Head, Neck & Brain Injuries | Lesson 2 | Part B
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Welcome back. Let’s get started on Part B of this lesson on Head Neck and Brain Injuries. We’ll begin by discussing Intracranial Pressure, move on to concussions, and finish with wounds to the neck.
To understand intracranial pressure (ICP), think of the skull as a rigid box. After brain injury, the skull may become overfilled with swollen brain tissue, blood, or CSF. The skull will not stretch like skin to deal with these changes. The skull may become too full and increase the pressure on the brain tissue. This is called increased intracranial pressure.
Increased ICP can also mean that the brain tissue itself is swelling, either from injury or from an illness such as epilepsy. Increased ICP can be the result of a brain injury and, it can also be the cause of a brain injury.
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Signs of increased intracranial pressure may include
- Abnormal respiratory patterns,
- Decreased pulse rate, headache, nausea, vomiting, decreased alertness, bradycardia, sluggish or nonreactive pupils, decerebrate posturing, and increased or widened blood pressure, and
- Cushing reflex: the symptom triad of increased systolic blood pressure, decreased pulse rate, and irregular respirations.
These signs could indicate other serious conditions besides increased ICP, such as a stroke, a brain tumor, or a recent head injury.
Increased ICP in infants can be the result of injury, such as falling off a bed, or it can be a sign of child abuse known as shaken baby syndrome, a condition in which a small child has been roughly handled to the point of brain injury. Symptoms are similar to adults, but Increased ICP can also cause the fontanel, the soft spot on the top of a baby’s head, to bulge outward.
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Intracranial hemorrhage (ICH) refers to acute bleeding inside the skull or brain.
Bleeding can occur between the skull and dura mater, beneath the dura mater but outside the brain, or within the tissue of the brain itself.
There are four types of ICH:
- epidural hematoma
- subdural hematoma
- subarachnoid hemorrhage, and
- intracerebral hemorrhage.
Most ICHs are due to a head injury. Factors that increase ICH risk include:
- a family history of ICH
- heavy alcohol use
- cigarette smoking
- the use of certain drugs, and
- extreme physical exertion.
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An epidural hematoma (EDH) occurs when blood accumulates between the skull and the dura mater, the thick membrane covering the brain.
- They typically occur when a skull fracture tears an underlying blood vessel; often as a result of a blow to the head that produces a linear fracture of the thin temporal bone
- EDHs are about half as common as subdural hematomas and usually occur in young adults.
- They occur four times as often among males compared with females and rarely before age 2 or after age 60.
Classic symptoms of EDH involve brief loss of consciousness followed by a period of awareness that may last several hours before brain function deteriorates, sometimes leaving the patient in a coma.
If untreated, the condition can cause increased blood pressure, difficulty breathing, damage to the brain function and even death.
Other symptoms include headache, vomiting and seizure.