Injuries to the brain, head or neck are commonplace in motor vehicle accidents, ranging from minor trauma that heals in a matter of days to serious damage which can cause life-long suffering, disability or, in more extreme cases, death. The more high-speed and direct the collision, the greater the chances are of the driver and passengers incurring serious injures.
Closed Head Trauma
A closed head trauma occurs when the head strikes the interior of the vehicle. In these cases, no objects have penetrated the skull and lodged in the brain, but something has hit the skull or face with considerable force.
The brain is suspended in fluid and tissue within the skull, and when an individual receives a closed head trauma, the force is dispersed around the brain to minimize any damage. However, a coup and counter croup injury may occur, where the brain is injured by the initial blow and then rebounds off the inside of the skull, causing a secondary region of damage.
Concussion, Cerebral Edema and Intracranial Hemorrhaging
A concussion is the most common type of traumatic brain injury, and is diagnosed based on behavioral changes such as loss of memory rather than physical damage to the brain. In most cases a the effects of a concussion will disappear over a matter of days, and the affected individual will make a full recovery.
Cerebral edema is when the brain swells within the cranial cavity, potentially causing further damage to itself as it presses against the skull. This can occur either as a result of the initial blow, or because the brain has been deprived of blood or oxygen. It is essential that anyone diagnosed with cerebral edema is closely monitored in case of complications.
As well as any superficial bleeding, bruising or lacerations on the scalp or face, there may be damage to the internal blood system that supplies the brain. This is called an intracranial hemorrhage. Often the bleeding is minor and the victim is kept under observation, but major bleeds may require surgery.
A subdural hematoma occurs when there is bleeding between the brain and the fibrous tissue that separates it from the skull. An epidural hematoma is when there is bleeding between the fibrous tissue surrounding the brain and the skull bone. This occurs typically when a blow is received to the temple, and is caused by damage to the arteries that supply the brain with blood.
Any form of intracranial hemorrhage may result in loss of consciousness. This may last a few moments or result in a comatose state, depending on the severity of the brain injury. Treatment of the trauma will often enable the individual to regain consciousness, but there may still be damage to the brain tissue as a result of the internal bleeding.
Contusions and Lacerations
A cerebral contusion is a bruise within the brain, where blood seeps into the tissue as a result of a minor intracranial hemorrhage. The damage this causes is usually short-term and highly localised.
Lacerations are cuts or tears in the brain tissue, and can result in long-term and extensive brain damage. They are often the result of sudden acceleration of decerlation events in serious collisions, where forces on the brain cause the cerebral tissue to twist and tear. Lacerations and lesions in the brain tissue can result in a long term comatose or vegetative state, where the affected individual requires life support.
Face, Neck and Skull Fractures
As well as causing potentially devastating brain damage, trauma to the head can result in fractures of the face or skull, as well as the cervical vertebrae in the neck. Additionally, if the neck is abruptly compacted, the increase in pressure may cause the discs of cartilage between the cervical vertebrae to rupture.
Depending on the type of fracture, an operation may be required to reconstruct the bone and, in the case of skull and upper facial fractures, check for damage to the brain and eyes. Any breaks to the nose or surrounding sinus area must be treated and monitored as they heal, as the airways may be compromised and become infected. If these infections are not treated swiftly, they can spread into the tissues surrounding the brain and cause serious complications such as bacterial meningitis.
Fractures to the vertebrae in the neck or upper back can result pinched nerves, leading to pain and potential temporary paralysis until the nerve tissue is freed by surgery and the fractures pinned and repaired.
Consequences of Head Trauma
Damage to the brain can have long-lasting physical, cognitive, and psychological repercussions. Additionally, the symptoms may take some time to appear. If someone has suffered a head injury then they should be seen immediately for medical testing, even if they are still conscious and clear of thought.
While many victims of head, face and neck injuries make a full recovery, trauma to the brain and spinal chord can have devastating, permanent repercussions, including brain damage that affects movement, personality and cognitive abilities. The rehabilitation process following a head injury is essential to improve chances of a complete recovery.
During rehabilitation, the injured individual will be be made medically stable and able to maintain their own life signs such as breathing and heartbeat in the intensive care ward. After this point the needs of the patient will be assessed, and the correct aftercare provided.
The aim of the rehabilitation program is to help individuals with significant traumatic brain injury recuperate, and to improve the patient's ability to function in the face of the residual and potentially life-long effects of their injuries.