Социална мрежа за здравето - с грижа за вашето здраве

Skull Fracture

The skull is made up of many bones that form a solid container for the brain. The face is the front part of the head and also helps protect the brain from injury. Depending upon the location of the fracture, there may or may not be a relationship between a fractured skull and underlying brain injury. Some bones of the skull tend to be thinner and more fragile than others - the temporal bone placed above the ear is quite thin and can be broken easier than the occipital bone which is placed at the back of the skull.  

Basilar skull fractures occur because of blunt trauma and describe a break in the bones at the base of the skull. Fractures can be linear or stellate (in a starburst-like pattern). The pattern of the break is associated with the type of force that is applied.  

Penetrating skull fractures are injuries caused by an object entering the brain. This incl. gunshot, stab wounds, impaled objects, etc.A depressed skull fracture occurs when a piece of skull is pushed toward the inside of the skull. Surgery may be required to elevate the depressed fragment. It is crucial to know if a fracture is open or closed.

An open fracture occurs when the skin is torn over the fracture site, which greatly increases infection risks, especially along with a depressed skull fracture. In that case brain tissue is exposed, which makes the situation way more serious and hard to deal with. A closed fracture means the skin is not damaged. It still protects the underlying fracture from contamination.

Intracranial Bleeding

“Intracranial” means any bleeding within the skull. “Intracerebral” is a term used to describe bleeding within the brain. Internal bleeding in the skull may or may not be associated with skull fracture. If the skull is intact doesn’t automatically mean that there is not underlying bleeding, or brain hemorrhage.

Epidural, subdural, and subarachnoid bleeding are terms that describe bleeding in the spaces between the meninges, the fibrous layered coverings of the brain. Sometimes, the terms hemorrhage (bleeding) and hematoma (blood clot) are interchanged. Any blood that accumulates within the skull can increase the pressure and compress the brain, causing traumatic impact. Also, blood is irritating and can cause edema or swelling while excess fluid is leaking from the inner blood vessels.

Subdural Hematoma

When force is applied to the head, bridging veins that cross through the subdural space can tear and bleed. The resultant blood clot increases pressure on the brain tissue. Subdural hematomas can occur at the site of trauma, or may occur contracoup – on the opposite side of the injury. In that case the brain accelerates toward the opposite side of the skull and crushes or bounces against the opposite side.

Chronic subdural hematoma may occur in patients who have had atrophy (shrinkage) of their brain tissue. These include the elderly and chronic alcoholics. Minor or unnoticed injuries can lead to some bleeding, but because there is enough space in the skull to accommodate the blood, there may be minimal initial symptoms. Asymptomatic (without symptoms) chronic subdural hematomas may be left to resolve on their own. This type of injury requires attention if the individual's mental status changes or further bleeding occurs.

Epidural Hematoma

If the head trauma is epidural the blood is trapped in a small area and can cause a hematoma or blood clot to form. Pressure can increase quickly within the epidural space, pushing the clot up against the brain and causing significant damage.Most cases require surgery. An epidural hematoma may often occur with trauma to the temporal bone located on the side of the head above the ear. Aside from the fact that the temporal bone is thinner than the other skull bones (frontal, parietal, occipital), it is also the location of the middle meningeal artery that runs just beneath the bone. Fracture of the temporal bone is associated with tearing of this artery and may lead to an epidural hematoma.

Intraparenchymal Hemorrhage

Also known as Intracerebral Hemorrhage and Cerebral Contusion

These terms describe bleeding within the brain tissue itself and can be considered a bruise to the brain tissue.Aside from the direct damage to the brain tissue that was injured, swelling or edema is the major complication of an intracerebral bleed.

Subarachnoid Hemorrhage

In a subarachnoid hemorrhage, blood accumulates in the space beneath the inner arachnoid layer of the meninges. The injury is often associated with an intracerebral bleed (see below). This is also the space where cerebral spinal fluid (CSF) flows and affected individuals can develop severe headache, nausea, vomiting, and a stiff neck because the blood causes significant irritation to this meningeal layer. It is the same response that can be seen in patients who have a leaking cerebral aneurysm or meningitis. Treatment is often observation and controlling the symptoms.

Diffuse Axonal Injury or Shear Injury

A potentially devastating brain injury occurs when the brain injury occurs to the axons, the part of the neurons or brain cell that allows those cells to send messages to each other. Because of the damage of electrical flow between cells, the affected individual often appears comatose with no evidence of bleeding within the brain. The mechanism of injury is usually acceleration-deceleration, and the nerve endings that connect the brain cells rip apart.Treatment is supportive. There is no surgery or other treatment presently available. The patient's basic needs are met hoping that the brain will recover on its own. Unfortunately, most don't fully recover. Concussions may be potentially considered a milder form of this type of injury.

