45:(TBI), primary brain injury occurs during the initial insult, and results from displacement of the physical structures of the brain. Secondary brain injury occurs gradually and may involve an array of cellular processes. Secondary injury, which is not caused by mechanical damage, can result from the primary injury or be independent of it. The fact that people sometimes deteriorate after brain injury was originally taken to mean that secondary injury was occurring. It is not well understood how much of a contribution primary and secondary injuries respectively have to the clinical manifestations of TBI.
198:
not die right away but rather days to weeks after the event. In addition, rather than improving after being hospitalized as most patients with other types of injuries do, about 40% of people with TBI deteriorate. This is often a result of secondary injury, which can damage neurons that were unharmed in the primary injury. It occurs after a variety of brain injury including
324:(oxygen deficiency). Furthermore, secondary injury presents opportunities for researchers to find drug therapies to limit or prevent the damage. Since a variety of processes occur in secondary injury, any treatments that are developed to halt or mitigate it will need to address more than one of these mechanisms.
197:
result of the injury. It results from processes initiated by the trauma. It occurs in the hours and days following the primary injury and plays a large role in the brain damage and death that results from TBI. Unlike in most forms of trauma a large percentage of the people killed by brain trauma do
180:
may be damaged in the primary injury, and neurons may die. Cells are killed in a nonspecific manner in primary injury. Tissues have a deformation threshold: if they are deformed past this threshold they are injured. Different regions in the brain may be more sensitive to mechanical loading due to
323:
Since primary injury occurs at the moment of trauma and is over so rapidly, little can be done to interfere with it other than prevention of the trauma itself. However, since secondary injury occurs over time, it can be prevented in part by taking measures to prevent complications such as hypoxia
185:
tissues may have different properties than other tissues. Thus some tissues may experience more force and be more injured in the primary injury. The primary injury leads to the secondary injury.
701:
Sullivan PG, Rabchevsky AG, Hicks RR, Gibson TR, Fletcher-Turner A, Scheff SW (2000). "Dose-response curve and optimal dosing regimen of cyclosporin A after traumatic brain injury in rats".
307:
after head trauma. Similar mechanisms are involved in secondary injury after ischemia, trauma, and injuries resulting when a person does not get enough oxygen. After stroke, an
327:
Thus efforts to reduce disability and death from TBI are thought to be best aimed at secondary injury, because the primary injury is thought to be irreversible.
956:
Armin SS, Colohan AR, Zhang JH (June 2006). "Traumatic subarachnoid hemorrhage: Our current understanding and its evolution over the past half century".
676:
640:
561:
485:
881:
848:
525:
452:
375:
904:
551:
271:(the chemicals used by brain cells to communicate) can cause secondary injury. Imbalances in some neurotransmitters can lead to
152:
In TBI, primary injuries result immediately from the initial trauma. Primary injury occurs at the moment of trauma and includes
666:
475:
513:
295:. Another factor in secondary injury is loss of cerebral autoregulation, the ability of the brain's blood vessels to regulate
366:
Scalea TM (2005). "Does it matter how head injured patients are resuscitated?". In
Valadka AB, Andrews BT (eds.).
1009:
440:
80:
628:
300:
199:
90:
336:
203:
42:
276:
241:
110:
38:
668:
Traumatic Brain Injury: Methods for
Clinical & Forensic Neuropsychiatric Assessment, Second Edition
477:
Traumatic Brain Injury: Methods for
Clinical & Forensic Neuropsychiatric Assessment, Second Edition
1004:
837:
Marion DW (2003). "Pathophysiology and treatment of intracranial hypertention". In
Andrews BT (ed.).
871:
838:
312:
296:
237:
210:
173:
131:
105:
95:
85:
981:
726:
416:
100:
49:
244:(the pressure within the skull). If intracranial pressure gets too high, it can lead to deadly
973:
938:
877:
844:
816:
767:
718:
672:
636:
600:
557:
521:
481:
448:
408:
391:
Ortega-Pérez, Stefany; Amaya-Rey, Maria (2018). "Secondary Brain Injury: A Concept
Analysis".
