Craniocerebral injuries

What are the causes of traumatic brain injuries?

Craniocerebral injuries are caused by external forces to the head as e.g.

• blows
• falls
• impacts.

More than half of all injured persons in an accident sustain traumatic brain injury.

What is the classification of traumatic brain injuries?

The severity of the traumatic brain injuries can be determined by two parameters: loss of conscience and duration of symptoms. These parameters allow a common but very schematic classification:

• TBI 1^st grade: (commotio cerebri, concussion) is a mild, closed brain injury without loss of conscience or a very short loss of conscience (less than 5 minutes). The brain is usually able to recover from a concussion within a few days. Symptoms of concussion may include amnesia surrounding the traumatic event and nausea.
• TBI 2^nd grade: (contusio cerebri, brain contusion) is a head injury with a short period of unconsciousness (up to 30 minutes). The exact localization of the damage is important for the appearance of late effects.
• TBI 3^rd grade: (compression cerebri, brain compression) is a head injury with a loss of consciousness for more than 30 minutes, which is caused by bleeding or edema that put pressure on the brain. This pressure must be released. If not, coma and even death are unavoidable consequences of cerebral compression.

Another possibility of classification is the Glasgow Coma Scale (GCS):

• GCS 3-8 points: severe traumatic brain injury
• GCS 9-12 points: moderate traumatic brain injury
• GCS 13-15 points: mild traumatic brain injury

What types of traumatic brain injuries are there?

Approximately 30% of people with severe head trauma sustain cranial bleeding. Post-traumatic hematomas are a very common consequence of skull fractures.

Epidural hematoma

Epidural hematomas occur between the dura mater (a tough membrane surrounding the brain tissue) and the skull. The bleeding is typically associated with skull fractures in younger patients and caused by a damaged artery (middle meningal artery) or its branches. Epidural hematomas caused by an injury of the brain are uncommon.

Epidural hematomas are always a surgical emergency, they have to be removed immediately.

Acute subdural hematoma

Acute subdural hematomas are more common than epidural hematomas. They appear between the dura mater and the surface of the brain and occur when blood vessels rupture.

Subacute subdural hematomas are usually seen in elderly patients or chronic alcoholics and are characterized by slower bleeding, i.e. the hematoma expands for a longer period of time. It may take several days before the brain is so intensely compressed to cause symptoms.

Acute subdural hematomas have to be treated surgically by opening the skull (craniotomy) and the dura mater.

Intracerebral hematoma

Intracerebral hematomas are a collection of blood within the brain tissue. A surgical treatment depends substantially of the type of the hematoma: surgery is required if the intracranial pressure is significantly increased and brain herniation is imminent.

How does our Center for Spinal Surgery and Neurotraumatology treat TBIs?

Diagnostics:

The local rescue helicopter "Christoph 2" is permanently stationed at the BGU Frankfurt. In the Emergency Room, a multidisciplinary and highly specialized team performs the medical examination and plans the best possible treatment. Our clinic offers all imaging modalities on a 24 hours / 7 days a week basis.

Treatment:

Surgery:

Our Center also specializes in the early detection and treatment of head injuries. Bleeding or displaced skull fractures are immediately treated surgically by experienced neurosurgeons.

Intensive care treatment:

Mild injuries are treated in the Center's ward. Severely injured patients are treated in the interdisciplinary Intensive Care Unit or Recovery Ward. A neurosurgeon is available around the clock for special treatment. Intracranial pressure measurement, transcranial Doppler sonography and electrophysiological monitoring are standard procedures in our Center.

Early rehabilitation:

Our Center for Spinal Surgery and Neurotraumatology works in close collaboration with rehabilitation centers in the Rhein-Main-Area. Depending on the physical impairment caused by the traumatic brain injury the best follow-up treatment will be defined in consultation with your family members and the colleagues providing the rehabilitation.

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