other causes of cerebral hypertension e.g. intracerebral hemorrhage, large brain tumors and hydrocephalus. ICP monitoring provides the only reliable method of assessing whether therapy will work and provide an early opportunity of switching to alternative therapy such as hyperosmolar therapy, sedatives, barbiturates and ventricular management. Jugular venous oximetry is the most widely used monitor for cerebral oxygenation .The main limitation of this form of monitoring is that it is global measure and regional change in cerebral oxygenation will not be detected . Near infrared spectroscopy is non- invasive method to estimate regional cerebral oxygenation. TCD has been used to provide a noninvasive assessment of CBF in TBI. TCD monitoring can be used to observe changes in flow velocity and waveform. Continuous EEG monitoring in the intensive care unit can now provide important data regarding cerebral function. These data are most often used in decision making regarding antiepileptic drug manipulation, the need for immediate neuroimaging studies, and alteration in therapy to assure adequate cerebral perfusion. The Somatosensory evoked potential is useful means of predicting outcome in post-traumatic patients.Bilaterally absent SEP is strongly associated with poor outcome. Objectives: This work aims to collect all data about the importance of central nervous system monitoring in head trauma patients to improve clinical outcome and to help management.