Blunt or closed non-missle trauma

Note:

Non-missle means head strikes hard surface and brain tissue is not exposed.

When the injury breaks the dura (is a missle trauma)

Examples are bullets and sharp projectiles.

Brain layers (DAP): dura, arachnoid, and pia matter

Young adults 15-35 years

Infants 6 months- 2 years

Young school age children

Adults 70 and older

(excludes neonates 1-6 months and

adults between ages 35  and 70)

Males 1.5x more likely in high crime areas, most prominent in African Americans

Loss of conciousness

(greater than 6 hours)

Difussed Axonal Injury

DAI: Diffused Axonal Injury

Definiton:

Results from shaking, axonal damage, shearing, tearing, or stretching or nerves fibers.

Ex. shaken baby syndrome

This results in the greatest # of disabled survivors.

50% of brain trauma causes focal injury

Focal injury accounts for 66% of mortality

Definition:

Caused by blunt trauma.

Focal injury is when the impact causes contusions and bleeding.  Can progress to edema and ICF.

Coup: Object strikes front of head and injures directly below point of impact.

Contrecoup: Object strikes back of head and injury on opposite side of impact.

extradural hematoma

subdural hematoma

intracranial hematoma

Is usually due to an arterial tear.

Pressure on brain, death.

Is an medical emergency

May have periods of lucidity with progressive loss of conciousness.

Define subdural hematoma.

Is caused by vein rupture.  Blood collects in space between the dura and the arachnoid layer.  Symptoms are slow to develop.

Common in older adults and boxers.

Most common cause is MVA (motor vehicle accident).

Acute: occurs with 48 hours.

Can cause headache, drowsiness, restlesness, confusion.

Can worsen conciousness and respirations.

Often located at top of skull

Chronic: develops weeks to months.

Common in older adults.

Result of alcohol abuse due to falls. 

Complain of chronic headaches and site tenderness.

Associated with MVA and falls.

Creates an expanding mass from hemmorage to the hematoma.

Causes compression of brain tissue with result in edema.

Clinical manisfestations:

decreased LOC, increases ICP

Mild Cerebral concussion (3 classes/grades)

Classic cerebral concussion

Confusion, disorientation, and varying degress of amnesia.

Requires close observation.

Most common type of brain injury.

List characteristics of

a mild cerebral concussion (classes 1-3)

Temporary axonal disturbances

causes attention and memory deficits with no loss of conscienceness

clinical manifestations are: confusion, disorientation, varying degrees of amnesia.

Immediate onset at time of injury.

Classified as a grade 4

Immediate loss of consciousness with in 6 hours.

Can be complicated or non complicated focal injury.

Disconnect of the cerbral and the brain stem reticular activating system. (RAS)

Physiologic and neurologic disfunction with out substantial anatomic disruption.

Retrograde and antrograde amnesia.  

Clinical manifestations

-headache

-cognigative imperment

-psychological complaint

-somatic complaints

-crainial nerve signs and symptoms

-treatment

relief of symptoms and reassurance

-close observation for 24hrs.

-spinal cord trauma effects 11,000 people per yr.

-injury to vertireble and neuro tissues

-caused by compression pulling shearing forces

-effects most mobile vertibre (c1-c2, c4-c7, t1-l2)

-simple fracture

-compressed fracture

-comminuted fracture

-dislocation

most common in young men