371:
292:
221:
965:
928:
920:
806:
798:
757:
710:
592:
400:
308:
284:
268:
245:
181:
differences in their properties that result from differences in their makeup; for example,
287:). Excitotoxicity can cause a variety of negative effects, including damage to cells by
933:
908:
811:
786:
272:
233:
229:
142:
119:
714:
17:
998:
924:
762:
745:
264:
985:
730:
420:
304:
303:, edema, ischemia and hypoxia. Ischemia is one of the leading causes of secondary
288:
161:
157:
136:
404:
252:
225:
802:
260:
207:
125:
969:
909:"Posttraumatic epilepsy: A major problem in desperate need of major advances"
596:
583:
Pitkänen A, McIntosh TK (2006). "Animal models of post-traumatic epilepsy".
279:
for excitatory neurotransmitters (those that increase the likelihood that a
216:
Secondary injury can result from complications of the injury. These include
153:
48:
Primary and secondary injuries occur in instances other than a TBI, such as
977:
942:
820:
722:
604:
412:
771:
256:
248:, in which parts of the brain are squeezed past structures in the skull.
217:
177:
280:
182:
169:
53:
447:. Washington, DC: American Psychiatric Association. pp. 27–33.
520:. Hagerstown, MD: Lippincott Williams & Wilkins. p. 1150.
870:
Andrews BT (2003). "Head injury management". In
Andrews BT (ed.).
556:. Hagerstown, MD: Lippincott Williams & Wilkins. p. 838.
553:
165:
275:, damage to brain cells that results from overactivation of
744:
Sauaia A, Moore FA, Moore EE, et al. (February 1995).
785:
Narayan RK, Michel ME, Ansell B, et al. (May 2002).
299:. Other factors in secondary damage are breakdown of the
37:
are ways to classify the injury processes that occur in
843:. New York: Thieme Medical Publishers. pp. 52–53.
368:
Neurotrauma: Evidence-Based
Answers To Common Questions
633:
Neurotrauma: New
Insights Into Pathology and Treatment
876:. New York: Thieme Medical Publishers. p. 125.
443:. In Silver JM, McAllister TW, Yudofsky SC (eds.).
627:LaPlaca MC, Simon CM, Prado GR, Cullen DR (2007).
629:"CNS injury biomechanics and experimental models"
255:(excessive carbon dioxide levels in the blood),
746:"Epidemiology of trauma deaths: A reassessment"
434:
432:
430:
267:. In addition, alterations in the release of
696:
694:
660:
658:
507:
505:
503:
8:
361:
359:
357:
355:
353:
351:
832:
830:
622:
620:
618:
616:
614:
516:. In Schiffer RB, Rao SM, Fogel BS (eds.).
932:
810:
761:
545:
543:
236:(swelling of the brain); changes in the
63:
347:
7:
224:(insufficient oxygen in the brain);
220:(insufficient blood flow); cerebral
671:. Boca Raton: CRC. pp. 26–32.
480:. Boca Raton: CRC. pp. 26–32.
65:Examples in traumatic brain injury
512:Hammeke TA, Gennarelli TA (2003).
445:Textbook Of Traumatic Brain Injury
25:
439:Gennarelli GA, Graham DI (2005).
925:10.1111/j.1535-7511.2005.00083.x
787:"Clinical trials in head injury"
763:10.1097/00005373-199502000-00006
393:Journal of Neuroscience Nursing
251:Other secondary injury include
873:Intensive Care in Neurosurgery
840:Intensive Care in Neurosurgery
1:
715:10.1016/S0306-4522(00)00380-8
259:(excessively acidic blood),
635:. Elsevier. pp. 13–19.
405:10.1097/JNN.0000000000000384
172:are stretched and torn. The
1026:
803:10.1089/089771502753754037
291:, potentially leading to
970:10.1179/016164106X115053
514:"Traumatic brain injury"
370:. Thieme. pp. 3–4.
81:Intracerebral hemorrhage
597:10.1089/neu.2006.23.241
238:blood flow to the brain
200:subarachnoid hemorrhage
193:Secondary injury is an
91:Subarachnoid hemorrhage
585:Journal of Neurotrauma
337:Wallerian degeneration
204:traumatic brain injury
43:traumatic brain injury
35:secondary brain injury
18:Secondary brain injury
665:Granacher RP (2007).
