Head Injuries

Our thoughts and prayers are with Bob Woodruff and Doug Vogt, both of whom suffered head injuries after a roadside bomb explosion in Iraq. Head injuries from these roadside bombs are a huge issue for our men and women serving in Iraq, and many questions regarding bomb related head injuries are surfacing. While we don't have many details on the extent of the injuries sustained by the two ABC newsmen, I had the opportunity to ask Dr. Arno Fried, head of the Department of Neurosurgery at Hackensack University Medical Center in Hackensack, New Jersey, his views on this type of head trauma. Here's what he had to say:

Q: What are the typical head injuries associated with an explosion?

A: There are several possibilities. There can be a closed impact to the head, which causes bleeding in the head. This can take the form of a hematoma between the skull and the lining of the brain, called the dura. This is called an epidural hematoma. The danger of an epidural hematoma is that it can rapidly put pressure on the brain, and often expands quickly because the source of the bleeding is a torn artery. The second type of hematoma is a subdural hematoma. This is more serious and is a blood clot that develops between the brain and the dura. Often a subdural hematoma is associated with bruising or contusions of the brain. These hematomas usually require a craniotomy or brain surgery to repair. Another possibility is that the blow to the head can fracture the skull. The skull fracture can be pushed into the brain by the force of the explosion. If the blast crushes the skull and opens the scalp, metal or shrapnel can be driven into the brain. A final possibility is the sheer force of the explosion can cause swelling and pressure. Often a pressure monitor will be inserted into the brain to monitor the intracranial pressure and treat it most effectively.

Q: What are the surgical steps taken after these types of injuries?

A: If there is any hematoma or blood clot that develops in or near the brain and it's putting pressure on the brain, prompt brain surgery is needed to remove the blood clot and stop the bleeding. If there is a depressed skull fracture with an opening of the scalp, surgery is
needed to remove the bone fragments from the brain and close the layers of the dura, skull and scalp to prevent infection of the brain. If elevation of the intracranial pressure were suspected, surgery would be done to place an intracranial pressure monitor in the brain to treat brain pressure more effectively. The key to treating a brain injury is the control of pressure buildup that will further damage the brain and the control of bleeding in or near the brain.

Q: What are some of the injuries associated with shrapnel wounds to the head?

A: Shrapnel injury to the head can cause any of the brain injuries described above. In addition, when any foreign object is driven into the brain, it can lead to a secondary infection of the brain, a brain abscess or meningitis. Weeks to months after a shrapnel injury to the brain, epileptic seizures can develop, which would require treatment.

Q: What is the long-term outcome after these types of injuries?

A: This depends on the type of injury, the degree of damage from the initial trauma, the location of the brain affected, the rapid treatment of the head injury, and the prevention of complications of the injury in the weeks following a severe head injury. Hematomas outside the brain that are evacuated quickly have less chance of causing long-term neurological problems. Penetrating injuries with laceration of brain tissue can cause more brain damage. Therefore, the outcome after a serious head injury can be very mild to very severe depending on the variables discussed. Rapid treatment by an experienced neurosurgeon in a medical facility capable of neurologic intensive care is the key to success.

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Dr. Manny Alvarez serves as Fox News Channel's senior managing health editor. He also serves as chairman of the department of obstetrics/gynecology and reproductive science at Hackensack University Medical Center in New Jersey. For more information on Dr. Manny's work, visit AskDrManny.com.