BIOMECHANICAL BASIS OF

TRAUMATIC BRAIN INJURY

(YOUMANS 324)

SNU
CLINICAL CLASSIFICATION OF
BRAIN INJURIES
 skull fracture, focal injury, diffuse brain
injury, penetrating injury, and blast injury.
 Focal injuries are defined simply as visible
damage that is generally limited to a
well-circumscribed region; examples of focal
injuries include contusions to ·the cortex
and subdural, epidural, and intracerebral
hematomas.
1. occur in nearly half of all patients with
severe brain
2. two thirds of brain injury-related deaths.
DIFFUSE BRAIN INJURY

 often occur without macroscopic structural

damage
 is associated with widespread brain dysfunction
 affects approximately 40% of patients with
severe brain injury.
 the most prevalent cause of disability in
survivors of TBI
 Commonly injuries in diffuse brain injury is the
axons within the white matter or the neuronal cell
body; for this reason, the prominent forms of
diffuse brain  injury are diffuse axonal injury
(DAI) and ischemic brain damage
MECHANISMS OF INJURY

 Loading : Static or Dynamic

1. Static :
 an uncommon occurrence and is used to
describe a situation in which force is applied
to the dead very slowly, typically occurring
over times longer than 200 msec.
 Squeezing or crushing of the skull commonly
occurs as seen in earthquakes, building
collapses, or machinery accidents, and it
involves fractures at the vault or basilar
skull region.
 consciousness is preserved after such loading.
2. Dynamic loading
 typically in durations of less than 50 msec.
 two types: impulsive or impact.
 Impulsive  the head is set into motion indirectly by a blow
to another body region. These conditions are not infrequent
in that any blow to the torso or face can often set the head
into violent motion without a direct impact to the skull.
 The resulting inertial force applied to the head causes
the brain to move within the skull; the nature and interac tion
of this brain motion with the internal skull structures leads to
injury along the brain surface and within the brain
parenchyma.
 Another example of impulse loading without the head
sustaining direct contact is the brain injury that results
from "shaken baby syndrome."
IMPACT LOADING

 is complex and usually results in a combination

of contact force and inertial (head motion)
force.
 The effects of contact phenomena vary with the
size of the impact object, the magnitude of force
delivered, and the direction of the force.
 Penetration, perforation, or localized
depressed skull fractures are more likely if the
object has a surface area of less than 2 square
inches
 shock waves can travel through the skull and
parenchyma from the point of impact  small
hemorrhages and contusion.
 Children also appear to be at greater
risk for diffuse brain injury
 the fundamental means of damaging the
skull and brain are the same: distortion or
straining of bone or soft tissues beyond
their functional or structural tolerance.
 Strain, or deformation  proximal cause
of tissue damage.
 strain  alterations in the functioning
of neural circuits and receptors and
changes in the properties of neural
tissue  Strain is often described as
compressive, tensile, dilational, or shear
in nature
 The three principal tissues involved in
brain injury (bone, vascular tissue, and
brain tissue) vary considerably in their
tolerances to compression, tension, and
shear. Bone, for example, is considerably
stronger than either
MECHANICAL CAUSE OF HEAD INJURY

 Two basic mechanism : Contact and inertial

(acceleration)
 Contact injuries  occur if the head were
prevented from moving. Because most
impacts also cause head motion to some
degree, contact injuries rarely occur
 two types: effects at or near the impact
site and those that produce effects
remote from the area of impact.
LOCAL CONTACT EFFECTS

