brain and spinal cord injuries

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Updated Dec 2025

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bez nadpisu head and spinal cord injuries department of neurology lf upjš košice brain/head injury brain and spinal cord injuries and post-traumatic conditions is a serious medical and socio-economic problem (permanent consequences, disability, financial costs, ...) most often in traffic accidents, sports and occupational accidents craniocerebral injury is damage to the skull, brain, or both, an injury mechanism splitt into : - open and closed - focal and diffuse brain/head injury - mechanism of action translating - head collision with second body acceleration - linear or rotary the patient may also fall as a result of the disease condition: syncope epileptic seizure intoxication stroke head injuries: classification primary – occur at the time of the accident - diffuse: brain concussion, brain contusion, diffuse axonal injury-dai - focal/multifocal: brain contusion secondary – occur later (the result of an accident) a) intracranial - complications of primary injury (epidural bleeding, subdural bleeding, intracerebral …

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$lamus, brain stem and cranial nerves injury indirectly after an injury to the vault or face bones „eyeglasses-like“ hematoma processus mastoideus ecchymosis – battle sign risks/complications: neuroinfection (purulent meningitis, brain abscess), csf fistula, ic hypotension syndrome (cfs), n. i and n.ii. injury, deafness, n.vii. damage csf - cerebrospinal fluid skull fractures - diagnosis - clinical physical evaluation- palpation - local pain, edema, or decline - skull x-ray or brain/skull ct (bone window) - liquorrhea nasalis (csf leakage through broken meninges) - otorrhea skull fractures- therapy linear skull fractures (fissurae calvae) mostly without clinical symptoms and requiring no surgical treatment observation to exclude the development of extracerebral hematoma impressive skull fractures with significant bone dislocation surgical repositioning of debris under great impression - rupture of the dura and brain contusion on the brain surface with expansive character in the frontal area - even less impression is elevated in a case when …$

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t relative displacement of adjacent parts of the brain with inertia mechanism of mtbi: diffuse axonal injury- dai (or diffuse axonal damage-dad) = functional or structural traumatic damage to the axons of brain white matter, mainly reticulo-cortical pathways loss of consciousness in mtbi - correlates with axonal damage, may also have image of qualitative change of consciousness (disturbance of the outer world perception) dai functional or structural traumatic axonal damage (brain white matter) differential movement of adjacent brain regions during acceleration and deceleration dai is major cause of prolonged coma after tbi, probably due to disruption of ascending reticular connections to cortex, angular forces > oblique/ sagital forces stretched axons = functional impairment , reversible impairment sheared axons = their ascend. and descendent degeneration, permanent damage mtbi - mild traumatic brain injury always comes suddenly duration of symptoms - different (a few seconds to hours) injury mechanism: either by moving …

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n, nauzea gradually, the patient takes over, is disoriented, can not make simple commands, confused, behavior changes, slow reactions, incoherent speech, motion coordination disorder, restlessness, crying (disappear within minutes) post-traumatic stunning (obnubilation) state: restlessness, aggression, uncritical status more often alcoholics and people with brain damage already before the accident amnesia covers the entire time of the obnubilation post- mtbi convulsions: specific non-epileptic phenomenon occurs within 2 seconds of the crash short-term tonic stiffness and subsequent two-sided, often asymmetrical myoclonic jerks up to 3 minutes (similar to convulsive syncope) post-concussion syndrome occurs when trying to start a normal personal and working life after head injury symptoms retreat within a few days or weeks improvement after mtbi – within 3 to 12 months 5 % - 1 or more symptoms are persistent even one year after the injury (headache, dizziness, fatigue, attention deficit, memory and selected executive functions problems) somatic and vegetative: …

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$ve finding brain mri : changes in tissue signal (hypersignal) in corpus callosum, subcortical white matter, in the thalamus and brainstem mtbi – differential diagnosis other states of short-term loss of consciousness: epileptic seizure syncope arhytmia intoxication diabetic coma patient with an uncertain history, is approaching laboratory examination of biochemical parameters in order to exclude metabolic disorders, cardiac disorders /ecg/, etc. mtbi – therapy 1) in the case of negative brain ct, and negative neurological findings and amnesia up to maximally 60 minutes - patient may be released 2) observation focal neurological deficit gcs < 15 points + prolonged posttraumatic amnesia/ agitation headache of high intensity persisting vomitus liquorrhea with suspected skull base fracture polytrauma koagulaopathy alcohol or drug intoxication suspected non- traumatic damage mode: repeatedly evaluated neurological status gcs < 15..... every 30 minutes gcs = 15..... every 30 minutes for the first 2 hours and if there is …$

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bez nadpisu head and spinal cord injuries department of neurology lf upjš košice brain/head injury brain and spinal cord injuries and post-traumatic conditions is a serious medical and socio-economic problem (permanent consequences, disability, financial costs, ...) most often in traffic accidents, sports and occupational accidents craniocerebral injury is damage to the skull, brain, or both, an injury mechanism splitt into : - open and closed - focal and diffuse brain/head injury - mechanism of action translating - head collision with second body acceleration - linear or rotary the patient may also fall as a result of the disease condition: syncope epileptic seizure intoxication stroke head injuries: classification primary – occur at the time of the accident - diffuse: brain concussion, …

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