Central Nervous System Trauma

Author(s):  
Colin Smith ◽  
R. Ross Reichard

This chapter covers the pathological changes seen in the nervous system, both the brain and spinal cord, as a result of the application of forces, including blunt force, penetrating, and blast head injuries. Forces can result in both focal pathology, such as contusions and subdural hemorrhage, and disseminated pathology, such as diffuse traumatic axonal injury; the macroscopic and microscopic changes of these lesions are discussed. In addition, the age-dependent pathology that may be seen, including abusive head trauma in infants, is discussed. While many of the changes associated with head injury are acute and cause immediate clinical problems, there is discussion of chronic traumatic encephalopathy, an evolving entity possibly associated with the long-term complications of head injury in some individuals.

2020 ◽  
Vol 22 (1) ◽  
pp. 387-407
Author(s):  
Eric A. Nauman ◽  
Thomas M. Talavage ◽  
Paul S. Auerbach

Subconcussive head injury represents a pathophysiology that spans the expertise of both clinical neurology and biomechanical engineering. From both viewpoints, the terms injury and damage, presented without qualifiers, are synonymously taken to mean a tissue alteration that may be recoverable. For clinicians, concussion is evolving from a purely clinical diagnosis to one that requires objective measurement, to be achieved by biomedical engineers. Subconcussive injury is defined as subclinical pathophysiology in which underlying cellular- or tissue-level damage (here, to the brain) is not severe enough to present readily observable symptoms. Our concern is not whether an individual has a (clinically diagnosed) concussion, but rather, how much accumulative damage an individual can tolerate before they will experience long-term deficit(s) in neurological health. This concern leads us to look for the history of damage-inducing events, while evaluating multiple approaches for avoiding injury through reduction or prevention of the associated mechanically induced damage.


Author(s):  
Colin Smith

This chapter describes and illustrates the various pathological processes that result from head injury. Clinical, neuroradiological, and pathological data allow the separation of focal or diffuse damage. Focal lesions include scalp and skull lesions, contusions and lacerations of the brain, and intracranial hemorrhages. Diffuse lesions in traumatic brain injury include diffuse ischemia, diffuse traumatic axonal injury, and diffuse brain swelling. The consequences of penetrating injuries, blast injuries, and chronic traumatic encephalopathy resulting from repetitive head injury are also described. Separate sections are devoted to spinal cord injury and the consequences of brain injury in infants and children.


Neurosurgery describes the surgical treatment and management of various disease processes that target the brain, spinal cord, and peripheral nervous system. The specialty is wide and varied as increasing numbers of neurological conditions can now be improved following neurosurgery; for example, some types of epilepsy respond to the insertion of a vagal nerve stimulator, Parkinson’s disease symptoms can be diminished with a deep brain stimulator, and intractable back pain may be improved following spinal surgery. Practitioners must be equipped with the knowledge and skills to care for these patients and meet their immediate and long-term needs.


Author(s):  
J. Eric Ahlskog

As a prelude to the treatment chapters that follow, we need to define and describe the types of problems and symptoms encountered in DLB and PDD. The clinical picture can be quite varied: problems encountered by one person may be quite different from those encountered by another person, and symptoms that are problematic in one individual may be minimal in another. In these disorders, the Lewy neurodegenerative process potentially affects certain nervous system regions but spares others. Affected areas include thinking and memory circuits, as well as movement (motor) function and the autonomic nervous system, which regulates primary functions such as bladder, bowel, and blood pressure control. Many other brain regions, by contrast, are spared or minimally involved, such as vision and sensation. The brain and spinal cord constitute the central nervous system. The interface between the brain and spinal cord is by way of the brain stem, as shown in Figure 4.1. Thought, memory, and reasoning are primarily organized in the thick layers of cortex overlying lower brain levels. Volitional movements, such as writing, throwing, or kicking, also emanate from the cortex and integrate with circuits just below, including those in the basal ganglia, shown in Figure 4.2. The basal ganglia includes the striatum, globus pallidus, subthalamic nucleus, and substantia nigra, as illustrated in Figure 4.2. Movement information is integrated and modulated in these basal ganglia nuclei and then transmitted down the brain stem to the spinal cord. At spinal cord levels the correct sequence of muscle activation that has been programmed is accomplished. Activated nerves from appropriate regions of the spinal cord relay the signals to the proper muscles. Sensory information from the periphery (limbs) travels in the opposite direction. How are these signals transmitted? Brain cells called neurons have long, wire-like extensions that interface with other neurons, effectively making up circuits that are slightly similar to computer circuits; this is illustrated in Figure 4.3. At the end of these wire-like extensions are tiny enlargements (terminals) that contain specific biological chemicals called neurotransmitters. Neurotransmitters are released when the electrical signal travels down that neuron to the end of that wire-like process.