Head Injury Causes

Head injuries can be closed or penetrating (open).

A closed head injury means you received a hard blow to the head from striking an object, but the object did not break the skull.
An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This is more likely to happen during traffic accidents at high speed or from a gunshot to the head.

Head injuries include:

• Concussion
• Scalp wounds
• Skull fractures

Causes

Common causes of head injury include:

• Home and work accidents
• Sports accidents
• Falls
• Physical assault
• Traffic accidents

Most of these injuries are minor because the skull protects the brain. Some injuries are severe enough to require a stay in the hospital.

Head injuries may cause bleeding in the brain tissue and the layers that surround the brain (subarachnoid hemorrhage, subdural hematomata extradural hematoma). Symptoms of a head injury can occur right away. Other symptoms develop slowly over several hours or days. Even if the skull is not fractured, the brain can hit the inside of the skull and be bruised.

The head may look fine, but problems could result from bleeding or swelling inside the skull. The spinal cord is also likely to be injured in any serious trauma. Some head injuries cause changes in brain function. This is called a traumatic brain injury.

For example, concussion is a mild traumatic brain injury. Symptoms of a concussion can range from mild to severe.

Learning to recognize a serious head injury and give basic first aid can save someone's life. For a moderate to severe head injury, call an ambulance immediately!

Get medical help right away if the person: 

• Is suddenly very sleepy
• Behaves abnormally
• Develops a severe headache or stiff neck
• Pupils are of unequal sizes
• Is unable to move a limb
• Loses consciousness, even briefly
• Vomits more than once
• Shows indications of head injury

Then take the following steps: 

Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.

Treat as if there is a spinal injury in case where the person is breathing and the heart rate is normal, but the person remains unconscious. Stabilize the head and neck by placing your hands on both sides of the person's head. Keep the head in line with the spine. Prevent movement.

Call an ambulance and wait for medical help.

Stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move the person's head. If blood soaks through the cloth, do not remove it. Place another cloth over the first one. Do not apply direct pressure to the bleeding site. Do not remove any objects of debris from the wound.

Cover the wound with sterile gauze dressing. Roll the person's head, neck, and body as onto the side to prevent choking if the person is vomiting. This still protects the spine, which you must always assume is injured in the case of a head injury. Children will often vomit once after a head injury. Inform the doctor about any similar events.

Apply ice to swollen and bruised areas.

What NOT to do

• Do NOT wash a deep or bleeding head wound
• Do NOT remove any object out of an open wound
• Do NOT remove a helmet if you suspect a serious head trauma
• Do NOT pick up a fallen child with signs of head injury
• Do NOT drink alcohol up to 48 hours from a serious head injury or accident
• Do NOT move the person (unless absolutely necessary)
• Do NOT shake the person

Therapy and healing

A serious head injury that involves bleeding or brain damage must be treated in a hospital. Sometimes, for a mild head injury, no specific treatment will be needed. Always look for symptoms of a head injury, some of which can show up to two days later. 

When to Contact a Medical Professional

Contact a medical professional immediately in one or more of the following situations:  

• Severe head or face bleeding
• The injured person is confused, tired, or unconscious
• The injured person stops breathing
• You suspect a serious head or neck injury for various reasons
• The injured person develops signs and/or symptoms of a serious head injury

The consequences of cranial trauma can lead to numerous complications, some of which may lead to life-threatening conditions. In general, the potential dangers of brain damage caused by head trauma can cause musculoskeletal trauma, and also affect speech centers in the brain, and seriously affect cognitive (mental) activity. 

There are various techniques and methods of treatment and rehabilitation of those affected by brain injury.

Rehabilitation of brain injuries includes various approaches: to acquire complete and/or symptomatic relief and treatment of patients from the early stages of diagnosis of trauma to its partial or complete recovery. Choosing the proper follow-up treatment, rehabilitation and follow-up is done after conducting a range of different clinical tests.

Studies are important for a proper understanding which parts of the brain are affected and to what extent. Based on the analysis, the patient is directed to the best form of treatment according to their specific needs and physical condition. Rehabilitation can be directed mainly to the effects of brain injury and their symptoms in order to recover as much as possible dysfunctions of the brain as a result of injury. Rehabilitation can be long and be supported medicated and non-pharmacological treatments.

Treatment and rehabilitation of brain injuries require thorough consideration and adequate specialized medical care and monitoring. 

Keep in mind that not all head injuries are preventable. Nevertheless, the following simple steps can help greatly reduce the risk:

• Always use safety equipment: seat belts, bicycle and motorcycle helmets
• Always follow driving and bicycle safety recommendations
• Do not drink and drive
• Do not allow yourself to be driven by someone under the influence