Comprehensive Review of Brain, Spinal Cord Injuries, and Neurological Disorders

Traumatic brain injury (TBI)

A disruption in normal brain function caused by an external force, often resulting from a blow or jolt to the head.

Epidural hematomas

Occur between the skull and the dura mater, often presenting with a lucid interval followed by rapid deterioration.

Subdural hematomas

Occur between the dura mater and the brain, typically presenting with gradual symptoms.

Intracerebral hematomas

Occur within the brain tissue itself, leading to localized neurological deficits.

Coup injuries

Injuries that occur at the site of impact.

Contrecoup injuries

Injuries that occur on the opposite side of the brain due to the brain's movement within the skull.

Focal brain injury

Localized to a specific area of the brain, often resulting in specific deficits.

Diffuse brain injury

Affects multiple areas of the brain, typically leading to widespread cognitive and functional impairments.

Mild concussions

May present with temporary confusion and headache.

Classic concussions

Can involve loss of consciousness, amnesia, and prolonged confusion.

Common injuries leading to spinal cord trauma

Include fractures, dislocations, and compression of the vertebrae.

Vertebral column

Protects the spinal cord; injuries can lead to manifestations such as paralysis, loss of sensation, and autonomic dysfunction depending on the level and severity of the injury.

Autonomic hyperreflexia

Characterized by an exaggerated autonomic response to stimuli below the level of spinal cord injury, leading to severe hypertension and other autonomic dysregulations.

Common causes for low back pain

Include muscle strain, herniated disks, degenerative disk disease, and spinal stenosis.

Degenerative disk disease

Involves the deterioration of intervertebral disks.

Spondylolysis

A defect in the vertebra.

Spondylolisthesis

The displacement of a vertebra.

Spinal stenosis

The narrowing of the spinal canal.

Herniated intervertebral disk

Occurs when the nucleus pulposus protrudes through the annulus fibrosus, potentially compressing nearby spinal nerves and causing pain, numbness, or weakness.

Seizure

A sudden, uncontrolled electrical disturbance in the brain, associated with conditions such as epilepsy, head trauma, and infections.

Aura

A perceptual disturbance experienced by some individuals before a seizure, often serving as a warning sign.

Partial seizures

Originate in a specific area of the brain and may or may not affect consciousness.

Generalized seizures

Involve both hemispheres of the brain from the onset.

Status epilepticus

Can be caused by abrupt withdrawal from antiepileptic medications, infections, or metabolic disturbances.

Epilepsy

A chronic neurological disorder characterized by recurrent, unprovoked seizures due to abnormal electrical activity in the brain.

Cerebrovascular accidents (CVAs)

Common causes include thrombus formation, embolism, and hemorrhage.

Thrombotic stroke

Results from blood clots in the arteries supplying the brain.

Transient Ischemic Attack (TIA)

Temporary episodes of neurological dysfunction.

Hemorrhagic stroke

Occurs due to bleeding in or around the brain.

Intracranial aneurysms

Often present as bulges in the arterial wall, which can lead to rupture and hemorrhage.

Saccular aneurysms

Berry-shaped aneurysms.

Fusiform aneurysms

Spindle-shaped aneurysms.

Mycotic aneurysms

Aneurysms caused by infection.

Traumatic aneurysms

Result from head injury.

Arteriovenous malformations

Involve abnormal connections between arteries and veins.

Cavernous angiomas

Vascular lesions with dilated blood vessels.

Capillary telangiectasia

Small dilated blood vessels.

Venous angiomas

Abnormal veins.

Subarachnoid hemorrhage

Often caused by the rupture of an aneurysm, leading to sudden severe headache, neck stiffness, and neurological deficits.

Migraine

Often unilateral and pulsating.

Cluster headaches

Occur in cyclical patterns.

Paroxysmal hemicrania

Short but frequent headaches.

Tension headaches

Characterized by a dull, pressing pain.

Central nervous system tumors

Can originate from glial cells, neurons, or meninges, and treatment may include surgery, radiation, and chemotherapy.

Compressive syndrome

Results from pressure on the spinal cord.

Irritative syndrome

Involves abnormal nerve activity.

Syringomyelic syndrome

Associated with the formation of a cyst within the spinal cord.

Bacterial meningitis

Characterized by a rapid onset, severe symptoms, and often requires antibiotics.

Aseptic (viral) meningitis

Typically has a milder course and is often viral in origin.

Fungal meningitis

Less common and often occurs in immunocompromised individuals.

Tubercular meningitis

Caused by Mycobacterium tuberculosis and presents with chronic symptoms.

CNS abscesses

Localized infections within the brain or spinal cord, often resulting from bacterial infections, leading to symptoms such as fever, headache, and neurological deficits.

Meningitis

The inflammation of the protective membranes covering the brain and spinal cord.

