Clinical Picture

Clinicians categorize brain injuries as resulting from either a closed-head injury (where the
cranium remains intact) or a penetrating head injury (where some object such as a bullet
enters the brain). In closed-head injury, the damage to the brain is indirect—caused by
inertial forces that cause the brain to come into violent contact with the interior skull wall or
by rotational forces that twist the brain mass relative to the brain stem. Not uncommonly,
closed-head injury also causes diffuse neuron damage because of inertial force. In other
words, the rapid movement of the rigid cranium is stopped in contact with an unyielding
object. However, the softer brain tissue within keeps moving, and this has a shearing effect
on nerve fibers and their synaptic interconnections.

Severe head injuries usually cause unconsciousness and disruption of circulatory, metabolic,
and neurotransmitter regulation. Normally, if a head injury is severe enough to result in
unconsciousness, the person experiences

Retrograde amnesia or inability to recall events immediately preceding the injury.

Apparently, the trauma interferes with the brain’s capacity to consolidate into long-term
storage the events that were still being processed at the time of the trauma.

Anterograde amnesia (also called posttraumatic amnesia) is the inability to store effectively
in memory events that happen during variable periods of time after the trauma Anterograde
amnesia is also frequently observed and is regarded by many as a negative prognostic sign.
A person rendered unconscious by a head injury usually passes through stages of confusion
on the way to recovering clear consciousness. This recovery of consciousness may be
complete in the course of minutes, or it may take hours or days.

Following a severe injury and loss of consciousness, a person’s pulse, temperature, blood
pressure, and important aspects of brain metabolism are all affected, and survival may be
uncertain. In rare cases, an individual may live for extended periods of time without regaining
consciousness, a condition known as a coma.

The duration of the coma is generally related to the severity of the injury. If the patient
survives, coma may be followed by delirium, marked by acute excitement and disorientation,
and hallucinations. Gradually the confusion may clear up and the individual may regain
contact with reality. Individual courses of recovery are highly variable and difficult to predict
Large numbers of relatively minor closed-head brain concussions and contusions (bruises)
occur every year as a result of car accidents, athletic injuries, falls, and other mishaps.
Even riding roller coasters that generate high G-forces may cause brain injury in some
people. It is estimated that two deaths per year can be attributed to brain hemorrhages that
result from roller coaster rides (Pelletier & Gilchrist, 2005). Exposure to high G-forces, such
as those experienced on some theme park rides, can cause neurological injury in some
individuals by creating small tears in delicate blood vessels in the brain.

People who play certain sports are at high risk of experiencing concussions and brain injuries.
For males, the greatest risk comes from playing football; for females, the greatest risk comes
from playing soccer (Lincoln et al., 2011). Moreover, because there is a critical period of
brain development that occurs from ages 10 to 12, it may be especially important for boys to
avoid tackle football until they have passed this stage (Stamm et al., 2015). Avoiding tackle
football until after age 12 is a wise decision because critical brain changes take place between
the ages of 10 and 12. Injuries sustained during this time may be especially problematic later