2018 ◽  
Vol 38 (03) ◽  
pp. 355-370
Author(s):  
Michael Sweeney

AbstractAutoimmune diseases of the nervous system in children are composed of a heterogeneous group of rare disorders that can affect the central or peripheral nervous system at any level. Presentations may occur in children of any age and are typically acute or subacute in onset. Consideration of an autoimmune process as the etiology of neurologic diseases in children is important, as it may lead to early initiation of immunotherapy and an improvement in long-term neurologic outcomes. The developing nervous and immune systems in children create unique challenges in diagnosis and treatment of these rare diseases. In this review, autoimmune diseases affecting the brain, spinal cord, nerve roots, peripheral nerves, neuromuscular junction, and muscle in children are described.


Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S21.1-S21
Author(s):  
Michael Pepper ◽  
Jeff Wayland ◽  
Adam Elwood ◽  
Spencer Walser ◽  
Vi Tran ◽  
...  

ObjectiveThe aim of our study is to assess the rate of concussion occurring while engaging in nontraditional sports such as Quidditch, and the effects that injury during a novelty sport may have on concussion detection when compared to more traditional sports.BackgroundConcussions, once dismissed as nonconsequential, are rapidly attracting notice for acute and long-term health effects. Rates of recovery with repeated trauma is known to decrease with each occurrence. In novelty sports, regulation of concussions and proper return-to-play(RTP) protocol are not routinely enforced, resulting in repetitive injury to the detriment of players.Design/MethodsIRB approval was obtained prior to survey distribution to all players associated with Major League Quidditch (MLQ). Responses were recorded and analyzed.Results157 responses were received. 63% were male and 37% female with mean age 22.9. 146 (93%) respondents confirmed or denied quidditch-related head injury. 22 (15%) denied head injury and 124 (85%) indicated hitting their heads while participating in the sport. 19% of respondents indicated >10 head injuries. 67 (54%) reported suspected concussion with an additional 41 (33%) reporting formal diagnosis with at least one concussion. EMS reported 18 injuries at MLQ matches. 5 (27.8%) were preliminarily diagnosed with concussion. 3 had no further treatment, 1 RTP and 1 received basic care. 0 recieved formal neurologic evaluation. Players were also asked about head injuries sustained in non-quidditch activities for comparison. 43 (27%) reported having medically diagnosed concussions outside of quidditch. 53 (34%) reported at least one suspected concussion without formal diagnosis. 24 (15%) answered maybe.ConclusionsOur data supports that concussion is a significant burden in novelty sports such as quidditch. It is vital to recognize that with the rise of nontraditional sports, the prevalence of concussions in younger nontraditional athletes may be underreported and that concussion specialists must be cognizant of both traditional and novelty sports when evaluating long term effects of head trauma.


2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Michael Saulle ◽  
Brian D. Greenwald

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that is a long-term consequence of single or repetitive closed head injuries for which there is no treatment and no definitive pre-mortem diagnosis. It has been closely tied to athletes who participate in contact sports like boxing, American football, soccer, professional wrestling and hockey. Risk factors include head trauma, presence of ApoE3 or ApoE4 allele, military service, and old age. It is histologically identified by the presence of tau-immunoreactive NFTs and NTs with some cases having a TDP-43 proteinopathy or beta-amyloid plaques. It has an insidious clinical presentation that begins with cognitive and emotional disturbances and can progress to Parkinsonian symptoms. The exact mechanism for CTE has not been precisely defined however, research suggest it is due to an ongoing metabolic and immunologic cascade called immunoexcitiotoxicity. Prevention and education are currently the most compelling way to combat CTE and will be an emphasis of both physicians and athletes. Further research is needed to aid in pre-mortem diagnosis, therapies, and support for individuals and their families living with CTE.


