Skull Fractures: Part II
As discussed in the previous article on skull fractures, the skull provides a protective layer around the brain.
Below the skull, cerebrospinal fluid also protects the brain. This is a watery fluid produced by special cells in the ventricles — four hollow spaces in the brain. They are enclosed in a meningeal covering, providing further cushioning for the brain. The brain is also protected by three thin membranes called “meninges.” The cerebrospinal fluid flows through the ventricles and within spaces between the meninges. Another function of cerebrospinal fluid is to bring nutrients from the blood to the brain and to remove waste products from the brain. Despite all of these methods of brain protection, meningeal attachments to the interior of the skull may limit the movement of the brain. This can transmit shearing forces to the brain from a blow, especially if the blow results in a fracture of the skull. This effectively ruins the otherwise smooth working of the system, amounting to a catastrophic injury.
A good example of this is a “coup-contracoup injury” that, as the name suggests, is a three-part traumatic brain injury (TBI). The first, or “coup injury,” is defined as a traumatic brain injury that results from the initial blow to the skull. A “coup-contracoup injury” is defined as the traumatic brain injury that results to the opposite side of the brain that received the initial blow. Therefore, a coup-contracoup injury is a traumatic brain injury that occurs when the force of the initial blow is strong enough to cause the brain to move in the opposite direction and hit the opposite side of the skull in a manner similar to a whiplash. An impact that is that hard enough to result in that is likely to result in a skull fracture on the side of the head receiving the initial blow[1].
There are three primary types of skull fractures seen in adults:
1. Linear skull fractures: The most common type. While the skull is broken, it is not moved and does not ordinarily result traumatic in brain injury. Individuals who sustain this type of skull fracture do not usually require medical intervention apart from hospitalization for a few days for observation.
2. Depressed skull fractures: More serious, and can occur with or without a cut in the scalp. The fracture may require surgery to rectify the skull deformity.
3. Basilar skull fractures: The most serious type because it involves a skull fracture occurring at the base of the skull. This type of fracture includes bruising around the individual’s eyes (causing “racoon eyes”) and behind the ears. More significantly, it may be accompanied by the drainage of cerebrospinal fluid from the nose and ears due to a tear in the meninges.
For example, one study showed that the presence of a skull fracture or concussion in individuals without intracranial hemorrhage or focal neurologic deficit was attended by cognitive impairments and emotional deficits at about double the rate as those without either complication[2].
Due to these neurological deficits, individuals sustaining such injuries generally require post-acute neurorehabilitative services. At NeuLife, our programs and services are focused and individualized. Our specialized programs and rehabilitation are tailored to each of our clients based on clinical needs and personal preferences. We focus on the achievement of personal fulfillment, increased independence and successful outcomes. Our multidisciplinary team carefully formulates a customized Client Goal Plan for each client.
NeuLife’s philosophy is that healing, wellness and personal fulfillment are best accomplished in a positive and uplifting therapeutic environment where caring staff encourage, assist and support each client so he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to increase function and independence. NeuLife seeks to achieve, for all of its clients, maximized, sustained outcomes that exceed the expectations of all persons served.
NeuLife, in Mount Dora, Florida, is a fully accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with traumatic brain injury (TBI), spinal cord injury (SCI), traumatic amputations and other catastrophic injuries.
2725 Robie Avenue
Mount Dora, Florida 32757
[1] http://northwestern.edu.neutotraumaticbraininjury/what-is-tbi/types-of-damage/
[2] Jackson,JS. J. Trauma. 2007 Jan;62(1)80-8. Long-term cognitive, emotional, and functional outcomes in trauma intensive care unit survivors without intracranial hemorrhage.PMID 17215737