631:. In Weber JT (ed.).
550:Porth, Carol (2007).
474:Granacher RP (2007).
277:biochemical receptors
242:intracranial pressure
111:Axonal stretch injury
313:biochemical cascades
301:blood–brain barrier
297:cerebral blood flow
174:blood brain barrier
132:cerebral blood flow
106:Cerebral laceration
96:Epidural hemorrhage
86:Subdural hemorrhage
66:
101:Cerebral contusion
64:
50:spinal cord injury
678:978-0-8493-8138-6
642:978-0-444-53017-2
563:978-0-7817-7087-3
487:978-0-8493-8138-6
293:neurodegeneration
269:neurotransmitters
150:
149:
27:Medical condition
16:(Redirected from
1017:
990:
989:
953:
947:
946:
936:
900:
894:
893:
891:
890:
867:
861:
860:
858:
857:
834:
825:
824:
814:
782:
776:
775:
765:
741:
735:
734:
698:
689:
688:
686:
685:
662:
653:
652:
650:
649:
624:
609:
608:
580:
574:
573:
571:
570:
547:
538:
537:
535:
534:
509:
498:
497:
495:
494:
471:
465:
464:
462:
461:
441:"Neuropathology"
436:
425:
424:
388:
382:
381:
363:
309:ischemic cascade
246:brain herniation
67:
21:
1025:
1024:
1020:
1019:
1018:
1016:
1015:
1014:
1010:Brain disorders
995:
994:
993:
955:
954:
950:
902:
901:
897:
888:
886:
884:
869:
868:
864:
855:
853:
851:
836:
835:
828:
784:
783:
779:
743:
742:
738:
700:
699:
692:
683:
681:
679:
664:
663:
656:
647:
645:
643:
626:
625:
612:
582:
581:
577:
568:
566:
564:
549:
548:
541:
532:
530:
528:
518:Neuropsychiatry
511:
510:
501:
492:
490:
488:
473:
472:
468:
459:
457:
455:
438:
437:
428:
390:
389:
385:
378:
365:
364:
349:
345:
333:
321:
191:
164:, in which the
62:
28:
23:
22:
15:
12:
11:
5:
1023:
1021:
1013:
1012:
1007:
997:
996:
992:
991:
948:
895:
882:
862:
849:
826:
791:J. Neurotrauma
777:
736:
690:
677:
654:
641:
610:
591:(2): 241–261.
575:
562:
539:
526:
499:
486:
466:
453:
426:
399:(4): 220–224.
383:
376:
346:
344:
341:
340:
339:
332:
329:
320:
317:
273:excitotoxicity
234:cerebral edema
230:blood pressure
202:, stroke, and
190:
187:
148:
147:
146:
145:
143:Excitotoxicity
140:
134:
128:
122:
120:Cerebral edema
115:
114:
113:
108:
103:
98:
93:
88:
83:
75:
74:
71:
61:
58:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
1022:
1011:
1008:
1006:
1003:
1002:
1000:
987:
983:
979:
975:
971:
967:
964:(4): 445–52.
963:
959:
952:
949:
944:
940:
935:
930:
926:
922:
918:
914:
913:Epilepsy Curr
910:
906:
905:Lowenstein DH
899:
896:
885:
883:1-58890-125-4
879:
875:
874:
866:
863:
852:
850:1-58890-125-4
846:
842:
841:
833:
831:
827:
822:
818:
813:
808:
804:
800:
797:(5): 503–57.
796:
792:
788:
781:
778:
773:
769:
764:
759:
756:(2): 185–93.
755:
751:
747:
740:
737:
732:
728:
724:
720:
716:
712:
709:(2): 289–95.
