Traumatic brainstem injury.

Traumatic brainstem injuries represent some of the most severe and life-threatening forms of head trauma, demanding a thorough understanding of their profound clinical implications. These injuries assume critical significance given the brainstem's role in controlling vital autonomic functions. Brainstem damage may be observed in many cases of head injury, occurring as primary injury or as hemorrhagic and ischemic complications from brain herniation and intracranial hypertension. This pattern is commonly seen as a secondary event in cases such as extra-axial or subdural hemorrhage, or intracerebral bleeding following head injury. In addition to hemorrhagic injuries and ischemia resulting from increased intracranial hypertension, traumatic brainstem injury may cause a significant impact on brain tissue as a form of diffuse axonal injury. Poor prognosis has been a common feature following severe traumatic brain injury, particularly in patients with brainstem involvement. In this chapter, we provide a critical discussion of the pathophysiology, diagnosis, and prognosis of these injuries.