Traumatic brain injury, including in military context: diagnosis, clinical presentation, and emergency care

As a result of military actions in Ukraine, hundreds of thousands of people, both military personnel and civilians, are suffering from injuries (particularly traumatic brain injuries — TBI). More often, these are multiple injuries, and less frequently, isolated TBI. TBI is, as a rule, damage not only to the skull but also to the brain, accompanied by more or less persistent dysfunction and symptoms. In wartime conditions, the mortality rate for severe TBI is approximately 30–40%, with a significant proportion of patients experiencing persistent neurological sequelae. In most cases, head trauma is combined with injuries to other parts of the body and is characterized by a severe clinical course and high mortality, especially in the first hour and the first 24 hours after the injury. TBI is characterized by significant polymorphism. This is due to the variability of the mechanisms of traumatic impact, the characteristics of the clinical course, and the structural diversity of tissue damage: the soft tissues of the head, the skull, the meninges, blood vessels, and brain parenchyma. Historically, several theories have been proposed to explain the mechanism of TBI: the vibration theory, the molecular theory, the concussion theory, the cerebrospinal fluid impact theory, the inertial intracranial brain displacement theory, the rotational theory, the pressure gradient theory, the cavitation brain injury theory, and the deformation theory. These theories are not used in modern clinical practice. It is currently believed that the pathophysiology of TBI involves primary mechanical injury and secondary processes (hypoxia, ischemia, edema, excitotoxicity, inflammation), which determine the prognosis. The objective of our study was to investigate the etiopathogenic mechanisms, clinical presentation, course of TBI in wartime conditions, treatment, and prognosis. The described knowledge of the etiopathogenic mechanisms of traumatic brain injury (in peacetime and wartime), clinical presentation, and diagnosis enables emergency medical services personnel and hospital staff to accurately assess the condition of the injured patient during evacuation and provide emergency medical care.