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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
DOI: 10.1055/s-0037-1598610
Review Article | Artigo de Revisão
Thieme-Revinter Publicações Ltda Rio de Janeiro, Brazil

Traumatismo cranioencefálico leve: uma breve revisão

Mild Traumatic Brain Injury: A Brief Review
Renan Ribeiro Teixeira
1   Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Almir Ferreira de Andrade
2   Emergency Neurosurgery Service, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Manoel Jacobsen Teixeira
1   Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
,
Eberval Gadelha Figueiredo
1   Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

02 December 2016

13 December 2016

Publication Date:
28 March 2017 (online)

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Resumo

Considerado a principal causa de invalidez, morte e consumo de recursos, o traumatismo cranioencefálico (TCE) pode ser definido como uma alteração da função normal do cérebro causada por colisão ou movimentos bruscos na cabeça, ou ainda por um ferimento penetrante. Os TCEs são classificados como leves, moderados ou graves. No caso dos traumas leves, há uma grande variedade em sua classificação, que pode ser feita com base no uso da escala de Glasgow entre 13 e 15, em alterações da consciência, em amnésia, na nona revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde (CID-9), e até na escala abreviada de lesões (EAL). Devido a sua importância (corresponde a 75% de todos os TCEs e, segundo o Centers for Disease Control and Prevention [CDC], há aproximadamente 500 novos casos por 100 mil pessoas por ano), este trabalho faz uma revisão breve apontando a epidemiologia, as formas de diagnóstico e os possíveis prognósticos. Assim, podemos entender melhor os traumas leves, pois este é um dos poucos distúrbios da medicina em que a classificação benigna é enganosa, e pode estar associada a complicações ao longo da vida.

Abstract

Considered to be the main cause of invalidity and death, besides being extremely costly to the health care system, cranioencephalic trauma can be defined as an alteration of the normal brain function that can be caused by collisions, abrupt head movements or even penetrating injuries. Traumatic brain injuries (TBI) can be classified as mild, moderate or severe. In the case of mild TBI, there is a great variability in its classification, which can be based on the Glasgow coma scale (between 13 and 15), alterations in consciousness, amnesia, the International Classification of Diseases, Ninth Revision (ICD-9), and even on the abbreviated injury scale (AIS). Due to the importance of mild TBI (it corresponds to 75% of all TBIs and, according to the Centers for Disease Control and Prevention [CDC], there are ∼ 500 new cases per every 100,000 persons per year), the present report consists of a brief review of the epidemiology, diagnosis and possible prognosis of this type of injury. Further understanding is paramount, since mild TBI is one of the few disorders in medicine in which the benign classification can be misleading and still be associated to further complications.

