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Learn About Brain

Head/Brain Injury

Head injury


Definition


A head injury is any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor bump on the skull to serious brain injury.

Head injury is classified as either closed or open (penetrating).

  • A closed head injury means you received a hard blow to the head from striking an object.
  • An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This usually happens when you move at high speed, such as going through the windshield during a car accident. It can also happen from a gunshot to the head.

There are several types of brain injuries. Two common types of head injuries are:

  • Concussion, the most common type of traumatic brain injury
  • Contusion, which is a bruise on the brain

See also:

  • Subarachnoid hemorrhage
  • Subdural hematoma

Alternative Names


Brain injury; Head trauma; Contusion

Considerations


Every year, millions of people sustain a head injury. Most of these injuries are minor because the skull provides the brain with considerable protection. The symptoms of minor head injuries usually go away on their own. More than half a million head injuries a year, however, are severe enough to require hospitalization.

Learning to recognize a serious head injury, and implementing basic first aid, can make the difference in saving someone's life.

In patients who have suffered a severe head injury, there is often one or more other organ systems injured. For example, a head injury is sometimes accompanied by a spinal injury.

Causes


Common causes of head injury include traffic accidents, falls, physical assault, and accidents at home, work, outdoors, or while playing sports.

Some head injuries result in prolonged or non-reversible brain damage. This can occur as a result of bleeding inside the brain or forces that damage the brain directly. These more serious head injuries may cause:

  • Changes in personality, emotions, or mental abilities
  • Speech and language problems
  • Loss of sensation, hearing, vision, taste, or smell
  • Seizures
  • Paralysis
  • Coma

Symptoms


The signs of a head injury can occur immediately or develop slowly over several hours. Even if the skull is not fractured, the brain can bang against the inside of the skull and be bruised. (This is called a concussion.) The head may look fine, but complications could result from bleeding inside the skull.

When encountering a person who just had a head injury, try to find out what happened. If he or she cannot tell you, look for clues and ask witnesses. In any serious head trauma, always assume the spinal cord is also injured.

The following symptoms suggest a more serious head injury -- other than a concussion or contusion -- and require emergency medical treatment:

  • Loss of consciousness, confusion, or drowsiness
  • Low breathing rate or drop in blood pressure
  • Convulsions
  • Fracture in the skull or face, facial bruising, swelling at the site of the injury, or scalp wound
  • Fluid drainage from nose, mouth, or ears (may be clear or bloody)
  • Severe headache
  • Initial improvement followed by worsening symptoms
  • Irritability (especially in children), personality changes, or unusual behavior
  • Restlessness, clumsiness, lack of coordination
  • Slurred speech or blurred vision
  • Inability to move one or more limbs
  • Stiff neck or vomiting
  • Pupil changes
  • Inability to hear, see, taste, or smell

First Aid


Get medical help immediately if the person:

  • Becomes unusually drowsy
  • Develops a severe headache or stiff neck
  • Vomits more than once
  • Loses consciousness (even if brief)
  • Behaves abnormally

For a moderate to severe head injury, take the following steps:

  1. Call 911.
  2. Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.
  3. If the person's breathing and heart rate are normal but the person is unconscious, treat as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the person's head, keeping the head in line with the spine and preventing movement. Wait for medical help.
  4. Stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move the person's head. If blood soaks through the cloth, DO NOT remove it. Place another cloth over the first one.
  5. If you suspect a skull fracture, DO NOT apply direct pressure to the bleeding site, and DO NOT remove any debris from the wound. Cover the wound with sterile gauze dressing.
  6. If the person is vomiting, roll the head, neck, and body as one unit to prevent choking. This still protects the spine, which you must always assume is injured in the case of a head injury. (Children often vomit ONCE after a head injury. This may not be a problem, but call a doctor for further guidance.)
  7. Apply ice packs to swollen areas.

