occurs when a person receives an impact to the head from an outside force, but the skull does not fracture or displace
In a closed head injury, what happens as the brain swells?
the brain may expand through any available opening in the skull (including eye sockets)
can cause CNs controlling eye mm to be impaired (CN III impaired = pupil appears dilated)
in a closed head injury, when herniation or cranial compression occur
What type of injury occurs when the force that hits a person's head is great enough that the skull can fracture or become displaced?
Open Head Injury
What is good about an open head injury?
brain has room to swell, which can reduce compression of brain tissue and ICP
What is bad about an open head injury?
b/c skull is damaged or open, it can't protect the brain as it did before (exposed and vulnerable to infection and damage)
What is ugly about an open head injury?
if skull is fractured or displace, bone fragments from the skull can enter the brain and cause further injury
Which type of injury has an observable pulse on the side of a patient's head?
open head injury w/ obvious skull deficits
What may doctors or therapists prescribe to protect the brain post open head injury when the person begins to get out of bed?
What are the types of skull fractures?
What are other appearances that occur from skull fractures?
depressed skull fracture:
broken piece moves in towards the brain (open or closed)
compound skull fracture:
scalp is disrupted and the skull is fractured
basilar skull fracture:
located at base of skull (neck area) and may include the opening at the base of the skull
bruising around eye orbits
blood collects behind the ears and causes bruising
Where might CSF leak through after head injury?
eyes and nose
What type of head injury encompasses both open and closed and is a broader term that describes an insult to the brain, not of a degenerative or congenital nature, but caused by external physical force?
Traumatic Brain Injury
What are the different terms for TBIs?
diffuse axonal injury
second impact syndrome
shaken baby syndrome
Diffuse Axonal Injury
injury is greatest in where the density difference is greatest
In a diffuse axonal injury, where does most tearing occur?
gray-white matter junction
In what type of brain damage does a diffuse axonal injury occur?
What causes a diffuse axonal injury?
shaking or strong rotation of the head, or by rotational forces
the stable brain lags behind any movement of the skull causing long tracts in the brain to stretch and then tear
What diagnoses diffuse axonal injury?
MRI (not CT)
What happens when nerve tissue in the brain tears?
tracts are disrupted
What are recruited for damage control during diffuse axonal injury?
white blood cells (this causes more damage when they mistakenly target both healthy and unhealthy tissue)
What is the result of diffuse axonal injuries?
temporary, permanent, localized, or widespread brain damage
could have variety of functional impairments depending on where shearing occured
Concussion occurs when:
brain receives trauma from an impact or a sudden movement or momentum change
What happens to blood vessels in the brain during concussion?
become stretched or torn (causing hemorrhage)
CN damage can also occur
What causes a concussion?
direct blow to head
violent shaking of the head
Do closed or open head injuries produce concussions?
What is the most common type of TBI?
If a person looses consciousness from concussion, it won't exceed __ minutes.
How does a person with a concussion feel if they remain conscious?
dazed or punch drunk
Can concussions be seen on diagnostic imaging test (CT)?
may or may not b/c damage may only be microscopic, non-localized, but widespread
B/c skull fractures, bleeding, or swelling may or may not be present, concussions are sometimes a diagnosis of exclusion and are considered a _______.
complex neurobehavioral syndrome
What happens from a concussion?
can cause diffuse axonal type injury resulting in permanent or temporary damage
How long can it take to recover from a concussion?
few months to a few years
may report problems w/ concentration, recent memory, abstract thinking
dizziness, irritability, fatigue, double vision, and personality changes
elderly pts are particularly affected by disequilibrium and chronic dizziness
What is a contusion a result of?
direct impact to the head
localized bruise (bleeding) on the brain (macroscopic)
Where do large contusions that may need to be surgically removed most commonly occur?
orbitofrontal cortex, anterior temporal lobe, and posterior portion of superior temporal gyrus area (w/ adjacent parietal area)
contusions that occur from the impact, w/ damage at the site of the blow as well as damage from "rebound" when the brain hits the opposite side of the brain
When do coup-contrecoup injuries occur?
when the force impacting the head is not only great enough to cause a great contusion at the site of impact, but also is able to move the brain and cause it to slam into the opposite side of the skull, causing additional damage
What is another name for second impact syndrome?
Second impact syndrome occurs when:
a person sustains a second TBI before the damage from the 1st TBI has healed
When does the second injury (of a second impact syndrome) occur?
from days to weeks following the 1st
Is loss of consciousness required in second impact syndrome?
In second impact syndrome, the second impact is more likely to cause:
brain swelling and widespread damage
Why must emergency medical treatment occur ASAP after second impact syndrome?
b/c death can occur rapidly
What are the long term effects of recurrent brain injury?
increased muscle tone
rapidly changing emotions
difficulty thinking and learning
Penetration injury occurs from:
impact of a bullet, knife, or other sharp object that forces hair, skin, bone, and other foreign fragments into the brain
objects traveling at low rates of speed through the skull and brain that can ricochet w/in the skull, widening the area of damage
What is a 'through-and-through' penetration injury?
occurs if an object enters the skull, goes through the brain and exits the skull
--include effects of penetration injuries plus additional shearing, stretching, and rupture of brain tissue
rare neurological condition in which a person can't physically move any part of the body except the eyes
person is conscious and able to think
vertical eye movements and eye blinking can be used to communicate w/ others and operate environmental controls
Acquired Brain Injury
describes any trauma that occurs to the brain after birth