Palavras-Chave

traumatismo encefálico - epidemiologia - diagnóstico - prognóstico

Keywords

brain injuries - epidemiology - diagnosis - prognosis
 

  • Referências

  • 1 Marshall LF, Marshall SB, Klauber MR. , et al. The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 1992; 9 (Suppl. 01) S287-S292
    PubMedSearch in Google Scholar
  • 2 Menon DK1, Schwab K, Wright DW, Maas AI. Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Position statement: Definition of traumatic brain injury. Arch Phys Med Rehabil 2010; 91 (11) 1637-1640
    CrossrefPubMedSearch in Google Scholar
  • 3 Krainin BM, Forsten RD, Kotwal RS, Lutz RH, Guskiewicz KM. Mild traumatic brain injury literature review and proposed changes to classification. J Spec Oper Med 2011; 11 (03) 38-47
    PubMedSearch in Google Scholar
  • 4 Levin HS, Diaz-Arrastia RR. Diagnosis, prognosis, and clinical management of mild traumatic brain injury. Lancet Neurol 2015; 14 (05) 506-517
    CrossrefPubMedSearch in Google Scholar
  • 5 Gaudêncio TG, Leão GM. A epidemiologia do traumatismo crânio-encefálico: um levantamento bibliográfico no Brasil. Rev Neurocienc 2013; 21 (03) 427-434
    PubMedSearch in Google Scholar
  • 6 Adams H, Mitchell DE, Graham DI, Doyle D. Diffuse brain damage of immediate impact type. Its relationship to ‘primary brain-stem damage’ in head injury. Brain 1977; 100 (03) 489-502
    CrossrefPubMedSearch in Google Scholar
  • 7 Kotapka MJ, Gennarelli TA, Graham DI. , et al. Selective vulnerability of hippocampal neurons in acceleration-induced experimental head injury. J Neurotrauma 1991; 8 (04) 247-258
    CrossrefPubMedSearch in Google Scholar
  • 8 Bigler ED. Anterior and middle cranial fossa in traumatic brain injury: relevant neuroanatomy and neuropathology in the study of neuropsychological outcome. Neuropsychology 2007; 21 (05) 515-531
    CrossrefPubMedSearch in Google Scholar
  • 9 Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. The Lancet 1974; 304 (7872): 81-84
    CrossrefPubMedSearch in Google Scholar
  • 10 Department of Veterans Affairs and Department of Defense. The Management of Concussion/mTBI Working Group. (2009). VA/DoD clinical practice guideline for management of concussion/ mild traumatic brain injury (mTBI). Accessed 20 July 2011 from ( http://www.healthquality.va.gov/management_of_concussion_ mtbi.asp ).
    PubMed
  • 11 Brasure M, Lamberty GJ, Sayer NA. , et al. Multidisciplinary postacute rehabilitation for moderate to severe traumatic brain injury in adults. Agency for Healthcare Research and Quality (AHRQ). AHRQ Comp Eff Rev 2012; 72: ES1-ES20 Available at http://effectivehealthcare.ahrq.gov/ehc/products/283/1141/CER72_TBIPostacute_FinalReport_20120725.pdf
    PubMedSearch in Google Scholar
  • 12 American Psychiatry Association et al. DSM-5: Manual diagnóstico e estatístico de transtornos mentais. São Paulo: Artmed Editora; 2014
    Search in Google Scholar
  • 13 Voss JD, Connolly J, Schwab KA, Scher AI. Update on the Epidemiology of Concussion/Mild Traumatic Brain Injury. Curr Pain Headache Rep 2015; 19 (07) 32
    CrossrefPubMedSearch in Google Scholar
  • 14 Walker W, Cifu DX, Hudak A, Goldberg G, Kunz RD, Sima A. Structured interview for mild traumatic brain injury after military blast: interrater agreement and development of diagnostic algorithm. J Neurotrauma 2015; 32: 464-473
    CrossrefPubMedSearch in Google Scholar
  • 15 Carroll LJ, Cassidy JD, Holm L, Kraus J, Coronado VG. ; WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004; 36 (43, Suppl) 113-125
    CrossrefPubMedSearch in Google Scholar
  • 16 Signoretti S, Vagnozzi R, Tavazzi B, Lazzarino G. Biochemical and neurochemical sequelae following mild traumatic brain injury: summary of experimental data and clinical implications. Neurosurg Focus 2010; 29 (05) E1
    PubMedSearch in Google Scholar
  • 17 Giza CC, Hovda DA. The neurometabolic cascade of con-cussion. J Athl Train 2001; 36 (03) 228-235
    PubMedSearch in Google Scholar
  • 18 DeLellis SM, Kane S, Katz K. The neurometabolic cascade and implications of mTBI: mitigating risk to the SOF community. J Spec Oper Med 2009; 9 (04) 36-42
    PubMedSearch in Google Scholar
  • 19 Hawley CA, de Burgh HT, Russell RJ, Mead A. Traumatic brain injury recorded in the UK Joint Theatre Trauma Registry among the UK Armed Forces. J Head Trauma Rehabil 2015; 30 (01) E47-E56
    PubMedSearch in Google Scholar
  • 20 Rosenthal JA, Foraker RE, Collins CL, Comstock RD. National high school athlete concussion rates from 2005–2006 to 2011–2012. Am J Sports Med 2014; 42 (07) 1710-1715
    CrossrefPubMedSearch in Google Scholar
  • 21 Yuh EL, Mukherjee P, Lingsma HF. , et al; TRACK-TBI Investigators. Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury. Ann Neurol 2013; 73 (02) 224-235
    CrossrefPubMedSearch in Google Scholar
  • 22 Furger RE, Nelson LD, Brooke Lerner E, McCrea MA. Frequency of factors that complicate the identification of mild traumatic brain injury in level I trauma center patients. Concussion 2016; 1 (02) CNC11
    PubMedSearch in Google Scholar
  • 23 Erlanger DM, Kaushik T, Broshek D, Freeman J, Feldman D, Festa J. Development and validation of a web-based screening tool for monitoring cognitive status. J Head Trauma Rehabil 2002; 17 (05) 458-476
    CrossrefPubMedSearch in Google Scholar
  • 24 Zumstein MA, Moser M, Mottini M. , et al. Long-term outcome in patients with mild traumatic brain injury: a prospective observational study. J Trauma 2011; 71 (01) 120-127
    CrossrefPubMedSearch in Google Scholar