For a mild head injury, no specific treatment may be needed. However, closely watch the person for any concerning symptoms over the next 24 hours. The symptoms of a serious head injury can be delayed. While the person is sleeping, wake him or her every 2 to 3 hours and ask simple questions to check alertness, such as "What is your name?"

If a child begins to play or run immediately after getting a bump on the head, serious injury is unlikely. However, as with anyone with a head injury, closely watch the child for 24 hours after the incident.

Over-the-counter pain medicine (like acetaminophen or ibuprofen) may be used for a mild headache. DO NOT take aspirin, because it can increase the risk of bleeding.

DO NOT


  • DO NOT wash a head wound that is deep or bleeding a lot.
  • DO NOT remove any object sticking out of a wound.
  • DO NOT move the person unless absolutely necessary.
  • DO NOT shake the person if he or she seems dazed.
  • DO NOT remove a helmet if you suspect a serious head injury.
  • DO NOT pick up a fallen child with any sign of head injury.
  • DO NOT drink alcohol within 48 hours of a serious head injury.

When to Contact a Medical Professional


Call 911 if:

  • There is severe head or facial bleeding.
  • The person is confused, drowsy, lethargic, or unconscious.
  • The person stops breathing.
  • You suspect a serious head or neck injury or the person develops any symptoms of a serious head injury.

Prevention


  • Always use safety equipment during activities that could result in head injury. These include seat belts, bicycle or motorcycle helmets, and hard hats.
  • Obey traffic signals when riding a bicycle. Be predictable so that other drivers will be able to determine your course.
  • Be visible. DO NOT ride a bicycle at night.
  • Use age-appropriate car seats or boosters for babies and young children.
  • Make sure that children have a safe area in which to play.
  • Supervise children of any age.
  • DO NOT drink and drive, and DO NOT allow yourself to be driven by someone who you know or suspect has been drinking alcohol.

References


Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

DeLee JC, Drez, Jr., D, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 2nd ed. Philadelphia, Pa: Saunders; 2003.

Goetz CG, Pappert EJ. Textbook of Clinical Neurology. 2nd ed. Philadelphia, Pa: Saunders; 2003:1130-1134.

 

Review Date: 1/8/2007
Reviewed By: Eric Perez, MD, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Concussion

Concussion


Definition


A concussion is a brain injury that may result in a bad headache or unconsciousness.

Causes


There are more than a million cases of concussion each year in the United States.

A concussion may result when the head hits an object or a moving object strikes the head. A concussion can result from a fall, sports activities, and car accidents. Significant movement of the brain (jarring) in any direction can cause unconsciousness. How long a person remains unconscious may indicate the severity of the concussion.

Often victims have no memory of events preceding the injury, or immediately after regaining consciousness. More severe head injuries can cause longer periods of memory loss (amnesia).

Usually, a person has the most memory loss immediately after getting hurt. Some of the memory comes back as time goes by. However, complete memory recovery for the event may not occur.

Bleeding into or around the brain can occur with any blow to the head, whether or not unconsciousness occurs. If someone has received a blow to the head, they should be watched closely for signs of possible brain damage.

Things to watch for include repeated vomiting, unequal pupils, confused mental state or varying levels of consciousness, seizure-like activity, weakness on one side of the body, or the inability to wake up (coma). If any of these signs are present, immediately call 911.

Symptoms


A concussion results from a significant blow to the head. Symptoms can range from mild to severe. They can include:

  • Headache
  • Loss of consciousness
  • Memory loss (amnesia) of events surrounding the injury

Emergency signs:

  • Altered level of consciousness (drowsy, hard to arouse, or similar changes)
  • Convulsions
  • Muscle weakness on one or both sides
  • Persistent confusion
  • Persistent unconsciousness (coma)
  • Repeated vomiting
  • Unequal pupils
  • Unusual eye movements
  • Walking problems

Exams and Tests


A neurological examination may show abnormalities.