Encephalitis

The inflammation of the brain itself, often leading to more severe neurological symptoms.

HIV-associated dementia

A cognitive impairment condition linked to human immunodeficiency virus (HIV).

Opportunistic infections

Infections that occur more frequently and are more severe in individuals with weakened immune systems, such as those with HIV.

Peripheral neuropathy

A condition resulting from damage to the peripheral nerves, leading to symptoms such as pain, weakness, and numbness.

Vector associated with Lyme disease

The black-legged tick, also known as the deer tick.

Infecting organism of Lyme disease

The bacterium Borrelia burgdorferi.

Manifestations of Lyme disease

Can include fever, headache, fatigue, and a characteristic skin rash called erythema migrans.

Neuropathy

A condition resulting from damage to the peripheral nerves, leading to symptoms such as pain, weakness, and numbness.

Myopathy

A disease of the muscle tissue that leads to muscle weakness, pain, and sometimes muscle wasting.

Incidence of traumatic brain injury by gender

Males have the highest incidence of traumatic brain injury in every age group.

Most common causes of traumatic brain injury in children and older adults

Falls, followed by unintentional blunt trauma and motor vehicle accidents.

Advancements in safety measures

Have led to a decrease in the incidence of traumatic brain injury.

Primary brain injury

Caused by direct impact.

Secondary brain injury

The indirect consequence of the primary injury, involving a cascade of cellular and molecular events.

Classification of primary brain injuries

Can be classified as focal, affecting one area, or diffuse, affecting multiple areas.

Significance of focal brain injury

Accounts for more than two-thirds of head injury deaths.

Coup injury

Occurs at the site of impact.

Contrecoup injury

Occurs when the brain rebounds and hits the opposite side of the skull.

Contusions

Bruises of the brain caused by blood leaks from injured vessels, often resulting in loss of consciousness.

Treatment options for contusions in TBI

May include controlling intracranial pressure and possibly surgery.

Area of impact and injury severity in TBI

The smaller the area of impact, the greater the severity of the injury.

Types of hematomas associated with contusions

Include epidural hematoma, subdural hematoma, and intracerebral hematoma.

Closed trauma in TBI

Involves the dura remaining intact.

Open trauma in TBI

Breaks the dura and exposes cranial contents.

Most common cause of epidural hematoma

Motor vehicle accidents.

Clinical manifestations of epidural hematoma

Include loss of consciousness, a lucid period, severe headaches, vomiting, drowsiness, confusion, seizures, and hemiparesis.

Treatment approach for epidural hematoma

Considered a medical emergency.

Acute subdural hematoma

Develops within hours after the injury.

Clinical manifestations of acute subdural hematoma

Include headache, drowsiness, restlessness or agitation, slowed cognition, and confusion.

Treatment for acute subdural hematoma

Involves performing a burr hole to remove the clot.

Subacute subdural hematoma

Develops after 48 hours to 2 weeks following the injury.

Chronic subdural hematoma

Develops over weeks to months as the subdural space gradually fills with blood.

Clinical manifestations of chronic subdural hematoma

Approximately 80% of patients complain of chronic headaches and tenderness at the site of injury.

Treatment options for chronic subdural hematoma

Include craniotomy to evacuate the gelatinous blood and percutaneous drainage.

Intracerebral hematoma

Acts as an expanding mass, leading to increased intracranial pressure (ICP) and compression of brain tissues.

Clinical manifestations of intracerebral hematoma

Includes a decreasing level of consciousness.

Treatment for intracerebral hematoma

Involves reducing ICP and allowing the hematoma to reabsorb slowly, with possible surgical intervention.

Open brain trauma

Produces both focal and diffuse injuries, with cranial contents in contact with the environment.

Injuries associated with open brain trauma

Include compound skull fractures and missile injuries such as bullets, rocks, and knives.

Complications associated with open brain trauma

A major complication is the risk of infection.

Mechanisms contributing to open brain trauma

Include crush injury and stretch injury, which damage tissues and blood vessels.

Clinical manifestations of open brain trauma

Most individuals lose consciousness, and the depth of coma and length of unresponsive state depend on the injury's location and extent.

Treatments for open brain trauma

Include nonsurgical or surgical débridement, cranioplasty, antibiotic administration, and bed rest for basilar skull fractures.

Relationship between shearing force and diffuse brain injury severity

The severity corresponds to the amount of shearing force applied to the brain.

Categories of diffuse brain injury

Include mild concussion, classic concussion, mild TBI, moderate TBI, and severe TBI.

Brain hypoperfusion

Refers to inadequate blood flow to the brain, which can lead to ischemia, a condition where there is insufficient blood supply to meet the metabolic demands of brain tissue.

Treatment approach for traumatic brain injury

Includes the removal of hematomas and management of symptoms to alleviate the effects of the injury.