Brain suffers from traumatic injury Brain swelling or bleeding increases intracranial volume Rigid cranium allows no room for expansion of contents so ICP increases Pressure on blood vessels within the brain causes blood flow to the brain slowly Cerebral hypoxia and ischemia occurs Intracranial pressure continues to rise. Brain may herniate Cerebral blood flow decreases Pathophysiology
The symptoms, apart from those local injury, depend on the severity and the distribution of the brain injury. Persistent localized pain usually suggest that a fracture is present. Fractures of the cranial vault may or may not produced swelling in the region of the fracture; therefore, an x-ray is needed for diagnosis.
Battle’s Sign - an area of ecchymosis (bruising) which is seen
over the mastoid.
CSF Otorrhea - cerebrospinal fluid leaking through the ears.
CSF Rhinorrhea - cerebrospinal fluid leaking through the nose.
Halo Sign - it is a blood stain surrounded by a yellowish stain
(CSF) which is usually seen on bed linens or pillows.
- Injuries at the thoracic level and below result in paraplegia.
- The hands, arms, head, and breathing are usually not
T1 to T8 : Most often have control of the hands, but lack
control of the abdominal muscles so control of the
trunk is difficult or impossible. Effects are less severe
the lower the injury.
T9 to T12 : Allows good trunk and abdominal muscle control,
and sitting balance is very good.
3. Lumbar and Sacral injuries - The effect of injuries to the lumbar or sacral region of the spinal canal are decreased control of the legs and hips, urinary system, and anus.
Central Cord and Other Syndromes 1. Central cord syndrome - is a form of incomplete spinal cord injury characterized by impairment in the arms and hands and, to a lesser extent, in the legs. - This is also referred to as inverse paraplegia, because the hands and arms are paralyzed while the legs and lower extremities work correctly. - Most often the damage is to the cervical or upper thoracic regions of the spinal cord, and characterized by weakness in the arms with relative sparing of the legs with variable sensory loss.
This condition is associated with ischemia, hemorrhage,
or necrosis involving the central portions of the spinal
cord (the large nerve fibers that carry information
directly from the cerebral cortex). Corticospinal fibers
destined for the legs are spared due to their more
external location in the spinal cord.
This clinical pattern may emerge during recovery from
spinal shock due to prolonged swelling around or near
the vertebrae, causing pressures on the cord.
The symptoms may be transient or permanent.
2. Anterior cord syndrome - is also an incomplete spinal cord injury. Below the injury, motor function, pain sensation, and temperature sensation is lost; touch, proprioception (sense of position in space), and vibration sense remain intact. 3. Brown-Séquard syndrome - usually occurs when the spinal cord is hemisectioned or injured on the lateral side. On the ipsilateral side of the injury (same side), there is a loss of motor function, proprioception, vibration, and deep touch. Contralaterally (opposite side of injury), there is a loss of pain, temperature, and light touch sensations.