Traumatic Brain Injury

Dear Colleagues,

Traumatic Brain Injury (TBI) remains a major public health problem and is a major cause of death and disability in, predominately, the young male population, mostly as victims of traffic accidents or falls.

The incidence of all closed head injuries admitted to hospitals is, conservatively, estimated to be 200 per 100,000 population. Of these, 10% are generally classified at admission as severe (Glasgow Coma Scale (GCS) ≤ 8), another 10% as moderate (GCS 9–12), and the rest as mild (GCS 13–15). Mild traumatic brain injury (GCS 13–15) the most common form of TBI results mainly from concussion. Fortunately, there is full neurological recovery in most of these cases, although many of these subjects have short-term memory and concentration difficulties. However, some of them may even suffer from long term sequels.

Of the subjects who suffer a severe TBI, approximately one-third die, even in the best of centers. Of the survivors, a sizeable fraction demonstrates significant long-term disability. Mortality and long term disability are the consequences of primary and secondary brain injuries.

Primary brain injury (brain contusions, intracerebral bleeding, diffuse axonal injury) result from direct impact of biomechanical forces on skull and brain tissue and can be classified as focal, diffuse or a combination.

Delayed or secondary brain injuries result from various secondary insults leading to tissue ischemia predominantly but nor exclusively affecting vulnerable areas of the brain (i.e., penumbra zones). They include hemodynamic and respiratory instability, neuro-humoral and metabolic derangements, mass lesions among others due to progression of hematoma or new hematoma within the first 24 hours after injury. The presence of delayed brain injury is associated with higher mortality, slower recovery, and poorer outcome at six months.

Pathophysiology and mechanisms responsible for some of the deleterious effects of brain injuries in many subjects still not are fully understood. Involvement of structural and functional alterations in neurofilaments cell membranes and mitochondria, metabolic changes, disruption of blood–brain barrier and autoregulation among others resulting in brain edema, neuroinflammation, cytotoxic events, i.e., resulting from excitotoxicity, could be identified thus far. However, many other factors including genetic predisposition might be involved additionally.

To date standard management of traumatic brain injury comprises surgery if indicated, supportive therapy, (analgo-sedation, circulatory and respiratory support, body temperature management, nutrition) as well as therapies directed to neuroprotection (i.e., intracerebral pressure (ICP) and cerebral perfusion pressure (CPP) management, management of oxygen consumption and brain edema) in order to maintain/restore intracranial hemodynamic, sufficient tissue perfusion, and minimized cerebral oxygen consumption targeting prevention or at least limitation of secondary insults leading to secondary brain injury as there is no causal treatment for TBI. Interventions have to be started at the site of the accident and be maintained throughout emergency room, intensive care unit and patient ward. Moreover, specific neuro-rehabilitation in the post-acute care is a mainstay to reduce long term sequels after brain injury.

In order to provide an update on traumatic brain injury, we invite reviews, research articles, or short communications which include, but are not limited to the topics listed below.

We look forward to your contributions.

Prof. Dr. Reto Stocker
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medical Sciences is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.