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My approach to teaching about severe injury and coma is to provide information in several layers. We start with the emotional support for the loved ones, see Coma, What Now? But I have also learned that some of you will feel compelled to understand as much as you can about the medical science and terms the doctors are using.
On this Severe Brain Injury Primer, we will address the issues of basic severe Closed Head Injury pathology, including the specific diagnosis of injury, Intracranial pressure and specifically help to understand the following:
· Skull Fractures
· Intracranial Lesions
· Cortical Contusions
· Epidural hematoma,
· Subdural hematoma.
· Contusions and Intracerebral Hematomas
· Severe Axonal Injury
· Brain Stem Injury
· Subarachnoid Hemorrhage
· Compressed Basil Cisterns
· Midline Shift.
· Compressed Ventricles
A skull fracture is a broken bone of the skull, not a per se injury to the brain. While it may not be the most severe of injuries, it can come with catastrophic injury to the brain. It takes considerable force to break any bone, particularly the skull. Depending on the vector and the degree of that force, it may be sufficient to damage the brain as well. Yet while the CT or X-ray may be excellent in identifying the fracture to the bone of the skull, they may not show significant injury to the brain.
It is also important to remember that the skull is there to protect the brain and can do so, even in cases when it is fractured. Breaking the skull can absorb considerable force, reducing the direct force on the brain. There are times when the skull is fractured with little gross damage to brain structures. Still, the risk of an associated hematoma (bruise) can be increased as much as 400 fold after a skull fracture.
The Role of Dura In Understanding Severe TBI Pathology
When the skull breaks, the energy is likely to be transferred by direct contact to the adjacent areas of brain tissue. The brain is encased in the “dura”, almost like a tight fitting bag. It is the dura which first makes contact with the skull in an injury event.
Gordon S. Johnson, Jr., the author of this page is a lawyer, not a doctor, who practices law with the Brain Injury Law Group, S.C. Click here for more on the firm.