Brain Injury

The brain has several features that distinguish it from other organ systems. The most important of these differences is that the brain is contained within the skull, a rigid and inelastic container. Because of this, only small increases in volume within the intracranial compartment can be tolerated before pressure within the compartment rises dramatically, causing neurological problems. When a significant head injury occurs, cerebral edema often develops, which increases swelling in the brain. Because the space inside the skull is fixed, the pressure within this compartment rises unless some action occurs to decrease the volume of one of the other intracranial components.

In pediatric head trauma, the child’s brain presents a different developmental substrate for injury. It has greater water content than the adult’s and is relatively resistant to damage from hypoxia. However, coma may still result from brainstem injury or bilateral hemispheric damage.

Spine Injury

The diagnosis of an unstable spinal injury and its subsequent management can be difficult, and a missed spine injury can have devastating long-term consequences. Therefore, spinal column injury must be presumed until it is excluded. The main concerns are which patients can be cleared by clinical exam alone, which imaging studies are necessary, and when should additional imaging be used. An assessment for ligamentous injury in the absence of a fracture is also important, especially in unconscious patients who are unable to complain of neck pain or tenderness.