Blunt Head Injuries

The major causes of blunt head injuries are motor-vehicle accidents, sports-related accidents, personal violence, physical abuse of children, blows to the head, and falls. The brain is injured either by direct contact injury to the head or by acceleration/deceleration movements of the head at the time of impact, causing motion of the brain within the skull. Sudden acceleration of the unsupported head usually results from a blow by a heavy object. Sudden deceleration of the moving head occurs in falls. These two mechanisms may act together (Table 12.1). Traumatic injury to the neurons is attributed, at least partly, to ionic fluxes. Damage to the cellular membrane at the time of injury allows an influx of sodium, chloride, water, and calcium into the neuronal

table 12.1.

Mechanisms and Types

of Cerebral Injuries

Acceleration/Deceleration

Contact Head Injury

Injury

Epidural hematoma

Subdural hematoma

Intracerebral hematoma

Diffuse axonal injury

Contusion

Contusion

Laceration

Concussion

compartment and an efflux of potassium into the extracellular compartment. These ionic exchanges, perpetuated by the release of excitatory neurotransmitters, disrupt neuronal functions and may even lead to neuronal disintegration.

The major types of blunt injuries are skull fractures, intracranial hemorrhages, and cerebral parenchymal injuries. These may occur singly or in combinations.

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