Brain and Spinal Cord Injury

Diagnosis

Because brain and spinal cord injuries are often life–threatening medical emergencies, the doctor must make a rapid initial diagnosis. The doctor or emergency medical technician (EMT) will normally first ask questions about how the injury occurred. If the injured person is unconscious or unable to respond, the doctor or EMT will ask witnesses for details about what happened. If a brain injury has occurred, the doctor will be particularly interested in the timing and duration of any loss of consciousness. For example, a person who was alert immediately after the injury but lost consciousness later may be experiencing bleeding or other fluid build–up within the brain.

After obtaining the initial history, the doctor will assess the patient’s neurological function. The doctor will examine the patient’s pupils for response to light, ask questions to determine whether the patient is confused or disoriented, and will test the patient’s motor responses. A high level of neurological function indicates a minor injury. Patients with impaired neurological function are normally given additional diagnostic tests, and are admitted to the hospital for observation.

A physical examination can identify the likely location of a spinal cord injury. During the initial diagnosis, the physician will test for the patient’s ability to feel or move the arms, legs, and other areas of the body to determine the most likely area of injury.

When brain or spinal cord injury is suspected, the physician will order computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, or x–rays of the affected area. A CT or MRI scan can identify swelling, bleeding, blood clots, or compression in the brain or spinal cord. X–rays can identify fractures of the skull or spine.

Because excessive pressure can quickly cause permanent nerve damage, the physician will normally insert a gauge inside the skull of someone with a severe injury. Reducing pressure within the brain or spinal cord may prevent the secondary damage to nerves that can result in permanent disability. A pressure–monitoring gauge can identify and track inflammation and bleeding within the brain, and is a critical part of intensive care.

Prevention and Screening

Many brain and spinal cord injuries can be prevented by using proper protective gear. Consistent use of seat beats in automobiles can reduce the risk of injuries during accidents. Proper use of car seats can reduce the risk of injury to infants and toddlers. Wearing a helmet while biking, motorcycling, or skating can significantly reduce the risk of head injuries associated with these activities. The risk of injury during contact sports (e.g., football) or other sports with fast–moving projectiles (e.g., hockey or baseball) can be reduced with the use of appropriate helmets and padding.

Injuries that occur in the home can often be prevented. Most brain and spinal injuries that occur in the home result from falls, especially on stairs, in bathrooms, and off ladders or stepstools. Infants, toddlers, and the elderly are especially at risk for falls inside the home. Protective barriers, railings, and handholds can help prevent falls and subsequent injury. Proper use of ladders and stepstools can minimize the risk as well.

Accidents and injuries associated with alcohol use can often be prevented. Alcohol use is a contributing factor in many brain and spinal cord injuries. Driving while under the influence is a major cause of automobile accidents. Excessive alcohol consumption is also often a factor in accidents around the home. Avoiding alcohol before driving or performing other activities that require good judgment or coordination can reduce the risk of accidents that lead to many brain and spine injuries.

Do not dive into shallow water.