Skull Fracture after Severe Head and Brain Trauma
Skull Fractures – Severe Brain Injury
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“Skull fracture” means that a bone of the skull has been broken. While it is possible that it can occur without a significant brain injury, it usually involves some brain injury. While the injury to the underlying brain can be relatively mild, a skull fracture can also cause catastrophic brain injury.
It takes considerable force to break the skull. The skull’s first role is to protect the brain. Like a bicycle helmet, it can sometimes absorb considerable force, reducing the direct force on the brain. There are times when the skull is fractured with little gross damage to brain structures. Still the amount of force it takes to fracture a skull, especially in motor vehicle accidents, likely involves enough force to injure brain tissue near the skull. The risk of an associated brain bruise can be increased 400 fold after a skull fracture.
Most skull fractures are readily diagnosed with CT or X-ray. Seeing actual injury to the brain is much more difficult with CT or X-ray, especially if the brain injury does not involve a bleed or hematoma. MRI’s are much more sensitive to brain injury.
Skull fractures are generally classified as either displaced or non-displaced. With a displaced skull fracture, the skull is pushed out of place, likely contacting and injuring the brain and or its protective coatings.
The Role of Dura In Understanding Skull Fracture and Severe Pathology
As we explained at The Skull, the Brains Helmet, between the skull and the brain are layers of meninges, which work to add a shock absorption system and protecting coating. The principal coating is the dura. The “dura”, is almost like a tight fitting bag. It is the dura which first makes contact with the skull in an injury event. While it protects the brain in some situations, this bag can also cause severe problems in cases of bleeds or hematoma, as it traps fluids in places that can rapidly escalate intracranial pressure.