Tests that may be performed include:

  • Head CT
  • MRI of the head

Treatment


An initial "baseline" neurological evaluation by a health care worker determines appropriate treatment for an uncomplicated concussion. If a blow to the head during athletics leads to a bad headache, a feeling of being confused (dazed), or unconsciousness, a trained person must determine when the person can return to playing sports.

If a child or young adult has lost consciousness, that person should not play sports for a period of 3 months. Studies have shown that there is an increased rate of brain injury and occasionally death in people who have had a previous concussion with unconsciousness.

Concussion complicated by bleeding or brain damage must be treated in a hospital.

Outlook (Prognosis)


Full recovery is expected from an uncomplicated concussion, although prolonged dizziness, irritability, headaches, and other symptoms may occur.

Possible Complications


  • Brain injury
  • Intracerebral hemorrhage

When to Contact a Medical Professional


Call your health care provider if anyone has a head injury that produces unconsciousness, or a head injury without unconsciousness that produces symptoms that cause concern.

Call 911 or go the emergency room if emergency signs develop.

Prevention


Attention to safety, including the use of appropriate athletic gear, such as bike helmets and seat belts, reduces the risk of head injury.

References


Ropper, AH, Gorson, KC. Clinical Practice; Concussion. N Engl J Med. 2007; 356: 166-172.

 

Review Date: 2/19/2008
Reviewed By: John E. Duldner, Jr., MD, MS, Assistant Professor of Emergency Medicine, Director of Research, Department of Emergency Medicine, Akron General Medical Center and Northeastern Ohio Universities College of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Subdural Hematoma

Subdural hematoma


Definition


A subdural hematoma is a collection of blood on the surface of the brain.

Alternative Names


Subdural hemorrhage

Causes


Subdural hematomas are usually the result of a serious head injury. When they occur in this way, it is called an "acute" subdural hematoma. Acute subdural hematomas are among the deadliest of all head injuries. The bleeding fills the brain area very rapidly, leaving little room for the brain, and are associated with brain injury.

Subdural hematomas can also after a very minor head injury, especially in the elderly. These go unnoticed for many days to many weeks, and are called "chronic" subdural hematomas. During a subdural hematoma, tiny veins between the surface of the brain and its outer covering (the dura) stretch and tear, allowing blood to collect. In the elderly, the veins are often already stretched because of brain atrophy (shrinkage).

Some subdural hematomas occur without cause (spontaneously).

The following increase your risk for a subdural hematoma:

  • Head injury
  • Very young or very old age
  • Anticoagulant medication (blood thinners)
  • Long term abuse of alcohol

Symptoms


  • Recent head injury
  • Loss of consciousness after head injury
  • Headache
  • Weakness
  • Numbness
  • Can't speak
  • Slurred speech
  • Nausea and vomiting
  • Lethargy
  • Seizures

In infants:

  • Bulging fontanelles
  • Increased head circumference
  • Separated sutures
  • Irritability
  • High-pitched cry
  • Focal seizures
  • Generalized tonic-clonic seizure

Exams and Tests


Always get medical help after a head injury. Older persons should receive medical care if they shows signs of memory problems or mental decline. An exam should include a complete neurologic exam.

Your doctor may order a brain imaging study if you have any of the following symptoms:

  • Weakness
  • Numbness
  • Inability to speak
  • Slurred speech
  • Persistent headache
  • Abnormal level of consciousness
  • Recent cognitive decline in an elderly person, even without of head injury

A CT scan or MRI scan would likely be done to evaluate for the presence of a subdural hematoma.

Treatment


A subdural hematoma is an emergency condition!

Emergency surgery may be needed to reduce pressure within the brain. This may involve drilling a small hole in the skull, which relieves pressure and allows the hematoma to drain. Large hematomas or solid blood clots may need to be removed through a procedure called a craniotomy, which creates a larger opening in the skull.

