Overview:

How devastating is an injury to the brain? Try to imagine waking up from an accident and being unable to read the newspaper or to hold a cup of coffee or to remember your son's name. The brain controls our ability to remember, to think, to solve problems and to make decisions.

Injury to the brain from an outside force can occur from a variety of causes. Automobile accidents, which account for approximately 50 percent of all cases are the most prevalent cause. Other common causes include falls (21 percent); assaults and violence, including physical abuse (12 percent); and sports and recreation related accidents (10 percent).

Damage to the brain may not be limited to the point of impact. For example, if a car driver's head hits the windshield, the front and back part of the brain may be damaged. The back part of the brain may be injured because the impact causes the brain to bounce around inside the skull. There are two common types of brain injuries: open head injury and closed head injury.

(a) Open Head Injury

An open head injury penetrates the skull and causes it to fracture. A linear fracture causes a break within the skull, without displacement of the bone fragments. A depressed fracture forces fragments of skull bone down toward the brain.

Below is an illustration of a depressed skull fracture, where the bone framents that penetrated the underlying brain, causing a contusion or laceration of the brain tissue. The fractured pieces were placed back together by screws and plates.

The management of a serious life threatening head injury involves both the primary brain injuries, such as the skull fractures and lacerations of brain tissue together with the secondary brain injuries, those that result from complications arising out of the brain's response to injury. Secondary brain injuries result from increased intracranial pressure, shifts in brain structures within the skull and inadequate oxygen and brain blood flow.

In treating head injuries patients, the major goals are to: 1) minimize the possibility of further damage to the brain from bony fragments of the skull, intracranial bleeding and brain swelling; and 2) minimize the possibility of intracranial infection from penetrating head injuries by removing the devitalized tissue, cleansing the wound and repairing openings in the dura and skull where infections can enter the intracranial space.

(b) Closed Head Injury

Any time the head is subjected to violent force or motion, the soft floating brain is slammed against the skull's uneven interior. Sometimes it rotates in the process. When this happens, the brain's threadlike nerve cells are stretched and strained, and may even be torn, at the point of impact (focal injury) and/or in a widely scattered fashion (diffuse injury). Many times such an accident causes both stretching and tearing of nerve fibers. While this nerve-cell deamage is usually microscopic, the effect on the brain's neurological circuits is quite significant.

(c) Consequences of Head Injuries

Most people who have experienced severe brain trauma display language, motor, or perceptual problems that can be traced to a specific incident.

In addition to suffering from head or neck pain, many people are disoriented and experience memory loss immediately after the brain injury. These complaints often pass within a few minutes, but over the next several hours the onset of dizziness, nausea, and fatigue is common. A week or two later, as the individual attempts to resume his or her normal responsibilities at home, school, or work, he or she may encounter another group of symptoms that have collectively come to be called postconcussive syndrome. These complaints include persistent headaches; fatigue; impaired attention, concentration, and decision-making ability; sleep disturbances; dizziness; loss of sex drive; intolerance to alcohol; reading adn communication difficulties; and emotional or behavioral problems. Any combination of these symptoms can occur.