{"id":17422,"date":"2022-07-20T18:08:33","date_gmt":"2022-07-20T16:08:33","guid":{"rendered":"https:\/\/neurologiaclinica.es\/neurological-diseases-and-disorders\/cranioencephalic-trauma\/"},"modified":"2025-04-28T11:22:50","modified_gmt":"2025-04-28T09:22:50","slug":"cranioencephalic-trauma","status":"publish","type":"page","link":"https:\/\/neurologiaclinica.es\/en\/neurological-diseases-and-disorders\/cranioencephalic-trauma\/","title":{"rendered":"Cranioencephalic trauma"},"content":{"rendered":"\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t\t
<\/div>\n\t\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t

Cranioencephalic trauma<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t

GENERAL ASPECTS OF A TCE<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

We speak of traumatic brain injury (TBI) in the event of any blow to the cranial or facial region. In young adults, it is the leading cause of mortality in the world and one of the main causes of acquired brain damage and disability. <\/span><\/p>\n

We classify them as mild, moderate or severe, with a different approach in each of these cases. For the classification by severity of TBI, we use the Glasglow coma scale, which has a maximum score of 15, when there is no impairment of the level of consciousness, and a minimum of 3 when the patient is in coma. <\/p>\n

We can also differentiate them into penetrating if an object enters the skull or closed when it does not.<\/p>\n

The leading cause of severe TBI in young adults and children is traffic accidents, and of mild TBI, falls and accidental blows. In the elderly, the main cause of TBI is falls. <\/p>\n

Other common causes are blows during sports activities, assaults, suicide attempts or accidents at work.<\/p>\n

Special care should be taken to avoid falls in the elderly due to the increased risk of intracranial hemorrhage, especially in the frail elderly and patients receiving anticoagulant therapy.<\/p>\n

<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

\n\t\t\t\t
\n\t\t\t\t\t

Most common symptoms in TBI<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Post-traumatic headache and dizziness are the most common symptoms. Post-traumatic amnesia may occur as a result of the concussion. Vomiting, confusion or tendency to sleep should alert us. Vertigo and tinnitus may occur due to alterations in the middle ear. <\/p>

Focal neurological symptoms such as loss of strength or sensitivity in the extremities, speech difficulties, visual disturbances or impaired level of consciousness indicate that we are probably facing a severe TBI.<\/p>

Focal neurological symptoms such as loss of strength or sensitivity in the extremities, speech difficulties, visual disturbances or impaired level of consciousness indicate that we are probably facing a severe TBI.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

\n\t\t\t\t
\n\t\t\t\t\t

Traumatic cranioencephalic injuries<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t
  1. Skull fracture<\/strong>. We identify them by performing an X-ray or a skull CT scan. Fractures increase the risk of intracranial hematoma. <\/li>
  2. Epidural hematoma.<\/strong> It is a collection of blood located between the skull and the dura mater (outer layer that protects the brain).<\/li>
  3. Subdural hematoma.<\/strong> In this case, the bleeding is located between the dura mater and the meninx (innermost layer protecting the brain, already in contact with the cerebral cortex). It involves a greater risk and severity than epidural hematoma. <\/li>
  4. Cerebral contusion.<\/strong> Swelling, edema and usually hemorrhage occur in an area of the brain as a result of a high-impact blow of the brain against the cranial bone.<\/li>
  5. Diffuse axonal injury.<\/strong> It is a serious situation that is accompanied by an increase in intracranial pressure with risk of deep coma and may compromise the patient’s life.<\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
    \n\t\t\t\t
    \n\t\t\t\t\t

    DIAGNOSIS AND TREATMENT<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
    \n\t\t\t\t
    \n\t\t\t\t\t\t\t\t\t

