Contusions
A cerebral contusion, more commonly referred to as a bruise, or localized collection of blood, occurs when capillaries (the smallest of a body’s blood vessels) are damaged by trauma, allowing blood to seep into the surrounding brain tissue.
A cerebral contusion is a bruise on the brain and can develop after a motor vehicle accident, sports injury, falls, trauma, accidents, air bag deployment, or assaults. The risk of bleeding is also greater if the patient is on a blood thinner or is taking natural blood thinning supplements or vitamins such as, chamomile, Goji berries, Gingko, fish oil, feverfew or bachelor’s buttons, Ginseng, willow bark, garlic, danshen or devils claw. Many times, healthcare providers do not ask the patient if they are taking herbal or natural blood thinners.
Cerebral contusions can cause headaches, weakness, numbness, memory loss, difficulty speaking, personality changes, lack of coordination and lethargy.
Cerebral contusions can also cause swelling in the brain. Measures must be taken to control any swelling in the brain or increased pressure on the brain. People with cerebral contusions may need to be admitted to the hospital and closely monitored.
Concussions
Concussion is frequently defined as a head injury with a temporary loss of brain function. A concussion can cause a variety of physical, cognitive and emotional symptoms. Concussions are traditionally caused by a blow to the head. The force disrupts the cellular processes in the brain for days, weeks, months or years.
Concussions are the most common type of Traumatic Brain Injury or TBI. Treatment of a concussion involves monitoring and rest. Symptoms usually go away entirely within three weeks, though they may persist, resulting in complications. Common causes of concussions are car accidents, motorcycle crashes, bicycle accidents, falls, and sports related injuries.
Symptoms: The most common symptom of a concussion is headache, however other symptoms include dizziness, vomiting, nausea, ringing in the ears, lack of fine motor skills or coordination, memory loss, personality changes, lethargy, difficulty maintaining balance, and vision impairment. Visual symptoms include light sensitivity, seeing bright lights, blurred vision, and double vision.
The diagnosis of a concussion is based on physical and neurological exams, duration of unconsciousness (usually less than 30 minutes) and post-traumatic amnesia ( usually less than 24 hours).
Treatment: Usually concussion symptoms go away without treatment. Traditionally, concussion sufferers are prescribed rest, including plenty of sleep at night plus rest during the day. Health care providers often recommend a gradual return to normal activities at a pace that does not cause symptoms to worsen.
Concussed individuals are advised not to drink alcohol or take drugs that have not been approved by a doctor, as they could impede healing.
Healthcare providers recommend that those suffering from concussion return for further medical care and evaluation 24 to 72 hours after the concussive event if the symptoms worsen.
Subdural Bleeding
A subdural hematoma (blood clot), also known as a subdural hemorrhage (SDH), is a form of traumatic brain injury in which blood gathers within the protective layers of tissue that surround the brain, usually resulting from tears or leaks in veins or arteries that cross the subdural space. Subdural hemorrhages cause an increase in intracranial pressure (ICP) or pressure in your brain, which can cause compression of and damage to delicate brain tissue. Subdural hematoma’s are often life-threatening if not quickly treated.
Subdural hematoma’s are classified as acute, subacute, and chronic, depending on the speed of their onset.
Acute subdural hematoma’s due to trauma are the most lethal of all head injuries and have the highest rate of mortality if they are not quickly diagnosed and treated with surgery. Acute bleeds develop after high speed acceleration or deceleration injuries. They are most severe if associated with cerebral contusions or bruises.
Chronic subdural bleeds develop over the period of days to weeks, often after minor head trauma. The bleeding from a chronic bleed is slow, probably from repeated minor bleeds. Since these bleeds progress slowly, they present the chance of being stopped before they cause significant damage.
Signs and symptoms of a chronic subdural bleed may show up in minutes, if not immediately, but can be delayed as much as 2 weeks. If the bleeds are large enough to put pressure on the brain, signs of increased intracranial pressure, or damage to part of the brain will be present.