708:
704:
697:
695:
691:
680:
674:
670:
669:
661:
659:
655:
644:
638:
634:
630:
623:
621:
619:
617:
615:
611:
606:
602:
598:
594:
590:
586:
579:
576:
565:
559:
555:
554:
546:
544:
540:
529:
527:0-7817-2655-7
523:
519:
515:
508:
506:
504:
500:
489:
483:
479:
478:
470:
467:
456:
454:1-58562-105-6
450:
446:
442:
435:
433:
431:
427:
422:
418:
414:
410:
406:
402:
398:
394:
387:
384:
379:
377:3-13-130781-1
373:
369:
362:
360:
358:
356:
354:
352:
348:
342:
338:
335:
334:
330:
328:
325:
318:
316:
315:takes place.
314:
310:
306:
302:
298:
294:
290:
289:free radicals
286:
282:
278:
274:
270:
266:
265:brain abscess
262:
258:
254:
249:
247:
243:
240:; and raised
239:
235:
231:
227:
223:
219:
214:
212:
209:
206:and involves
205:
201:
196:
188:
186:
184:
179:
175:
171:
167:
163:
160:, and axonal
159:
158:blood vessels
155:
144:
141:
138:
135:
133:
129:
127:
123:
121:
118:
117:
116:
112:
109:
107:
104:
102:
99:
97:
94:
92:
89:
87:
84:
82:
79:
78:
77:
76:
72:
69:
68:
59:
57:
55:
51:
46:
44:
40:
36:
32:
19:
961:
957:
951:
916:
912:
898:
887:. Retrieved
872:
865:
854:. Retrieved
839:
794:
790:
780:
753:
749:
739:
706:
703:Neuroscience
702:
682:. Retrieved
667:
646:. Retrieved
632:
588:
584:
578:
567:. Retrieved
552:
531:. Retrieved
517:
491:. Retrieved
476:
469:
458:. Retrieved
444:
396:
392:
386:
367:
326:
322:
305:brain damage
250:
215:
194:
192:
156:, damage to
151:
137:Free radical
47:
39:brain injury
34:
30:
29:
1005:Neurotrauma
958:Neurol. Res
311:, a set of
253:hypercapnia
226:hypotension
999:Categories
919:(1): 1–5.
889:2008-06-08
856:2008-06-08
684:2008-07-06
648:2008-06-10
569:2008-07-03
533:2008-06-16
493:2008-07-06
460:2008-06-10
343:References
319:Prevention
261:meningitis
183:myelinated
126:metabolism
73:Secondary
903:Garga N,
208:metabolic
189:Secondary
154:contusion
139:formation
124:Impaired
986:23726077
978:16759448
943:16477313
907:(2006).
821:12042091
750:J Trauma
731:20457228
723:11074152
605:16503807
421:51602244
413:29985274
331:See also
257:acidosis
218:ischemia
211:cascades
195:indirect
178:meninges
162:shearing
130:Altered
70:Primary
934:1363374
812:1462953
772:7869433
222:hypoxia
170:neurons
60:Primary
31:Primary
984:
976:
941:
931:
880:
847:
819:
809:
770:
729:
721:
675:
639:
603:
560:
524:
484:
451:
419:
411:
374:
281:neuron
263:, and
54:stroke
41:. In
982:S2CID
727:S2CID
417:S2CID
283:will
228:(low
166:axons
974:PMID
939:PMID
878:ISBN
845:ISBN
817:PMID
768:PMID
719:PMID
673:ISBN
637:ISBN
601:PMID
558:ISBN
522:ISBN
482:ISBN
449:ISBN
409:PMID
372:ISBN
285:fire
176:and
52:and
33:and
966:doi
929:PMC
921:doi
807:PMC
799:doi
758:doi
711:doi
707:101
593:doi
401:doi
232:);
168:of
1001::
980:.
972:.
962:28
960:.
937:.
927:.
915:.
911:.
829:^
815:.
805:.
795:19
793:.
789:.
766:.
754:38
752:.
748:.
725:.
717:.
705:.
693:^
657:^
613:^
599:.
589:23
587:.
542:^
502:^
429:^
415:.
407:.
397:50
395:.
350:^
213:.
56:.
988:.
968::
945:.
923::
917:6
892:.
859:.
823:.
801::
774:.
760::
733:.
713::
687:.
651:.
607:.
595::
572:.
536:.
496:.
463:.
423:.
403::
380:.
20:)
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.