Brain and Spinal Cord Injury

Symptoms

The symptoms of brain injury depend on the areas of the brain that are damaged [Table 1]. A brain injury can be localized to a single area (focal damage), or can spread out over a wide area of the brain (diffuse damage). Localized damage usually occurs at the place where an object strikes the head or penetrates the brain. When this type of damage occurs, the function performed by that part of the brain may be temporarily or permanently lost.

The brain moving within or colliding with the skull usually causes diffuse damage. Because the speech and language areas of the brain sit in pockets of the skull that allow the most movement, they are the most common areas to be injured. As a result, difficulty communicating is a common symptom of closed head injuries. Other symptoms of brain injury may include difficulty swallowing, loss of coordination or balance, blurry or double vision, loss of consciousness, impaired memory, confusion or drowsiness, slurred speech, vomiting, changes in ability to smell, or fluid or blood leaking from the nose or ears. In the most severe cases, heartbeat and breathing may stop, and the injured person may enter a coma or die.

The type and severity of spinal cord injury will determine the kinds of symptoms that emerge [Table 2]. Typical symptoms of whiplash injuries include headache, neck or back pain, swelling in the affected area, and bruising on the neck or back. Compression injuries, dislocation injuries, or severe whiplash may result in weakness, tingling, or numbness in the arms or legs. Other symptoms may include loss of bladder or bowel control and difficulty breathing. In the most severe cases, spinal cord injury results in total paralysis and loss of sensation below the site of damage.

The extent of damage depends upon the location of the damage to the brain or spinal cord [Table 3] [Figure 1]. Nerves run from the brain through the spinal cord to specific areas of the body. Some nerves travel a relatively short distance through the spinal cord; others, like those that control leg movement, travel long distances through the cord. When the spinal cord is injured, nerve function is affected, causing weakness, paralysis, and loss of sensation below the injury. Consequently, the lower the injury is in the spinal cord, the more localized the symptoms. For example, an injury to the lower spine may affect only leg movement and sensation, whereas an injury to the neck may cause paralysis of the arms, legs, and chest muscles.

^a Loss of bladder and bowel control can occur with severe injury anywhere in the spinal cord.

Symptoms of brain injury usually develop soon after the trauma. In some cases, however, an injured person will have no symptoms at first, only to develop serious symptoms hours or days later. In minor cases, a person with a head injury may have a mild headache, a lump on the head, and a bruise or a cut on the scalp. The absence of major physical symptoms, however, does not rule out a serious brain injury. Especially in cases where an injury causes fluid to build up within the brain, symptoms may not appear until much later. For this reason, a person who has experienced a brain injury should be watched closely for any sign of delayed symptoms.

Figure 1. The spinal cord

The spinal cord can be divided into four major areas: the cervical region (neck), the thoracic region (chest), the lumbar region (lower back), and the sacral region (tailbone). Injuries to the spinal cord affect movement and sensation controlled by the nerves in the spinal cord below the injured area.

Risk Factors

Although anyone can experience brain or spine injuries, most injuries occur in young men between the ages of 15 and 24, presumably because many young men engage in active, high–risk lifestyles.

Young children and adults over 75 years of age are more susceptible to brain injuries because of their increased risk of falling.

Failure to use protective gear such as seat belts while riding in automobiles or helmets while riding a bike increases your risk of sustaining serious head or spinal cord injury should an accident occur.