Signs and symptoms of subdural hematoma can include any one, or any combination of the following:
- Headache (either constant or fluctuating)
- Loss of consciousness or fluctuating levels of consciousness
- Difficulty in waking up
- Memory loss
- Irritability
- Personality changes
- Loss of appetite
- Feelings of numbness
- Dizziness
- Disorientation
- Amnesia
- Weakness
- Nausea and/or Vomiting
- Slurred speech or inability to speak
- Difficulty walking
- Altered breathing patterns
- Loss of hearing or ringing in the ears
- Blurred vision
- Abnormal movement of the eyes
A subdural hematoma or hemorrhage can develop after a motor vehicle accident, sports injury, falls, trauma, accidents, air bag deployment, or assaults. Subdural hematoma’s can also occur in the absence of any trauma when a person is on blood thinners or platelet medicines such as Coumadin, Lovenox, Plavix, aspirin, Aggrenox, and Heparin. The risk of bleeding is also greater if the patient is on a blood thinner and is also taking natural blood thinning supplements or vitamins such as, chamomile, Goji berries, Gingko, fish oil, feverfew or bachelor’s buttons, Ginseng, willow bark, garlic, danshen or devils claw.
After suffering a head injury, it is important that a patient receive a prompt and complete medical assessment, including a neurological examination, x-ray, CT scan or MRI.
Diffuse Axonal Injury
Diffuse axonal injury (DAI) is one of the most common and devastating types of traumatic brain injury. A Diffuse axonal injury is one where damage occurs over a more widespread area than in a focal brain injury. Diffuse axonal injury refers to extensive lesions in the brain and is one of the major causes of unconsciousness and persistent vegetative state following head trauma. Oftentimes the outcome is Coma, with over 90% of patients with severe DAI never regaining consciousness. Those who do wake up often remain significantly impaired.
DAI is the result of when the head is rapidly accelerated or decelerated, or the brain is abruptly shifted back and forth in the skull, as a result of a motor vehicle accident, roll over accident, sports accident, shaken baby syndrome, assaults, fights, blows to the head, and falls.
DAI is difficult to detect since it does not show up well on CT Scans or with other macroscopic imaging techniques, though it shows up microscopically. However, there are characteristics typical of DAI that may or may not show up on a CT scan. DAI’s presence can be inferred when small bleeds are visible in the corpus callosum, (the part of the brain that connects the left and right cerebral hemispheres). This injury is frequently more severe than is realized, and medical professionals should suspect DAI in any patients whose CT scans appear normal but who have symptoms like unconsciousness.
DAI is classified into grades based on severity of the injury.
In Grade I, widespread axonal damage is present but no focal abnormalities are seen.
In Grade II, damage found in Grade I is present in addition to focal abnormalities, especially in the corpus callosum.
Grade III damage encompasses both Grades I and II plus brainstem injury and often tears in the tissue.
Treatment for a diffuse axonal injury includes immediately stabilizing the patient and trying to limit increases in intracranial pressure (ICP) or pressure on the brain.
Coup-Contrecoup
A coup injury is an injury on the brain under the site of impact with an object, and a contrecoup injury occurs on the opposite side of where the brain that was impacted. Coup and contrecoup injury are associated with a cerebral contusion, a type of traumatic brain injury in which the brain is bruised. Coup and contrecoup injuries can occur individually or together. When a moving object hits the stationary head, coup injuries are typical, while contrecoup injuries are produced when the moving head strikes a stationary object.
In a coup injury, the brain collides with the inside of the skull at the area of impact. The coup injury may be caused when, during an impact, the skull is temporarily bent inward, and hits the brain. But, when the skull bends inward, it may set the brain into motion, causing it to move and hit the skull on the opposite side and resulting in a contrecoup injury. The injuries can also be caused by acceleration or deceleration alone, in the absence of an impact. In injuries associated with acceleration or deceleration but with no impact, the brain is thought to bounce off the inside of the skull and hit the opposite side, potentially resulting in both coup and contrecoup injuries.
