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Neuropathophysiology of Delirium in Traumatic Brain Injury

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Figure 9–4. Traumatic brain injury pathology and confusion.Three types of brain injury can each result in delirium (confusion), which commonly occurs following emergence from coma or minimal conscious state. Diffuse axonal injury alone or in combination with focal injuries can lead to delirium; when these are combined with hypoxic/ischemic damage, the resultant delirium can be especially prolonged.Source. Adapted from Katz 1992; Katz and Alexander 1994; Povlishock and Katz 2005.

Figure 9–5. Neurobiological phases of acute recovery following traumatic brain injury.Numerous alterations of brain function and structure, especially at the cellular level, occur immediately at the time of brain injury. The severity of these alterations depends on whether the injury is mild, moderate, or severe. Within hours to days these changes evolve and also induce consequences that impair the normal electrochemical and neural network functioning of the brain. Cortical and thalamic impaired function result in delirium. Ach = acetylcholine; APP = amyloid precursor protein; ATP = adenosine triphosphate; A = amyloid beta; EEG = electroencephalogram.

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