الفهرس 
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Abstract
Closed head trauma is the damage to the brain inside an intact skull resulting from external mechanical forces such as rapid acceleration and deceleration, impact or blast waves. The type, direction, intensity and duration of these forces; all contribute to the characteristics and severity of traumatic brain injury; this can be explained by linear acceleration theory, head rotation theory and recently, stereo tactical theory.
Traumatic brain injury (TBI); is the leading cause of death and disability around the world and present a major worldwide social, economic and health problems, common causes of TBI include violence, transportation accidents, constructions and sports.
The presentation of the head injured patients depends on the severity of head trauma that can be classified into mild, moderate and severe categories. Symptoms vary from headache, vomiting and transient loss of consciousness (concussion) in mild head trauma to weakness, deterioration of conscious level or even deep coma due to increased ICP in severe head injuries. The Glasgow Coma Scale (GCS) is the most commonly system used for classifying TBI severity, grades a person’s level of consciousness on a scale of 3–15 based on verbal, motor, and eye-opening reactions to stimuli.
Closed head trauma leads to a primary injury which is, the initial injury caused by the impact on the brain causing structural changes as epidural haematoma, subdural haematoma, subarachnoid haemorrhage, intraventricular haemorrhage or cerebral contusions, and a secondary injury which can result from complications of the injuries; these include cerebral hypoxia, hypotension and cerebral edema.
ICP monitoring plays an important role in diagnosis and treatment in acute head injury:
• It helps in detecting the changes of ICP early and making therapeutic decisions easier.
• ICP monitoring is primarily a means for guiding therapy, as it is not possible to treat ICP accurately without knowing what it is.
• It helps to predict the patients’ outcome.
Although ICP monitoring has played an important role in improving outcomes in patients with acute head injury, the procedure is not without risk, producing a low incidence of hemorrhagic or infectious complications.
There are 2 methods for ICP monitoring either invasive or noninvasive methods;
A- Invasive methods:
(1) External ventricular drain (EVD)
(2) Intraparenchymal monitors
(3) Subdural monitors
(4) Other methods; subarachnoid and epidural probes
B- Non invasive methods
(1) Tissue resonance analysis (TRA)
(2)Transcranial Doppler (TCD)
(3)Tympanic membrane displacement
(4)Jugular venous oxygen saturation monitoring
(5)Palpation of the open fontanelle in infants
Management of head injured patients begin with the pre-hospital care for securing of the air way and resuscitation to prevent the development of secondary brain injury together with evaluation and care of other injuries, this is followed by transferal to a neurosurgical unit, clinical evaluation including full neurological assessment and investigations to assess the severity of the injury. CT scan is the diagnostic study of choice in the evaluation of TBI because it has a rapid acquisition time, is universally available, is easy to interpret, and is reliable.
Recent trends for the management of head trauma include medical treatment for maintaining constant cerebral blood flow as ICP monitoring, hyperventilation in addition to the role of diuretics and barbiturate therapy. Surgical intervention based on a number of factors including premorbid state, the severity of initial injury, the onset and rapidity of neurological deterioration.
Recently, decompressive craniectomy has become an accepted and effective therapy for patient with malignant intra-cranial hypertension, while the role of Hinge Craniotomy may be only appropriate for borderline cases, despite the potential advantages regarding the limited cosmetic defect.
Recent advances in management of closed head injuries include stem cell therapy which represents a new hope in management of deficits following head injuries, Multipotential stem cells are a contemporary choice for cell therapy TBI, as replacement of multiple cell types may be required for functional recovery. There are several promising studies in which the transplantation of various progenitor cells have improved tissue survival and functional outcome. And neutraceuticals which are natural treatments that can be effective in reducing sequale of TBI.
Neutraceuticals are natural treatments can be effective in reducing some of the sequelae of TBI. An excellent example of neutraceuticals that have been extensively reported to reduce secondary effects of TBI and improve behavioral outcome is magnesium (Mg2+), other neutraceuticals that have been reported to positively impact the neuroprotective and/or rehabilitative process after TBI include cytidinediphosphocoline (CDP-choline), creatine, vitamins B3 and E.
Prognosis of closed head trauma worsens with the severity of injury, most injuries are mild and don’t cause permanent disability; however, all severity levels of head trauma have the potential to cause significant, long standing disability. A number of brain-specific biochemical markers are available like S-100B, neuron specific enolase (NSE), glial fibrillary acidic protein, lactate dehydrogenase, myelin basic protein, and creatine kinase-B. The assessment of these markers can be done in cerebrospinal fluid (CSF) and blood.