[Pathophysiology of intracranial injuries]

Area of Science:

• Neuroscience
• Trauma Surgery
• Neurology

Background:

• Traumatic brain injury (TBI) is a complex condition affecting the brain, classified by injury type (focal vs. diffuse) and timing (primary vs. secondary).
• Secondary brain damage involves processes like ischemia, excitotoxicity, neuroinflammation, cerebral edema, and increased intracranial pressure.
• Long-term TBI sequelae include seizures, neurodegeneration, and an increased risk of Alzheimer's disease due to protein misfolding (tauopathy).

Purpose of the Study:

• To review the pathophysiology of traumatic brain injury (TBI).
• To evaluate the utility of acute phase biomarkers for TBI severity assessment, morbidity, and mortality prediction.
• To discuss the limitations of current biomarkers and the potential of novel candidates.

Main Methods:

• Literature review of TBI pathophysiology and biomarker research.
• Analysis of existing biomarkers (S-100β, NSE) and emerging candidates (GFAP, pNF-H).
• Discussion of biomarker specificity, sensitivity, and need for large-scale validation.

Main Results:

• TBI involves primary mechanical insult followed by secondary injury cascades.
• Established biomarkers like S-100β and NSE exhibit low specificity for TBI.
• Emerging biomarkers such as GFAP and pNF-H show promise but require extensive validation.

Conclusions:

• Understanding TBI's complex pathophysiology is crucial for developing effective treatments.
• There is a critical need for specific and reliable acute phase biomarkers for TBI.
• Further large-scale studies are essential to validate novel biomarkers like GFAP and pNF-H for clinical use in TBI management.