Medicines used to treat a subdural hematoma depend on the type of subdural hematoma, the severity of symptoms, and how much brain damage there is. Diuretics may be used to reduce swelling. Anti-convulsant medications such as phenytoin may be used to control or prevent seizures.

Outlook (Prognosis)


The outlook following a subdural hematoma varies widely depending on the type of head injury, the size of the blood collection, and how quickly treatment is obtained.

Acute subdural hematomas present the largest challenge, with high rates of death and injury. Subacute and chronic subdural hematomas have good outcomes in most cases, with symptoms going away after the blood collection is drained.

There is a high frequency of seizures following a subdural hematoma, but these are usually well controlled with medication.

Possible Complications


  • Temporary or permanent weakness, numbness, difficulty speaking
  • Seizures
  • Brain herniation
  • Persistent symptoms such as memory loss, dizziness, headache, anxiety, and difficulty concentrating

When to Contact a Medical Professional


A subdural hematoma requires emergency medical attention. Call 911 or your local emergency number, or go immediately to an emergency room.

Spinal injuries often occur with head injuries, so try to keep the person's neck still if you must move him or her before help arrives.

Prevention


Always use safety equipment at work and play to reduce your risk of a head injury. For example, use hard hats, bicycle or motorcycle helmets, and seat belts.

 

Review Date: 7/14/2006
Reviewed By: J.A. Lee, M.D., Division of Surgery, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Hemorrhage

Subarachnoid hemorrhage


Definition


Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space.

Alternative Names


Hemorrhage - subarachnoid

Causes


Subarachnoid hemorrhage can be caused by:

  • Bleeding from an arteriovenous malformation (AVM)
  • Bleeding disorder
  • Cerebral aneurysm rupture
  • Head injury
  • Unknown cause (idiopathic)
  • Use of blood thinners

Injury-related subarachnoid hemorrhage is often seen in the elderly who have fallen and hit their head. Among the young, the most common injury leading to subarachnoid hemorrhage is motor vehicle crashes.

Subarachnoid hemorrhage due to rupture of a cerebral aneurysm occurs in approximately 10-15 out of 10,000 people. However, some studies suggest that number may be slightly lower. Subarachnoid hemorrhage due to rupture of a cerebral aneurysm is most common in persons age 20 to 60. It is slightly more common in women than men.

Risks include:

  • Aneurysms in other blood vessels
  • Disorders associated with aneurysm or weakened blood vessels
  • Fibromuscular dysplasia (FMD) and other connective tissue disorders
  • High blood pressure
  • History of polycystic kidney disease
  • Smoking

A strong family history of aneurysms may also increase your risk.

Symptoms

The main symptom is a severe headache that starts suddenly and is often worse near the back of the head. Patients often describe it as the "worst headache ever" and unlike any other type of headache pain. The headache may start after a popping or snapping feeling in the head.

Other symptoms:

  • Decreased consciousness and alertness
  • Difficulty or loss of movement or feeling
  • Mood and personality changes, including confusion and irritability
  • Muscle aches (especially neck pain and shoulder pain)
  • Nausea and vomiting
  • Photophobia (light bothers or hurts the eyes)
  • Seizure
  • Stiff neck
  • Vision problems, including double vision, blind spots, or temporary vision loss in one eye

Additional symptoms that may be associated with this disease:

  • Eyelid drooping
  • Eyes, pupils different size
  • Opisthotonos (not very common)
  • Seizures

Exams and Tests


A physical exam may show a stiff neck due to irritated meninges, the tissues that cover the brain. Except those in a deep coma, persons with a subarachnoid hemorrhage may resist neck movement.

A neurological exam may show signs of decreased nerve and brain function (focal neurologic deficit).

An eye exam may show signs of bleeding in the brain. Decreased eye movements can be a sign of damage to the cranial nerves. In milder cases, no problems may be seen on an eye exam.

