Nervous System (Brain)

• Concentration
• Abstract Thought
• Memory
• Affect
• Judgment
• Inhibitions
• Voluntary Movement
• Broca's Area (formation of speech)

• —Analyses sensory information
• —Relays sensory information to other areas of the brain
• —Awareness of spatial orientation

• Auditory receptive areas
• Memory patterns
• Wernicke's area (processing of words and understanding of speech)

Primary visual center

A primary injury occurs at the time of the traumatic event.

Secondary injury occurs after the initial injury (primary) as a result of edema and ischemia. Hematomas worsen outcomes as well due to the limited room for swelling in the skull.

• An epidural hematoma occurs between the dura and the skull.
• It is a result of arterial bleeding into the epidural space, and often caused by fracture of the temporal bone.

• Short unconsciousness is first, followed by:
• Lucid intervals in which the brain is able to compensate for increased ICP, followed by:
• Rapid deterioration due to the brain no longer being able to compensate for increased ICP. Arterial bleeding causes the rapid deterioration.

• Subdural hematomas occur beneath the dura and above the arachnoid. 
• They result from venous bleeding.
• Usually due to trauma.

• Acute SDHs present in less than 48 hours after injury.
• Sub-acute and acute are more likely than chronic SDHs to result in major brain damage.

• Sub-acute SDHs present between 48 hours and 2 weeks after injury.
• Sub-acute and acute are more likely than chronic SDHs to result in major brain damage.

• Chronic SDHs present from 2 weeks to several months after injury.
• Can be caused by minor injuries, and symptoms "come and go".

Within the brain.

• Significant brain edema
• ICP elevations
• Hemorrhagic stroke