    First of all, it is essential to perform a clinical evaluation with an assessment of the level of consciousness, neurological examination and identification of symptoms and personal risk factors. Based on this initial assessment, the neurologist will decide which diagnostic tests are indicated. In emergency situations, the first choice is a cranial CT scan, since brain MRI requires more study time, identifies the hemorrhage worse and is a less accessible test. <\/span><\/p>

    The approach to be followed differs according to the severity of the TBI. In many cases, hospital observation for at least 24 hours and repeat brain imaging studies are required. Severe TBI should always be admitted to a center with Neurology, Neurosurgery and Intensive Care Unit. <\/p>

    In some situations, urgent surgical intervention by neurosurgery will be necessary, for example, in the case of a fracture compressing the brain, open wounds or large intracranial hematoma compressing other brain structures.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

    \n\t\t\t\t
    \n\t\t\t\t\t

    PROGNOSIS AND SEQUELAE<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
    \n\t\t\t\t
    \n\t\t\t\t\t\t\t\t\t

    In severe TBI in coma, the evolution of the level of consciousness during the first weeks will be crucial to assess the medium and long-term prognosis. It is necessary to initiate neuro-rehabilitation measures, including cognition and behavioral intervention, during hospital admission and continue them at discharge. <\/span><\/p>

    The sequelae will depend on the areas affected and will be more likely in patients who have suffered acute axonal injury. Motor or sensory deficits in extremities, gait, coordination and balance, speech, language or visual disturbances may appear. There is a risk of secondary epilepsy if permanent residual lesions remain in the cerebral cortex. Post-traumatic headache tends to improve with time. There may be secondary cognitive impairment and, in case of frontal lobe involvement, behavioral changes. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

    \n\t\t\t\t
    \n\t\t\t\t\t

    FREQUENT QUESTIONS<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
    \n\t\t\t\t
    \n\t\t\t\t\t\t\t\t\t

    When should I go to the neurological emergency room?<\/strong><\/p>

    1. If I have had a high-impact TBI, for example, a traffic accident, an assault, a fall from a height or a blow with a blunt object.<\/li>
    2. If there are risk factors: elderly people, children under 2 years of age, diseases affecting coagulation, anticoagulant treatment, chronic alcoholism, drug addiction, epilepsy, history of neurosurgery or severe underlying diseases such as an oncology patient with active disease.<\/li>
    3. If risk symptoms appear: headache, vomiting, amnesia, confusion or loss of consciousness.<\/li><\/ol>

      <\/p>

      If I am discharged, what should I watch for at home?<\/strong><\/p>

      A period of observation at home is recommended for at least 24 hours after discharge. During this time it is necessary to be accompanied and to wake the patient every 2 hours to evaluate the neurological situation. If drowsiness, vomiting, headache that does not respond to usual analgesia, loss of strength or sensation of cramping, speech or language alteration, vision problems, confusion, convulsions or strange behavior appear, the patient should return to the emergency department. <\/p>

      <\/p>

      What can I do to prevent TBI?<\/strong><\/p>

      1. Avoid consumption of alcohol and other intoxicants.<\/li>
      2. Always use seat belts in the vehicle and helmets when riding a motorcycle or bicycle.<\/li>
      3. Use of walking aids for the elderly or people with disabilities<\/li>
      4. Follow the appropriate precautionary measures when practicing sports.<\/li>
      5. Avoid risk situations in elderly, frail people and small children. Eliminate those elements in the home that may favor falls, such as obstacles, rugs or unnecessary steps. <\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
        \n\t\t\t\t\t\t
        \n\t\t\t\t\t
        \n\t\t\t
        \n\t\t\t\t\t\t
        \n\t\t\t\t
        \n\t\t\t\t\t\t\t\t\t
        Links of interest<\/h6>

        https:\/\/fedace.org\/<\/a><\/p>

        https:\/\/www.apanefa.es\/<\/a><\/p>

        https:\/\/senec.es\/informacion-al-paciente\/<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