If your doctor thinks you may have a subarachnoid hemorrhage, a head CT scan (without dye contrast) should be immediately done. In some cases, the scan may be normal, especially if there has only been a small bleed. If the CT scan is normal, a lumbar puncture (spinal tap) must be performed. Patients with SAH will have blood in their spinal fluid.

Cerebral angiography of blood vessels of the brain may show small aneurysms or other vascular problems. This test can pinpoint the exact location of the bleed and can tell if there are blood vessel spasms.

Transcranial doppler ultrasound is used to look at blood flow through the skull. It can also detect blood vessel spasms and may be used to guide treatment.

Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are occasionally used to diagnose a stroke or tumor.

Treatment


The goals of treatment are to save your life, repair the cause of bleeding, relieve symptoms, and prevent complications.

If the hemorrhage is due to an injury, surgery is done only to remove large collections of blood or to relieve pressure on the brain.

If the hemorrhage is due to the rupture of an aneurysm, surgery is needed to repair the aneurym. If the patient is critically ill, surgery may have to wait until the person is more stable. Surgery may involve a craniotomy and aneurysm clipping, which closes the aneurysm, or endovascular coiling, a procedure in which coils are placed within the aneurysm to prevent further bleeding.

If no aneurysm is found, the person should be closely watched by a health care team and may need repeated imaging tests.

Treatment for coma or decreased alertness status may be needed. This may include special positioning, life support, and methods to protect the airway. A draining tube may be placed into the brain to relieve pressure.

If the person is conscious, strict bed rest may be advised. The person will be told to avoid activites that can increase pressure inside the head. Such activities include bending over, straining, and suddenly changing position. The doctor may prescribe stool softeners or laxatives to prevent straining during bowel movements.

Blood pressure will be strictly controlled. This requires medicines given through an IV line. The medicine often requires frequent adjustments. A medicine called calcium channel blocker is used to prevent blood vessel spams.

Pain killers and anti-anxiety medications may be used to relieve headache and reduce intracranial pressure. Phenytoin or other medications may be used to prevent or treat seizures.

Outlook (Prognosis)


How well a patient with SAH does depends on a number of different factors, including the location and extent of the bleeding, as well as any complications. Older age and more severe symptoms from the beginning are associated with a poorer prognosis.

Complete recovery can occur after treatment, but death may occur in some cases with or without treatment.

Possible Complications


Repeated bleeding is the most serious complication. If a cerebral aneurysm bleeds for a second time, the outlook is significantly worsened.

Changes in consciousness and alertness due to a subarachnoid hemorrhage may become worse and lead to coma or death.

Other complications include:

  • Stroke
  • Seizures
  • Medication side effects
  • Complications of surgery

When to Contact a Medical Professional


Go to the emergency room or call the local emergency number (such as 911) you have symptoms of a subarachnoid hemorrhage.

Prevention


Identification and successful treatment of an aneurysm would prevent subarachnoid hemorrhage.

References


Kirmani JF, Alkawi A, Ahmed S, et al. Endovascular treatment of subarachnoid hemorrhage. Neurol Res. 2005;27 Suppl 1:103-7.

Edlow JA. Diagnosis of subarachnoid hemorrhage. Neurocrit Care. 2005;2(2):99-109.

Bird S. Failure to diagnose: subarachnoid haemorrhage. Aust Fam Physician. 2005 Aug;34(8):682-3.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:2362-2363.

 

Review Date: 6/7/2007
Reviewed By: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Speech Impairment

Speech impairment (adult)


Definition


Speech impairment may be any of several speech problems, particularly the following:

  • Dysarthria is difficult, poorly pronounced speech, such as slurring.
  • Aphasia is a problem with expressing or understanding written or spoken language.

Dysarthria is occasionally confused with aphasia. It is important to distinguish between a difficulty in pronunciation of words, as opposed to a problem with the production of language, as these have different causes.

