Let's talk a bit about brain injuries, which can include anything from seemingly minor hits to the noggin to severe stroke. The brain itself sits bathed in cerebrospinal fluid within the skull. The spinal cord emerges from the brain at the bottom; its protection afforded by the vertebrae of the spine.

It's a pretty snug fit inside the skull, but there's still just enough room such that a knock on the head with sufficient force causes the brain to bounce back and forth from the impact. A bang forceful enough could cause two brain injuries; one at the point of impact and the other at the opposite point where the brain bounced off the opposite side of the skull.

The term "concussion" is used when there is a head injury with any transient (short-lived or minor) neurological deficits that last only for a few moments after the injury. A neurologic deficit means anything from trouble remembering things, headache or double vision. Regardless of "short-lived" or not, most blunt traumas to the head should be medically evaluated. You may not need an MRI or emergency treatment right then and there, but at least a baseline evaluation could be documented against and comparisons could be made should the situation change within 24 hours or as long as 24 days.

One of the most difficult treatment decisions a medical person has to make is what to do with a patient that has sustained even what seems like a minor head injury. There are no clear-cut guidelines; even the standard of keeping a person awake or at least waking him every two hours is debated as to its usefulness. The one thing that is indisputable is that repeated insults to the head have a cumulative negative effect. All the more reason for protective equipment like helmets to be worn when head injuries are a possibility.

Strokes (the new terminology is "brain attack," analogous to "heart attack"), do not require any external force to occur. They occur as a result of either a blood clot blocking blood supply of oxygen and other vital nutrients to brain tissue, or the blood vessel itself rupturing allowing bleeding within the brain, which then builds pressure against brain tissue leading to that area's cellular death. Strokes occur suddenly, without warning or precipitating an event and unless they are Transient Ischemic Attacks (TIAs), which are little strokes from which the brain recovers quickly, the symptoms are far more dramatic than the symptoms of concussion. Suspected strokes and TIAs are an emergent condition and require immediate medical attention. Treatment is available to stop the progression of stroke and maybe even reverse the potential damage already sustained by the brain.

Since the skull is a bone, its most concerning injury is a fracture. When the skin over the head or scalp is broken there will always be a lot of blood. However, the laceration should be thoroughly cleansed and evaluated by a professional person to ascertain the presence of any tissue that looks like brain matter poking through a laceration. Obviously, a situation that speaks for itself as to its degree of concern.

Whenever an individual has a head injury or suspicions of stroke, especially the very young or very old, you can never be faulted for raising the question of obtaining a medical evaluation.

Agnes Oblas is a nurse practitioner with a private practice and residence in Ahwatukee Foothills. For questions, or if there is a topic you would like her to address, call her at (602) 405-6320 or e-mail her at agirnnp@cox.net. Her Web site is www.newpathshealth.com.

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