 linear and depressed skull fractures, some

basilar skull fractures, epidural hematomas,
and coup contusions.
 Mechanistically, the local inbending caused
by the impact creates compressive strain
on the outer skull surface and tensile
strain on the inner surface
REMOTE EFFECT
 can produce remote injuries as a result
of either skull distortion or stress waves.
These mechanisms contribute to vault
fractures away from
 the impact site  to basilar skull fractures,
and to contrecoup and intermediate coup
 the basilar  least resistance  of basilar
skull fractures may occur as a result of
remote contact loading.
 The second mechanism for remote
damage from contact loading is the effect
of stress waves originating at the point
of impact
 the areas of stress concentration
secondary to reverberating shock waves 
deep within the brain and not at its
surface.
HEAD MOTION (INERTIAL)
INJURIES
 called acceleration-deceleration injuries 
differential movement of the skull and
brain can be produced by head acceleration
or motion.
 the skull and dura to move relative to the
brain surface  causing localized strain 
parasagittal bridging veins between the
brain surface and dura tear  cause
about 60% of acute subdural hematomas.
 head acceleration can produce strain 
brain parenchyma and widespread
disturbances in brain function or
structures.
 Strain within the brain parenchyma can be
manifested as classic "cerebral concussion,"
DAI and associated hemorrhages from
tearing of tissue,
TYPES OF HEAD ACCELERATION

 Three types of acceleration can occur:

translational, rotational, and angular
 Translational  the center of gravity of the
brain (the pineal region) moves in a straight
line
 does not cause diffuse brain injuries, but
it can produce focal injuries, including
contrecoup contusions and intracerebral and
subdural hematomas.
 rotational acceleration the center of
gravity of the brain without the center of
gravity it self moving.
 angular acceleration  translational and
rotational acceleration are combined  e
most common head motion encountered
clinically.
 angular acceleration is the most damaging
brain injury mechanism because it
combines the injurious mechanism of both
translational and rotational movements, e
ZONE OF CLINICAL INJURY

An abbreviated format to describe human tolerance to

specific head motions often uses both the magnitude and
duration of acceleration
 In zone I  very brief durations of acceleration
are highly unlikely to cause injury because the
strains do not propagate to deeper brain structures
and the relative motion between the brain and
skull is small.
 In zone II, slightly longer acceleration durations
allow strains to penetrate the periphery but
do not significantly move into the deep region of
the brain  injury to the brain periphery and
cortical vessels are more common.
 In zone III  longer durations of acceleration,
injuries can occur to both the peripheral and
deep parts of the brain.
INJURIES AND THEIR
MECHANISMS
 Skull Fracture : Linear fracture, depressed
fracture, Basilar
 Focal brain injuries : EDH, Coup,
countrecoup and intermediate contusion,
SDH
 Diffuse brain injuries : cerebral conccusion,
diffuse axonal injuries
 SKULL FRACTURE
 Linear fractures occur solely because of the
contact effects secondary to impact
 Depressed fracture  Small, hard impacting
objects cause depressed fractures.
 Basilar Fracture  direct impact or propagation
of stress waves through the skull as a result
of remote impact  the thin anterior basilar
skull  particularly susceptible to remote
contact effects because the structure of this
region is considerably weaker and not as
effective in managing the local skull
deformations initiated by remote impact.
 FOCAL BRAIN INJURY
 EDH  can be considered a more complex
case of linear skull fracture  vessels in
the underlying dural membrane are torn
and bleeding ensues into the epidural
space.
 Coup Contusions  Immediately under the
impact point, coup contusions arise
principally from the local skull bending
or fracture caused by an impact from a
relatively small, hard object.
 FOCAL BRAIN INJURY
 Contrecoup Contusions  cavitation effects and
inertial loading  the more likely mechanism of
contrecoup damage is translational or angular head
motion.
 intermediate Coup Contusions  Vascular disruption in
brain surfaces that are not adjacent to the skull.
 ICH  are most often associated with extensive
cortical contusions.
 SDH contusion and laceration (complicated
subdural hematomas). The third type  form of
vascular disruption; it involves tearing of parasagittal
bridging veins located along the interhemispheric
fissure and sagittal sinus. it results entirely from
inertial and not from contact forces
 DIFFUSE BRAIN INJURY
 Cerebral Concussion  produced entirely by inertial
loading and not from contact phenomena effects 
most of the strain is insufficient to cause structural
damage. Instead, damage to the structures may
be either partially or completely reversible
 Diffuse Axonal Injury  One of the two most
important pathologic substrates producing prolonged
traumatic coma not attributable to mass
lesions . The amount and location of axonal damage
as a consequence of rotational acceleration probably
determine the severity (depth and duration) of the
injury, as well as the quality of recovery.
 Thank yoou