Alternative Names


Language impairment; Impairment of speech; Inability to speak; Aphasia; Dysarthria; Slurred speech

 

Considerations


DYSARTHRIA

Dysarthria is generally apparent in daily conversation where there is difficulty expressing certain sounds or words. This condition may be caused by taking excess medications such as narcotics, phenytoin, or carbamazepine. Alcohol intoxication causes dysarthria.

Degenerative neurological (nervous system) disorders affecting the cerebellum, basal ganglia, or brainstem (all are important parts of the brain) can also cause dysarthria. Stroke that affects the brainstem or cerebellar regions can also cause dysarthria. Any facial weakness, such as Bell's palsy or tongue weakness, can cause dysarthria.

APHASIA

Aphasia is loss of communication skills that were previously learned. It commonly occurs following strokes, or in people with brain tumors or degenerative diseases that affect the language areas of the brain. This term does not apply to children who have never developed communication skills.

In some cases of aphasia, the problem eventually corrects itself, but in others the condition is irreversible.

Causes


DYSARTHRIA

  • Poorly fitting dentures
  • Alcohol intoxication
  • Side effects of medications that act on the central nervous system
  • Degenerative neurological disorders, such as Parkinson disease or Huntington disease (more common in dysarthria than aphasia)
  • Stroke
  • Transient ischemic attack (TIA)
  • Head trauma
  • Other dementias
APHASIA
  • Head trauma
  • Alzheimer's disease
  • Stroke
  • Transient ischemic attack (TIA)
  • Brain tumor (more common in aphasia than dysarthria)
  • Other dementias

Home Care


For dysarthria, speaking slowly is encouraged, and the use of hand gestures, when necessary, is recommended. Family and friends need to provide plenty of time for those afflicted with the disorder to express themselves. Medications that are causing the problem should be stopped, if possible. Use of alcohol should be minimized.

For aphasia, family members may need to provide frequent orientation reminders, such as what day it is, because disorientation and confusion often follow the onset of aphasia.

A relaxed, calm environment where external stimuli are kept to a minimum is important.

Speak in a normal tone of voice (this condition is not a hearing or emotional problem), use simple phrases to avoid misunderstandings, and don't assume that the affected person understands. Frustration, profanity, and depression are typical responses in people suffering from aphasia.

Provide communication aids, if possible, depending on the particular person and condition.

When to Contact a Medical Professional


  • If impairment or loss of communication comes on suddenly, call your health care provider immediately.
  • If there is any unexplained impairment of speech or written language, call your provider.

What to Expect at Your Office Visit


The health care provider will take a medical history and perform a physical examination. The medical history may require the assistance of family or friends.

Medical history questions documenting speech impairment may include the following:

  • When did it develop?
  • Did it develop suddenly?
  • Is there a problem with clearly pronouncing words (dysarthria)?
  • Is there a problem understanding speech?
  • Is there a problem expressing thoughts through speech?
  • Is there a problem understanding writing?
  • Is there a problem expressing thoughts through writing?
  • Has there been a recent head injury?
  • Are there problems with dentures?
  • What medications are used?
  • Is there recent or former heavy alcohol use?
  • What other symptoms are also present?

The physical examination will include a detailed evaluation of brain function.

Diagnostic tests that may be performed include the following:

  • CT scan of the head
  • MRI of the head
  • EEG
  • X-rays of the skull
  • Blood tests
  • Urine tests
  • Lumbar puncture
  • MR angiography
  • Cerebral angiography

The health care provider may provide a referral to a speech pathologist, and in some cases, to a social worker.

 

Review Date: 9/7/2006
Reviewed By: Kenneth Gross, M.D., Neurology, North Miami, FL. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Skull Fracture

Skull fracture


Definition


A skull fracture is a fracture or break in the cranial (skull) bones. See also concussion.

Alternative Names


Basilar skull fracture; Depressed skull fracture; Linear skull fracture

Considerations


Skull fractures may occur with head injuries. Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull. It may be accompanied by injury to the brain.

