The pathophysiology of traumatic brain injury: a case study approach

Traumatic brain injury (TBI) is an acquired brain injury of sudden onset, caused by a significant impact to the cranium from a sudden external force. The energy exerted by the external force causes intracranial injury owing to distortion of the brain and initiates a cascade of changes at ionic, cellular, metabolic and inflammatory levels. TBI is the leading cause of morbidity and mortality in individuals under the age of 45 years worldwide (Werner and Engelhard, 2007). It is considered a lifelong disease process, as those who survive significant TBI often experience long-term physical disability, neurocognitive deficits and neuropsychiatric sequelae (Masel and De Witt, 2010). It is associated with high socioeconomic costs in terms of both lost income potential and health-care provision, as many of those who survive significant TBI would otherwise be socially and financially self-sufficient. Caring for patients who have suffered a TBI requires nurses to have an in-depth knowledge and clear understanding of the pathophysiology of brain injury. However, there is evidence that nurses caring for this patient group do not perceive that they have a strong knowledge base (Watts et al. 2011). This article aims to explain the complex pathophysiology that follows TBI using a case study approach. Fundamental concepts of intracranial physiology are presented with an explanation of altered cerebral haemodynamics and cellular changes following TBI.