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Most head injuries occur because the head is suddenly forced to stop or start moving, or to turn rapidly. These are called 'acceleration' injuries. Running a motor vehicle into a lampost; being hit from behind when you are stopped at traffic lights; or a punch on the jaw that swings the head round are examples of this. As the brain is forced to follow the movements of the head it gets pulled out of shape and stretched, so that its nerve fibres, together with the arteries and veins that run through it, are torn across. Damage of this sort is usually widespread throughout the brain, though some areas are worse affected than others. Such injuries are commonly referred to as a whiplash injury which can lead to a claim for whiplash compensation.
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A weapon used in an assault, the steering wheel of a car in a traffic accident, or just falling against the sharp edge of the curb can tear the scalp, break through the skull and injure the brain directly. This sort of injury often affects only quite a small area of brain and though it can have serious results it may cause less problems than an acceleration injury, in which the damage is widespread. Both sorts of injury may occur at once, especially in traffic accidents.
In many accidents the brain is damaged more than once. The victim may be flung out of the car and injure their head again as they land on the road. They may be trapped in the car and pinned down so that they can't breathe properly and their brain becomes starved of oxygen and some of its cells die.
Often there are fractures of the limbs and damage to the chest and abdomen. So much blood may be lost from these injuries that the circulation of blood to the brain fails, and again parts of it will die.
The brain swells when it has been injured, just as other parts of the body do. Normally the brain fits closely inside the skull, with only a little space to spare. When it swells, this space is soon taken up; and if swelling continues, the pressure inside the skull - 'the intracranial pressure' - rises and the brain is compressed. If the pressure goes on rising, the arteries of the brain are squeezed shut, the circulation to the brain stops and the brain dies.
Causes:
Brain Oedema
The most important cause of brain swelling is the fluid that accumulates in the
damaged brain - brain oedema. This can be reduced by controlling the amount of
water and salt in the body, and by making sure that the brain has all the oxygen
and food it needs, and is able to get rid of waste products like carbon dioxide.
Managing this situation is one of the most important tasks of the hospital team.
Blood clots
Another important cause of increased intracranial pressure is a leak of blood
from a vein or an artery in the brain, torn at the moment of the accident. This
forms a clot, which may lie inside the brain or over its surface, and which
compresses it. Often the clot can be removed by an operation.
Causes of increased intracranial pressure that can happen later:
Subdural haematoma
Occasionally, a week or a month after injury, someone who seems to be making a
good recovery stops getting better and slips back. Two common causes are: A
blood clot located in the space around the brain, not big enough to cause
trouble at first, may grow with time and cause symptoms several weeks later.
This is called a 'chronic subdural haematoma'. It can usually be removed
successfully by an operation.
Hydrocephalus following head injury
The normal circulation of fluid round the brain may be blocked by the effects of
injury, and weeks or months later the fluid can build up and cause a rise of
intracranial pressure. Again this can be treated quite simply by an operation.
More information on the treatment of head injuries.
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