Which of the following is considered secondary damage in TBI?

• A. Contulsions
• B. Epidural hematoma
• C. Diffuse axonal injury
• D. Increased intracranial pressure

Answer: (D)

Secondary damage in traumatic brain injury refers to the processes that develop after the initial mechanical impact and can worsen brain injury over time, such as swelling and rising intracranial pressure that reduce cerebral perfusion. Increased intracranial pressure is a classic example because post-injury edema, hemorrhage, and other factors add volume inside the skull, which raises pressure, diminishes blood flow to brain tissue, and can lead to herniation if not treated. The other options describe injuries that occur at the moment of impact and are considered primary injuries: convulsions reflect immediate neuronal hyperexcitability from the trauma, an epidural hematoma is a focal bleed caused by vessel rupture during the event, and diffuse axonal injury results from rapid acceleration/deceleration that shears axons.