Neurological Traumas

Traumas// Injury
(Neuro-Traumas)
Introduction:
Neurological trauma is an injury to the brain, spine or nerves. Accidents
involving vehicles, bikes, sports or falls usually cause these types of injuries.
Neurological trauma can often affect many areas of the body including the organs,
blood vessels, muscles and bones.

Classification of nervous traumas:

It can be classified into;
1. Head injury
2. Brain injury
3. Spinal injury

1. HEAD INJURY


> Is a broad classification that includes injury to the scalp, skull, and the brain.
> Traumatic brain injury is the most serious type of head injury.
> The most common causes of traumatic brain injury are motor vehicle crashes,
violence, and falls.
> Groups at the highest risks for traumatic brain injury includes ages 15-24 years and
males, who suffer traumatic brain injury at a rate almost twice of the females.

Damage to the brain from traumatic injury takes two forms:

PRIMARY INJURY and SECONDARY INJURY
• Primary injury is the initial damage to the brain that results from the traumatic event.
This may include contusions, lacerations, and torn blood vessels from the impact,
acceleration, deceleration, or foreign object penetration.
• Secondary injury evolves over the ensuing hours and days after the initial injury and
is due primarily to brain swelling or ongoing bleeding.

Clinical Manifestations
• Physical complaints (dizziness, fatigue, headache, visual disturbances, trouble
sleeping, sensitivity to light and sound, poor balance)
• Cognitivechanges (poor concentration, memory problems, poor judgement,
impulsivity, slowed performance, difficulty putting thoughts into words)

• Psychosocial concerns (depression , anger outbursts, irritability, personality

changes, anxiety).

Diagnosis of Traumatic Brain Injury:

• X-ray, MRI (magnetic resonance imaging), and CT (computerized tomography) can
sometimes diagnose head and brain injuries by showing areas of fracture, hemorrhage,
or other kinds of tissue injury.
• These techniques are usually employed initially in the case of any head trauma to
check for life threatening bleeding or swelling in brain tissue.
 Brain Injury/Trauma
• The brain cannot store oxygen and glucose to any significant degree. Because the
cerebral cells need an interrupted blood supply to obtain this nutrients, irreversible
brain damage and cell death occur when the blood supply is interrupted for even a few
minutes

Classifications of Brain Injury

• Closed (blunt )brain injury occurs when the head accelerates and then
rapidly decelerates or collides with another object and brain tissue is damage, but there
is no opening through the skull and dura.
• Open brain injury occurs when an object penetrates the skull, enters the
brain and damages the soft brain tissue in its path or when blunt trauma to the head is
so severe that it opens the scalp, skull and dura to expose the brain.
Types of Brain Injury

1. CONCUSSION- A cerebral concussion after head injury is temporary loss of

neurologic function with no appear structural damage.
• A concussion generally involves a period of consciousness lasting from few
seconds to a few minutes.
- The jarring of the brain may be so slight as to cause only dizziness and spots before
the eyes or it may be severe enough to cause complete loss of consciousness for a time.
2. CONTUSION:
• Cerebral contusion is a more severe injury in which the brain is bruised, with
possible surface hemorrhage.
• Contusions or bruising is likely to occur when outside energy causes a portion
of the brain to crash into the inner surface of the skull. While contusions can occur
anywhere, they are most common in the frontal and temporal lobes of the brain.

3. INTRACRANIAL INJURY::
• Hematomas that develop within the cranial vault are the most serious brain injuries.
• A hematoma may be epidural, subdural or intracerebral.

CLINICAL MANIFESTATION:
Altered level of consciousness
Confusion
• Pupillary abnormalities
. Altered or absent gag reflex
• Absent corneal reflex
• Sudden onset of neurologic deficits
• Changes in vital signs
• Vision and hearing impairment
. Sensory dysfunction
• Spasticity
• Headache
• Vertigo
• Movement disorders
• Seizures
Management:
• Care of the client with ICP
• Monitor drainage from ears and nose
• Monitor for signs and symptoms of meningitis, atelectasis, pneumonia, UTI
• CT scan
• MRI
• Positron emission tomography

3. SPINAL INJURY
. Spinal cord injury causes myelopathy or damage to white matter or myelinated fiber
tracts that carry sensation and motor signals to and from the brain.
• It also damages gray matter in the central part of the spinal, causing segmental losses
of interneurons and motoneurons.

Spinal injury is divided into 2 categories:

• Primary injuries are the result of the initial injury or trauma and are usually
permanent.
• Secondary injuries are usually the result of a contusion or tear injury, in which the
nerve fibers begin to swell and disintegrate.
• A secondary chain of events produces ischemia, hypoxia, edema and hemorrhagic
lesions, which in turn result in destruction of myelin and axon.
• These secondary reactions, believed to be the
principal causes of the spinal cord degeneration
at the level of injury, are now thought to be
reversible 4 to 6 hours after injury.

2 Most Familiar Types Of Spinal Cord Injury Are:

• Injury from Trauma: Injuries incurred due to accidents, gunshots, falls and so on.
• Injury from Disease: Injuries occurring from diseases like spina bifida, tumors, polio
or Friedreich's ataxia.

CAUSES
1. Traumas - such as automobile accidents, falls, gunshots, diving, accidents,
war injuries, etc.
2. Tumor- such as meningiomas, ependymomas, astrocytomas, and metastatic
cancer.
3. Ischemia- resulting from occlusion of spinal blood vessels, including
dissecting aortic aneurisms, emboli, arteriosclerosis.
4. Developmental disorders- such as spina bifida, meningomyolcoele, and other.

5. Neurodegenerative diseases- such as Friedreich's ataxia, spinocerebellar

ataxia, etc.
6. Demyelinative diseases- such as Multiple Sclerosis.
7. Transverse myelitis- resulting from spinal cord stroke, inflammation, or other
causes.
8. Vascular malformations- such as arteriovenous malformation (AVN), dural
arteriovenous fistula (AVF), spinal hemangioma, cavernous angioma and aneurysm.
Effects of Spinal injury.
1. Impairment of partial or complete movement.
 2. Chronic pain
3. Bowel and bladder function is regulated by the sacral region of the spine, so it
is very common to experience dysfunction of the bowel and bladder, including
infections of the bladder, and anal incontinence.
4. Sexual function is also associated with the sacral region and is often affected.
5. Inability or reduced ability to regulate heart rate, blood pressure, sweating and
hence body temperature.
6. Spasticity (increased reflexes and stiffness of the limbs).
7. Neuropathic pain.
8. Abnormal increases in blood pressure, sweating, and other autonomic
responses to pain or sensory disturbances.
9. Atrophy of muscle.
10. Osteoporosis (loss of calcium) and bone degeneration.
11. Gallbladder and renal stones.

Treatment:
• Treatment for acute traumatic spinal cord injuries have consisted of giving high dose
methylprednisolone if the injury occurred within 8 hours.
• Breakthrough medical research shows stem cell transplants could have the potential
to help or cure paralysis caused by spinal injury.
• Stem cells are primal cells found in all multi-cellular organisms. They can be made
to differentiate into a range of specialized cells including nerve cells, which can be
transplanted into the body.

Interventions:
Diving injuries may be prevented by:
• Education about diving hazards and safe behaviour
• Supervision by life guards
• Diving instruction
• Access to emergency services for rapid first aid and treatment.
N/B
Where appropriate, the provision of safe access to water supplies in rural areas will
help reduce injuries and damage to the spine due to carrying water.