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 sequelae. This concept is known as the Monro-Kellie doctrine, which states that the total intracranial volume is fixed by the inelastic volume of the skull. This volume is divided into three compartments: the brain parenchyma, the blood volume, and the cerebrospinal fluid (CSF). 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 in the volume of one of the other intracranial components.
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.
Surgical Locations: Sisters of Charity Hospital, Niagara Falls Memorial Medical Center, Millard Fillmore Suburban Hospital, Mercy Hospital of Buffalo, Buffalo General Medical Center, Gates Vascular Institute, Kenmore Mercy Hospital