You are handling the case of a man who was struck on the top of the head by a steel beam. You come across medical terms that describe his injury. Here is an explanation of common types of injuries.

There are two broad types of traumatic brain injuries: closed or open.

A closed head injury is when there is a blow to the head or sudden, severe movement of the head which causes the brain to move about within the skull. This is the most common type of brain injury and can cause brain swelling. Although the skull is a rigid box which protects the brain, if the brain swells or there is bleeding, there is no room for additional fluids or swelling. Therefore, there can be increased pressure on the brain, and tissue compression. If this pressure is left untreated, and the brain continues to swell, it can eventually lead to pushing the brain through the base of the skull. This compresses the area that controls breathing and can eventually lead to death.

An open head injury occurs when the skull is fractured and penetrated. This can be caused by a severe blow powerful enough to break the skull. Portions of the skull can be pressed into the brain. Penetrating injuries, such as gunshots, sharp objects, and projectiles can cause foreign material, such as bone fragments, hair, dirt, and skin into the brain. The person may be more at risk for developing infections because of this. This type of injury can cause brain swelling, as well as lacerations from the skull fragments

A coup/contrecoup injury is caused when there is sudden acceleration and deceleration of the head. An example of this would be a motor vehicle accident when the person is hit from behind. This often involves a “whiplash” injury. The person’s head is thrown forward with great force, and then thrown back. The brain travels within the skull. The front area of the brain hits the inside of the skull when the person goes forward. When the person is then thrown backward, the back of the brain also hits the inside of the skull. The person sustains injuries at both areas of impact.

An epidural hematoma is a collection of blood caused when there is bleeding between the inside of the skull and the outer lining of the brain (the dura). Because there is very little extra space within the skull, this bleeding can quickly increase the pressure within the skull. The brain can be compressed which can compromise blood supply to the brain. It can also damage the nerve pathways, blood vessels, and brain tissue.

A subdural hematoma is a collection of blood caused when there is bleeding between the outer lining of the brain (the dura) and the brain tissue. This also quickly increases the pressure within the skull and will require surgery to drain the blood clot.

A subarachnoid hematoma is a collection of blood between the arachnoid space and the pia mater (the second and third protective layer of the brain).

Diffuse axonal injury is a very devastating injury and may involve no impact. It causes permanent damage to the nerves in the brain. Rapid acceleration of the head can cause the brain to move in the skull. This can cause shearing forces that can destroy the axons of the brain which are needed for proper brain function.

Secondary insults such as hypotension (low blood pressure) and hypoxia (low oxygen levels) are the most prominent secondary trauma-induced injuries. Both dramatically affect long term outcome and mortality rates. Low blood pressure is critical because it leads to decreased brain perfusion.

The patient’s chances of recovery will be affected by his age, other medical problems, the type and extent of the injury, and the care that he receives during the critical stages of his illness.

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