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The parts of the brain are composed of types of matter that have different densities. To visualize the differences of density within the brain, imagine a Jell-O mold that contains fruits, nuts, and different layers of Jell-O. When the Jell-O is shaken, different parts of the mold move at different speeds. And with violent shaking, the different layers of Jell-O actually can separate. A similar occurrence can happen to the parts of the brain that have varying densities.
When the brain is shaken, the resulting irritation can cause swelling or blood clots. Blood clots can be very large and require surgery to have them removed, or they can be very small. Irritation from swelling or bleeding can lead to either seizures, or to the disruption or death of the brain cells. When brain cells die, they cannot be recovered.
The brain works erratically when an injury irritates it through either swelling, blood clots, changes in the composition of the blood, or the destruction of connections within the brain. This irritation may cause chemicals that do not normally occur in the brain to be released there. In more severe injuries, large amounts of these chemicals can actually destroy more of the brain.
The above are secondary injuries that neurosurgeons try to prevent. Unfortunately, no magic cure or way to absolutely prevent secondary injuries exists yet.
EVALUATION
When a patient has a head injury and comes into medical care, first we obtain a special type of x-ray called a CT scan. A CT scan allows us to look inside of the skull to determine if there is any bleeding. If there is a large amount of blood and it is located in a certain position, the patient may benefit from having an operation as soon as possible. Not all bleeding, however, requires an immediate operation.
Damaged areas of the brain do not always show bleeding within the first couple of hours after the trauma. Sometimes damaged areas of the brain soften after a period of time, and then bleeding may occur. Follow-up x-rays (CT scans) are often performed a day or so after the trauma. A CT scan will be done only on those patients who may re-bleed or who have a change in the neurological exam. If the patient does not have an initial operation, they will then be closely monitored to determine if a future operation is needed. In very minimal head injuries, this can be done at home; in more moderate injuries, it will be done in the hospital; in very severe injuries, monitoring will occur in the Intensive Care Unit.
CONCUSSION
Those individuals who suffer a mild head injury--such as being hit hard in the head which is followed by nausea, vomiting, mild loss of memory before or after the event, or even a loss of consciousness--can be regarded as having a concussion. Just as head injury has a large spectrum of conditions, concussions can be broken down into three or four different types. An adult should observe people, who have head concussions, for 24 to 48 hours after the incident. The adult should check on that person every couple of hours to be sure they have not become too sleepy or unable to waken, that their eyes still work, as well as their arms and legs, and that
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