The brain can be affected directly by damage to the nervous system tissue and bleeding. The brain can also be affected indirectly by blood clots that form under the skull and then compress the underlying brain tissue (subdural or epidural hematoma).

A simple fracture is a break in the bone without damage to the skin.

A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone.

A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain.

A compound fracture involves a break in, or loss of skin and splintering of the bone.

Causes


  • Head trauma
  • Falls, automobile accidents, physical assault, and sports

Symptoms


  • Bleeding from wound, ears, nose, or around eyes
  • Bruising behind the ears or under the eyes
  • Changes in pupils (sizes unequal, not reactive to light)
  • Confusion
  • Convulsions
  • Difficulties with balance
  • Drainage of clear or bloody fluid from ears or nose
  • Drowsiness
  • Headache
  • Loss of consciousness
  • Nausea
  • Restlessness, irritability
  • Slurred speech
  • Stiff neck
  • Swelling
  • Visual disturbances
  • Vomiting

Note: The only symptom may be a bump on the head. A bump or bruise may take up to 24 hours to develop.

First Aid


1. Check the airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.

2. Avoid moving the victim (unless absolutely necessary) until medical help arrives. Instruct someone to call 911 (or the local emergency number) for medical assistance.

3. If the victim must be moved, take care to stabilize the head and neck. Place your hands on both sides of the head and under the shoulders. Do not allow the head to bend forward or backward, or to twist or turn.

4. Carefully check the site of injury, but do not probe in or around the site with a foreign object. It can be difficult to know if the skull is fractured or depressed (dented in) at the site of injury.

5. If there is bleeding, apply firm pressure with a clean cloth to control blood loss over a broad area.

6. If blood soaks through, do not remove the original cloth. Instead, apply additional cloths on top, and continue to apply pressure.

7. If the victim is vomiting, stabilize the head and neck (as outlined in number 3, above), and carefully turn the victim to the side to prevent choking on vomit.

8. If the victim is conscious and experiencing any of the previously listed symptoms, transport to the nearest emergency medical facility (even if the patient does not think medical assistance is necessary).

DO NOT


  • DO NOT move the victim unless absolutely necessary -- head injuries may be associated with spinal injuries.
  • DO NOT remove protruding objects.
  • DO NOT allow the victim to continue to engage in physical activities.
  • DO NOT forget to observe the victim closely until medical help arrives.
  • DO NOT give the victim any medications before consulting a physician.
  • DO NOT leave the victim alone, even if there are no complaints or obvious injuries.

When to Contact a Medical Professional


  • There are problems with breathing or circulation.
  • Direct pressure does not stop bleeding from the nose, ear(s), or wound.
  • There is drainage of clear fluid from the nose or ears.
  • There is facial swelling, bleeding, or bruising.
  • There is an object protruding from the skull.
  • The victim is unconscious, is experiencing convulsions, has multiple injuries, appears to be in any distress, or is not lucid.

Prevention


1. Use car seats or seat belts whenever in a motor vehicle.

2. Use helmets whenever biking, skating, skiing, climbing, or playing contact sports.

3. Use equipment designed specifically for the type of sport or recreation in which you are participating.

4. Provide appropriate supervision for children of any age.

5. Do not allow children to bike or skate at night.

6. Provide highly visible clothing.

7. Teach children to obey traffic rules and signals.

8. Educate individuals about risks of various work, recreational, or sport activities and how to avoid injury.

9. Report any concerns you might have about abuse.

References


Dias MS. Traumatic brain and spinal cord injury. Pediatr Clin North Am. 2004; 51(2): 271-303.

Marx, J. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby; 2006.

 

Review Date: 2/19/2008
Reviewed By: John E. Duldner, Jr., MD, MS, Assistant Professor of Emergency Medicine, Director of Research, Department of Emergency Medicine, Akron General Medical Center and Northeastern Ohio Universities College of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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