Traumatic lesions in the CNS

  • Brain trauma is one leading cause of death of young adults in developed countries 

  • Cause: traffic accidents, industrial accidents, or sports. 

  • Cause of death in persons with head trauma is usually herniation due to mass effect, increased intracranial pressure. 

  • Spinal trauma with the same causes is source of irreversible disability 

Mechanism

  • 1./Direct (the harmful agent affect directly the brain or spine, e.g. s bullet in the brain, strike on the head etc) 

  •     Indirect (acceleration or deceleration of the brain within the skull, e.g. by a car accident) 

  • 2,/ Closed (if the meninges are not opened to the environment, no dural tear, no CSF leak) 

  •       Open (if the intracranium opened, giving way to CSF leak out, and infectious agent into the skull) 

Types of traumatic brain damage 

Brain commotion 

  • shaking of the brain within the skull, caused by direct or indirect, closed head trauma. 

Symptoms: 

  • brief unconsciousness (1-2 sec), 

  • short amnestic period, 

  • headache, dizziness, nausea, fatigue, 

  • no focal signs. 

  • No structural brain damage on CT or MR 

  • Treatment: bedrest, painkillers (no specific treatment/hospitalisation) 

  • Outcome: Usually total recovery in a few weeks. 

Brain contusion 

  • the brain smashed, when suddenly pushed to the inner surface of the skull, 

  • causing structural brain damage, 

  • oedema and haemorrhage 

Symptoms: like in commotion, 

  • with focal neurological signs, 

  • condition is usually more severe 

Dg: CT or MR demonstrates the 

destroyed

 brain tissue, haemorrhage and oedema. 

Treatment: surgical removal of the

 haematoma, osmodiuretics, supportive care 

Outcome: varies on the severity of brain damage

Epidural bleeding. 

  • (between the bone and the dura mater) 

  • Arterial origin= usually rupture of the middle meningeal artery, 

  • caused by temporal or parietal bone fracture 

  • Symptoms: hyper-rapid development of severe symptoms (hemiparesis, anisochoria, decreased level of consciousness, coma or death) 

  • Diagnosis: CT. 

  • Treatment: urgent surgical removal, otherwise the patient dies in most cases.

Subdural bleeding 

  • (between the brain and dura mater) 

  • acute, subacute, chronic 

  • Variable latency of the development after head trauma: from hours to months. 

  • Venous origin („bridging veins”, on the superior brain surface). 

  • Skull fracture is not necessary. 

  • Symptoms: less rapid, sometimes insidous growth. 

  • non specific (headache, hemiparesis, dementia, seisures) 

  • Diagnostics: CT. 

  • Treatment: surgical removal. 

  • 1./ Posttraumatic epilepsy. Caused by the direct irritating effect of the haematoma on the brain cortex, or of the scar, formed after the healing of the brain contusion. 

  • Early (within one week from injury) 

  • Late (from one week to years) 

  • 2./ Prolonged headache. 

  • 3./ Fatigue. 

  • 4/. Irritability, concentration difficulties,  depression. 

  • 5./ Personality changes 

  • 7./ Hormonal disorders. 

  • 8./Dementia (after repeated trauma, e.g.  in contact sports)