Blunt and Penetrating Severe Traumatic Brain Injury

Neurol Clin. 2021 May;39(2):443-469. doi: 10.1016/j.ncl.2021.02.009. Epub 2021 Mar 31.


Severe traumatic brain injury is a common problem. Current practices focus on the importance of early resuscitation, transfer to high-volume centers, and provider expertise across multiple specialties. In the emergency department, patients should receive urgent intracranial imaging and consideration for tranexamic acid. Close observation in the intensive care unit environment helps identify problems, such as seizure, intracranial pressure crisis, and injury progression. In addition to traditional neurologic examination, patients benefit from use of intracranial monitors. Monitors gather physiologic data on intracranial and cerebral perfusion pressures to help guide therapy. Brain tissue oxygenation monitoring and cerebromicrodialysis show promise in studies.

Keywords: Intensive care management; Penetrating brain injury; Review article; Severe traumatic brain injury; Summary.

Publication types

  • Review

MeSH terms

  • Brain Injuries, Traumatic / etiology
  • Brain Injuries, Traumatic / therapy*
  • Head Injuries, Closed / complications
  • Head Injuries, Closed / therapy*
  • Head Injuries, Penetrating / complications
  • Head Injuries, Penetrating / therapy*
  • Humans
  • Monitoring, Physiologic / methods
  • Neurophysiological Monitoring / methods