Traumatic Central Nervous System Injury

Abstract

Neurotrauma is a major health problem worldwide, causing serious disability in hundreds of thousands of people every year. Research has begun to uncover the key biochemical processes that are unleashed after injury, which cause further damage to neurons and axons, as well as the biological signals that control regrowth of new functional structures to replace injured tissue. A coordinated interplay between acute neuroprotective treatment and stimulation of regeneration will offer new hope to patients suffering from the effects of brain or spinal cord injury.

Keywords: trauma; brain; spinal cord; neuron; axon

Figure 1.

Computed tomograms showing two common examples of traumatic brain injury. (a) Haemorrhagic contusions appear as white areas in the inferior aspect of both frontal lobes, a typical location for this type of parenchymal injury. (b) An epidural haematoma displays a characteristic biconvex shape and is most frequently due to a skull fracture and rupture of a meningeal artery. The gradual leakage of blood causes an accumulation of a haematoma between the skull and dura, with fatal consequences if large enough. Courtesy of Drs B. Guiot and P. Kalapos.

Figure 2.

(a) Topographical organization of ascending (spinothalamic tracts and posterior columns) and descending (corticospinal tract) white matter tracts in the cervical spinal cord. Fibres subserving arm and leg function are segregated. There is also a discrete grouping of axons subserving sacral (S), lumbar (L), thoracic (T) and cervical (C) segments. This type of topography often explains unique complexes of signs and symptoms depending on where in the cord a lesion appears. (b) Corticospinal fibres subserving arm function decussate at the medullary–C1 level, whereas leg fibres cross the midline lower at C1–C2. For this reason, high cord lesions may produce unusual patterns of bibrachial paresis or triplegia. Modified from Tator , with permission of The McGraw‐Hill Companies.

Figure 3.

Examples of cervical spinal cord injury as seen with magnetic resonance imaging. (a) T2‐weighted image of the cervical cord of a young boy who fell and struck his head. The odontoid process of C2 is pushed back, compressing the high cervical cord. The high signal intensity within the cord (arrow) represents oedema, but the substance of the cord was not otherwise damaged. The patient's cervical spine was surgically stabilized and he remained neurologically intact. (b) Image showing a fracture of the C4 vertebra with fragments compressing the adjacent cervical cord. High signal indicates fluid accumulation in the cord parenchyma, indicating oedema and contusion (single arrow). Low signal (double arrow) represents areas of haemorrhagic injury. Such injuries frequently result in severe neurological disability. Courtesy of Drs H. Dunlap and C. Tator.

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Stys, Peter K(Jan 2003) Traumatic Central Nervous System Injury. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1038/npg.els.0000274]