Coup and contrecoup injuries can occur from fights, falls, automobile accidents, motorcycle accidents, air bag deployment, sports injuries, work place injuries, assaults, and shaken baby syndrome or abuse.
After suffering a head injury, it is important that a patient receive a prompt and complete medical assessment, including a neurological examination, x-ray, CT scan or MRI.
Intraventricular Hemorrhage
An intraventricular hemorrhage, often abbreviated “IVH,” is a bleeding into the brain’s ventricular system, where the spinal fluid is produced and circulates around the brain. While this type of hemorrhage is most common in infants, specifically premature babies or those with low birth weight, it does occur in adults as well. Most intraventricular hemorrhages occur in the first 72 hours after birth in situations involving premature infants. With regard to adults, it has been found to occur in 35% of moderate to severe traumatic brain injuries. The injury requires a great deal of force to cause the hemorrhage. Thus the hemorrhage usually does not occur without extensive associated damage, and so the outcome is rarely good. Additionally, IVH in adults can result from an intracerebral hemorrhage caused by high blood pressure.
In both adults and infants, IVH can cause a dangerous increase in intracranial pressure, damage to the brain tissue, and hydrocephalus or “water on the brain.”
Symptoms in infants may be minimal and sometimes nonexistent; however, they are diagnosed with an ultrasound of the head which is typically performed on a premature infant within the first week of birth. There are stages of bleeding (Grade 1-4) and the long term effects of the hemorrhage increase respectively. IVH cannot be stopped once it has begun, however, preventing preterm delivery has been found to be the leading way to prevent intraventricular hemorrhages in infants.
Hypoxia
Cerebral hypoxia is when there is a decrease in oxygen supply to your brain. The brain is very sensitive to decreased levels of oxygen and the brain cells can start to die after 4 minutes of being deprived of oxygen. The sooner the oxygen supply is restored to the brain, the lower the risk of severe brain damage and death.
Hypoxia to the brain can be caused by cardiac arrest, respiratory arrest, drowning, electrocution, abnormal heart rhythms, strangulation, choking, suffocation, carbon monoxide poisoning, untreated respiratory problems, asthma, prolonged seizures, congestive heart failure, pulmonary edema, over or under medicated, sedative medications, severe allergic reactions or anaphylaxis, or medical errors.
Treatment depends on the underlying cause of the lack of oxygen or hypoxia. Oxygen needs to be immediately administered.
Anoxia
Cerebral anoxia is when there is a dramatic decrease in the amount of oxygen reaching the brain. It is an extreme form of hypoxia or “low oxygen.” The brain is very sensitive to decreased levels of oxygen and the brain cells can start to die after 4 minutes of being deprived of oxygen. The sooner the oxygen supply is restored to the brain, the lower the risk of severe brain damage and death.
Anoxia to the brain can be caused by cardiac arrest, respiratory arrest, drowning, electrocution, abnormal heart rhythms, strangulation, choking, suffocation, carbon monoxide poisoning, untreated respiratory problems, asthma, prolonged seizures, congestive heart failure, pulmonary edema, over or under medicated, sedative medications, severe allergic reactions or anaphylaxis, or medical errors.
Treatment depends on the underlying cause of the lack of oxygen or anoxia. Oxygen needs to be immediately administered.
Penetration Head Injury
A penetrating head injury or open head injury is a head injury where the skin, skull, and protective layers surrounding the brain have been penetrated by an object.
Penetration head injuries can occur from a portion of bone from a fractured skull, bullets, knives, screwdrivers, ice picks, assaults, objects falling onto the head, falls, motor vehicle accidents, motorcycle accidents, sports accidents, or workplace injuries.
The prognosis for penetrating head injuries varies depending on the mechanism of injury and the area of the brain involved. Immediate emergency treatment is required. In addition to the head trauma itself, the person is at risk for excessive bleeding or hemorrhage. Once the object is removed, there is the risk of infection, seizures, swelling of the brain, shock, and clotting problems due to the brain releasing thromboplastin after the insult or injury. Surgery may be required to remove the object, remove or debride damaged tissue, repair vessels or reduce increased pressure on the brain.