The intention of the author in the present paper, is, not to bring forwards any new facts, but to take a general review of the inferences deducible from the series of facts detailed by him in previous papers communicated to this Society. He divides the nerves into two classes, essentially differing in their functions. The first comprehends those nerves, which, proceeding directly from the brain and spinal cord to other parts, convey in the one case to those parts the influence of those organs only from which they originate, and thus excite to con­traction the muscles of voluntary motion ; and in the other case transmit to the sensorium impressions made on the parts to which they are distributed. The second class comprises what may betermed the Ganglionic nerves, or those which enter ganglions, pro­perly so called; that term being limited to such protuberances only as receive branches of nerves proceeding from the brain and spiral cord. These nerves are distributed more especially to the vital or­ gans, as the thoracic and abdominal viscera, and to the muscles sub­servient to their functions. The nerves belonging to this class also convey impressions to the sensorium, and occasionally excite the muscles of involuntary motion, which, in common with all muscles, possess an inherent power of contractility dependent solely on their own mechanism, and which in ordinary cases are excited by stimuli peculiar to themselves. But the most important function of the gan­glionic nerves, is that of supporting the processes of secretion and assimilation, which require for their performance the combined influ­ence of the whole brain and spinal cord. Viewed as a whole, the system of ganglionic nerves, therefore, constitutes, in the strictest sense, a vital organ. Thus the sensorium, though connected by means of the cerebral and spinal nerves only partially with the organs of sense and voluntary motion, is, by means of the ganglionic nerves, connected generally with all the functions of the animal body. Hence affections of the stomach and other vital organs extend their influence over every part of the frame; while those of a muscle of voluntary motion, or even of an organ of sense, although possessing greater sensibility, are confined to the injured part. From a due consideration of the phenomena of the nervous system, it would appear that they imply the operation of more than one prin­ciple of action. The sensorial power is wholly distinct from the ner­vous power; the former residing chiefly in the brain, while the latter belongs equally to the spinal cord and brain, and may be exercised independently of the sensorial power. In like manner, the muscular power resides in the muscles, and may be called into action by various irritations independently of the nervous power, though fre­quently excited by the action of that power. The muscles of volun­tary motion are subjected to the sensorial power through the inter­vention of the nervous system; and those of involuntary motion are also, under certain circumstances, capable of being excited through the nerves by the sensorial power, particularly when under the influ­ence of the passions. The same observation applies also to other actions which properly belong to the nervous power, such as the evolution of caloric from the blood, and the various processes of se­cretion and of assimilation. That the nervous power is in these instances merely the agent of other powers, and is independent of the peculiar organization of the nerves, is proved by the same effects being produced by galvanism, transmitted through conductors diffe­rent from the nerves. The successive subordination of these several powers is shown during death, when the sensorial functions are the first to cease, and the animal no longer feels or wills, but yet the nervous power still continues to exist, as is proved by the nerves be­ing capable, when stimulated, of exciting contractions in the muscles, both of voluntary and of involuntary motion,of producing the evolution of caloric and of renewing the processes of secretion. In like manner the power of contraction, inherent in the muscular fibre, survives the destniction of both the sensorial and nervous powers, having an existence independent of either, although in the entire state of the functions they are subjected to the entire influence of both.


1972 ◽  
Vol 37 (5) ◽  
pp. 580-590 ◽  
Author(s):  
Enrica Grossi-Paoletti ◽  
Pietro Paoletti ◽  
Stefano Pezzotta ◽  
Davide Schiffer ◽  
Armando Fabiani

✓ Tumors of the nervous system grew in rats treated at birth with ethylnitrosourea through intracerebral or subcutaneous routes and in fetal rats treated through the mother. In 80% to 85% of the rats, single and multiple tumors developed in the brain and spinal cord regardless of the route of administration. Gasserian neurinomas, oligodendrogliomas, and oligogendroglial foci were the most frequent neoplasms. General morphological aspects and frequency of tumor localizations in relation to drug administration route are discussed. Thymidine incorporation into DNA, and RNA/DNA ratio, were evaluated in order to estimate tumor proliferation rate and growth. Desmosterol, a characteristic sterol of brain tumors, was detected in all the tumors. Regions of the brain and spinal cord of treated rats showed the presence of microscopic pretumoral areas (oligodendroglial foci) which incorporated thymidine into DNA in contrast to the brains of control rats.


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