        \n\t\t\t
        \n\t\t\t\t\t\t
        \n\t\t\t\t
        \n\t\t\t\t\t\t\t
        \n\t\t\t
        <\/div>\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
        \n\t\t\t\t
        \n\t\t\t\t\t\t\t
        \n\t\t\t\t\t\t\t\n\t\t\t\t\t\"Picture\n\t\t\t\t<\/a>\n\t\t\t\n\t\t\t
        \n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t

        \n\t\t\t\t\t\t\tDr. Fernando P\u00e9rez Parra\t\t\t\t\t\t<\/h4>\n\t\t\t\t\t<\/a>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t
        \n\t\t\t\t\t\t

        Date of issue 02\/15\/2024<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\tREQUEST APPOINTMENT\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

        \n\t\t\t\t
        \n\t\t\t\t\t\t\t\t\t
        \n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t<\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\tGo to List of neurological diseases and disorders<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
        \n\t\t\t\t\t\t
        \n\t\t\t\t\t
        \n\t\t\t
        \n\t\t\t\t\t\t
        \n\t\t\t\t
        \n\t\t\t\t\t\t\t
        \n\n\t\t\t\t\t\t
        \n\t\t\t\t\n\t\t\t\t
        \n\n\t\t\t\t\t\t\t\t\t

        \n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSpecialists\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

        \n\t\t\t\t\t\tMeet our extensive team\n\n\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

        \n\t\t\t
        \n\t\t\t\t\t\t
        \n\t\t\t\t
        \n\t\t\t\t\t\t\t
        \n\n\t\t\t\t\t\t
        \n\t\t\t\t\n\t\t\t\t
        \n\n\t\t\t\t\t\t\t\t\t

        \n\t\t\t\t\t\t\n\t\t\t\t\t\t\tWhat are we dealing with?\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

        \n\t\t\t\t\t\tSpecialized professionals\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

        \n\t\t\t
        \n\t\t\t\t\t\t
        \n\t\t\t\t
        \n\t\t\t\t\t\t\t
        \n\n\t\t\t\t\t\t
        \n\t\t\t\t\n\t\t\t\t
        \n\n\t\t\t\t\t\t\t\t\t

        \n\t\t\t\t\t\t\n\t\t\t\t\t\t\tRequest an appointment\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t

        \n\t\t\t\t\t\tContact us\n\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

        \n\t\t\t\t\t\t\t
        <\/div>\n\t\t\t\t\t\t\t
        \n\t\t\t\t\t
        \n\t\t\t
        \n\t\t\t\t\t\t
        \n\t\t\t\t
        \n\t\t\t\t\t

        GET INFO:<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
        \n\t\t\t\t
        \n\t\t\t\t\t\t\t\t\t
        \n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tAbout our Programs, Units and Treatments<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

        GENERAL ASPECTS OF A TCE We speak of traumatic brain injury (TBI) in the event of any blow to the cranial or facial region. In young adults, it is the leading cause of mortality in the world and one of the main causes of acquired brain damage and disability. We classify them as mild, moderate […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":16593,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-17422","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/neurologiaclinica.es\/en\/wp-json\/wp\/v2\/pages\/17422","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/neurologiaclinica.es\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/neurologiaclinica.es\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/neurologiaclinica.es\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/neurologiaclinica.es\/en\/wp-json\/wp\/v2\/comments?post=17422"}],"version-history":[{"count":7,"href":"https:\/\/neurologiaclinica.es\/en\/wp-json\/wp\/v2\/pages\/17422\/revisions"}],"predecessor-version":[{"id":17786,"href":"https:\/\/neurologiaclinica.es\/en\/wp-json\/wp\/v2\/pages\/17422\/revisions\/17786"}],"up":[{"embeddable":true,"href":"https:\/\/neurologiaclinica.es\/en\/wp-json\/wp\/v2\/pages\/16593"}],"wp:attachment":[{"href":"https:\/\/neurologiaclinica.es\/en\/wp-json\/wp\/v2\/media?parent=17422"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}