Brain & Spine Trauma

An epidural (extradural) hematoma is a collection of blood between the inner surface of the skull and the brain's outer membrane (dura mater). It most often results from injury to the middle meningeal artery associated with a temporal bone fracture, can expand rapidly, and generally has a good outcome with early surgical evacuation. It is a neurosurgical emergency requiring prompt diagnosis.

An acute subdural hematoma (aSDH) is a collection of blood in the space between the dura mater and the arachnoid membrane that accumulates within the first few days after injury. It usually develops after severe head trauma, is frequently accompanied by underlying brain injury, and may require prompt diagnosis and surgical treatment.

An intracerebral hematoma (ICH) is bleeding that develops within the brain tissue itself. It may be spontaneous (often due to high blood pressure) or traumatic; the spontaneous form is the most common type of hemorrhagic stroke. The bleeding directly damages brain tissue, creates a mass effect and raises intracranial pressure. It requires urgent diagnosis and appropriate management.

Traumatic subarachnoid hemorrhage (tSAH) is bleeding into the subarachnoid space surrounding the brain surface (the space containing cerebrospinal fluid) following head trauma. It is the most common type of bleeding in moderate-to-severe head injury. The course is usually good with isolated, thin bleeds, but can be more serious when accompanied by other lesions.

Diffuse axonal injury (DAI) is widespread shearing injury of the nerve-fiber extensions (axons) in the white matter of the brain, caused by high-speed rotational and acceleration-deceleration trauma. It is one of the major causes of severe traumatic brain injury, often runs a course of prolonged loss of consciousness, and may show fewer findings on imaging than expected.

Depressed skull fractures are traumatic fractures in which fragments of the skull bone are pushed inward toward the brain surface. They may be closed (simple) or open (compound); open fractures carry a high risk of infection. Treatment is planned according to the type of fracture, the degree of depression and any accompanying injuries.

Skull base fractures are traumatic fractures of the bones that form the floor of the skull. Because cranial nerves and blood vessels pass through these bones, such fractures can lead to complications including cerebrospinal fluid leakage (fistula), cranial nerve injury and vascular injury. The diagnosis is made with thin-slice CT, and most cases are managed conservatively.

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that develops over years following repeated head trauma and minor impacts. It is characterized by abnormal accumulation of tau protein in the brain. It is seen particularly in people involved in contact sports and in those exposed to repeated head trauma; at present a definitive diagnosis is made only by post-mortem examination.

Cervical spine fractures are traumatic injuries affecting the neck vertebrae (C1-C7) and account for a substantial portion of spinal trauma. The most common causes are motor vehicle accidents, falls, diving and sports injuries. The cervical spine is divided into upper (C1-C2) and lower (C3-C7) regions, each with characteristic fracture patterns. Treatment may be conservative or surgical depending on fracture type, stability and neurological status.

Thoracic and lumbar vertebral fractures are traumatic injuries affecting the mid and lower back and account for a large share of all spinal fractures. They most often result from falls, motor vehicle accidents and sports injuries. The thoracolumbar junction (T11-L2) is the most frequent fracture site because it is the transition between the rigid thoracic spine and the mobile lumbar spine. Treatment may be conservative or surgical depending on the degree of instability, neurological status and pain severity.

Spinal cord injury (SCI) is a serious neurological condition characterized by loss of motor, sensory and autonomic function following traumatic or non-traumatic damage to the spinal cord. The most common causes are motor vehicle accidents, falls and sports injuries. Cervical level injuries can result in tetraplegia, while thoracic-lumbar injuries can result in paraplegia. The severity and prognosis of the injury are assessed using the ASIA scale.