How Does A Secondary Brain Injury Occur?

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A traumatic brain injury (TBI) is a common medical condition that occurs as a result of sudden damage to the brain. There are many causes of head injury in children and adults. The Mayo Clinic asserts that the most common events that could cause a traumatic brain injury include: violence, sports injuries, vehicle-related collisions, falls, explosive blasts and other combat injuries. The specific symptoms that manifest as a result of a TBI will vary significantly, as they depend on the type of injury, the severity of the injury, as well as the area of the brain that was injured.

Traumatic brain injuries can be divided into two classifications known as primary and secondary brain injuries. As defined in Recent Advances in Pathophysiology of Traumatic Brain Injury, “primary injury denotes to the first collision that promotes the bran to be knocked inside the skull.” A secondary brain injury is caused by the physiologic responses to the initial injury. As Johns Hopkins Medicine pointedly explains, “Secondary brain injury refers to the changes that evolve over a period of hours to days after the primary brain injury. It includes an entire series of steps or stages of cellular, chemical, tissue, or blood vessel changes in the brain that contribute to further destruction of brain tissue.” A secondary brain injury is an indirect result of processes initiated by the trauma of the primary brain injury.

Secondary Injury

Every individual is different and when exposed to a TBI has the propensity to experience a wide-range of possible secondary injuries. The American Speech-Language-Hearing Association (ASHA) provides the following list of examples of secondary injuries that individuals diagnosed with a TBI are at increased risk of developing:

  • Hypoxia: insufficient oxygen in the brain
  • Ischemia: insufficient blood flow
  • Raised intracranial pressure: increased pressure within the skull that could lead to herniation
  • Hypo/ hypertension: low/ high blood pressure
  • Meningitis: infection of the meningeal layers
  • Epilepsy
  • Biochemical changes: changes in levels of sodium, neurotransmitters, potassium, etc.
  • Cerebral edema: swelling of the brain

It is important to note that a secondary brain injury cannot occur without a primary injury, and further, not all individuals that experience a primary brain injury will inevitably go on to develop a secondary injury. 

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