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More on Brain and Spine Trauma
Neurology and Neuroscience
Brain and Spine Trauma
About Brain and Spine Trauma
Brain and spinal injuries are most often caused by motor vehicle crashes, sports injuries, firearms, or falls on the playground, at work, or in the home. More than a million Americans experience a brain injury each year, and 80,000 people have long-term disabilities as a result of their injury. Spinal cord injuries affect between four and five million Americans yearly, and 400,000 live with the continuing effects of these injuries.
Brain trauma is usually the result of a direct blow to the head, which can bruise the brain and damage its internal tissues and blood vessels. The severity of a brain injury can range from a mild concussion to a severe injury that results in coma or even death. In a closed brain injury there is no break in the skull and the brain is jarred against the sides of the skull, shearing (or tearing) the internal lining, nerves, tissues, and blood vessels, causing bleeding, bruising, or swelling. In a penetrating or open head injury the skull is broken.
The sudden and profound injury the brain sustains at the time of the accident is called the primary brain injury. It can be followed by secondary brain injury, a cascade of cellular, chemical, tissue, or blood vessel changes that evolve in the hours to days after the accident. These changes can further destroy brain tissue.
An injury to the spinal cord, the central carrier of signals throughout the body, may be simply a bruise (or contusion), or a partial or complete tear. A mild contusion may cause the temporary loss of some function below the site of the injury. A complete transection, or severing of the spinal cord, causes a total and permanent loss of sensation and movement below the site of the tear.
NewYork-Presbyterian's Approach to Brain and Spine Trauma
NewYork-Presbyterian Hospital provides expert care to patients with brain and spinal injuries. Patients treated at NewYork-Presbyterian benefit from the combined skills of a team of specialists that includes neurosurgeons, endovascular surgeons, neurologists, neuroradiologists, and anesthesiologists. Our Neurology and Neurosurgery programs consistently rank among the top five in the country in US News and World Report's America's Best Hospitals Survey.
Level One Trauma Center
Our Hospital houses a New York State designated Level 1 Adult Trauma Program at its NewYork-Presbyterian Hospital/Weill Cornell Medical Center campus, and a Level 1 Regional Pediatric Trauma Program at both its NewYork-Presbyterian/Weill Cornell and NewYork-Presbyterian Hospital/Columbia University Medical Center campuses. At both locations, specially trained and designated trauma teams are available 24 hours a day, seven days a week to treat the most severely injured patients.
NewYork-Presbyterian/Columbia and NewYork-Presbyterian Hospital/Weill Cornell both treat trauma patients in their Neurological Intensive Care Units, or Neuro-ICUs. The Neuro-ICUs have specially trained medical staff, sophisticated monitoring techniques, and specialized treatments that are focused solely on improving the outcomes of patients with brain or spine trauma and other neurological problems.
Treatment for Brain and Spine Trauma
Mild Brain Injury
Treatment for brain and spine trauma is individualized, and depends on the extent of the injury. People who have suffered a mild traumatic brain injury have symptoms such as a temporary loss of consciousness and a loss of some memory of the events immediately before or after the accident. They may feel dazed, disoriented, or confused and have temporary focal neurological deficits such as problems with vision, smell, hearing, taste, and eye movements. People with these symptoms should be evaluated with CT scan of the brain to rule out possible bleeding inside the skull. In most cases people recover completely from a mild brain injury within a few weeks, and do not require further treatment. If a patient's symptoms do not subside within 30 to 60 days, he or she should be evaluated by a neurologist and neuropsychologist.
Severe Brain Injury
Patients with severe head injuries require monitoring to determine if the brain has swollen and intracranial pressure (pressure inside the skull) is increased, as this can lead to brain damage. Neurologists use a technique called intracranial pressure (ICP) monitoring to measure the level of pressure within a patient's skull. Surgeons may remove part of the skull to alleviate the pressure on the brain and prevent further swelling. This procedure is called a decompressive craniectomy. Neurologists may also use cooling technologies that monitor the temperature of the brain and body to prevent fever, which can develop in patients suffering from brain injury. Ongoing care for brain trauma patients may include rehabilitation and medications to address neurological and physical changes resulting from the injury.
People who have suffered a spinal injury require immediate treatment to prevent further damage to the spinal cord. At the scene of the accident medical personnel should immobilize the person's head, neck, and back and administer steroid medications to control swelling. Immediate surgery may be necessary to evaluate the state of the spinal cord, stabilize fractured vertebrae, release pressure from the injured area, and treat injuries to other parts of the body.
There is no way to regenerate nerve tissue that has been damaged, but ongoing treatment and rehabilitation may allow some people with spinal trauma to regain some feeling and function. Depending on the severity of the injury, patients may require long-term interventions such as mechanical ventilation to help them breath, a catheter to drain the bladder, or a feeding tube to provide extra nutrition and calories.
Rehabilitation for Brain and Spine Trauma Patients
Physical, occupational, and speech therapy are important parts of the long-term recovery process for people with brain and spinal injuries. Rehabilitation focuses on preventing muscle wasting and contracture, helping patients retrain certain muscles to make up for the loss of others, and improving communication in patients who have lost some ability to speak and gesture.
Rehabilitation of the patient with a brain injury begins during the acute treatment phase and becomes more comprehensive as the patient's condition improves. Depending on the region of the brain that is damaged, people who have suffered a severe brain injury may lose some part of muscle, speech, vision, hearing, and taste, and may also experience long- or short-term changes in personality or behavior. Rehabilitation specialists work with patients to recover from or compensate for these losses, and can help patients and their families focus on maximizing the patient's capabilities at home and in their community.
NewYork-Presbyterian Hospital's Rehabilitation Program has been cited by US News and World Report as one of the best in the country. Our multi-disciplinary rehabilitation team includes physical therapists, occupational therapists, and physicians trained specifically in neurological rehabilitation. Team members create an individualized treatment and recovery plan for each patient. The rehabilitation program provides treatment in all phases of care, including acute care, and in-patient and out-patient settings.
Research for Brain and Spine Trauma
Doctors at NewYork-Presbyterian Hospital are involved in several ongoing research trials to optimize neurological outcomes in patients who have sustained brain or spinal cord injuries.