Neurotraumatology | Doctors & Treatment Information

Neurotraumatology deals with traumatic injuries to the skull, brain, spine, spinal cord, and peripheral nerves.

The focus is on fractures and damage to the brain and spinal cord that cause neurological disorders. Doctors use conservative or surgical methods for treatment.

• Traumatic Brain Injury

In a traumatic brain injury, the skin, skull, meninges, brain, and blood vessels may be affected. Approximately 50% of traffic accident victims suffer from a traumatic brain injury.

In 80% of cases, the injury is mild; 20% have moderate or severe injuries. These typically involve skull fractures, cerebral hemorrhages, brain swelling, or contusions.

To assess the severity of the injury, doctors use the Glasgow Coma Scale (GCS). It measures the patient’s level of consciousness as well as verbal and motor responses.

Symptoms of mild trauma (GS 13–15) subside within a few days. In cases of moderate trauma (GS 9–12), symptoms may take up to a month to subside. Long-term effects are rare. Severe trauma (GS 3–8), which is accompanied by a loss of consciousness lasting more than 30 minutes, can lead to long-term complications.

Common causes of traumatic brain injury include falls, traffic accidents, and sports injuries @ vladim_ka /AdobeStock

• Spinal Trauma

Spinal trauma affects the spine and the spinal cord. Vertebrae, intervertebral discs, ligaments, and the spinal cord may be affected. Here, too, the spectrum of injuries ranges from temporary functional impairments to contusions with tissue damage.

Each year, approximately 30 out of every million people suffer traumatic paraplegia as a result of spinal trauma. Depending on whether the injury occurs in the cervical, thoracic, or lumbar region, it results in paraplegia or tetraplegia.

Paraplegia refers to the complete paralysis (plegia) of both legs. Tetraplegia is the complete paralysis (plegia) of all four limbs and is one of the forms of spinal cord injury.

Complete paralysis involves a loss of both superficial and deep sensation. The patient can no longer feel their limbs. In addition, reflexes and bladder and bowel function are impaired. Incomplete paralysis presents with varying patterns of sensory loss.

• Traumatic Damage to Peripheral Nerves

Peripheral nerves are also affected by traumatic injuries: hemorrhages, swelling, contusions, or tears of the nerves may occur.

Neurological injuries lead to impaired function of the affected organs. Classifying the injury by severity allows for a prognosis regarding the nerve’s ability to regenerate and the duration of recovery.

Peripheral nerves can recover from mild compression injuries within 3–4 weeks. In the case of a complete transection, surgical repair is necessary, as the nerve will not heal on its own. If only the axon is affected, the prognosis is more favorable and the nerve can regenerate.

The cause is usually a forceful impact. This can be blunt force, such as from a fall, blow, or collision. Traffic accidents account for 50–70% of traumatic neurological injuries.

The following causes are also responsible for damage to the central nervous system and the peripheral nervous system:

• Accidents in the home
• Work-related accidents
• Sports accidents
• Penetrating injuries
• Gunshot wounds

Traumatic injuries can affect people of any age, regardless of gender. Road traffic and certain sports are among the main risk factors.

Young men between the ages of 20 and 40 are more frequently affected by paraplegia. However, in many cases, the ability to walk can be fully or partially restored.

Only 50% of patients with spinal cord trauma remain wheelchair-dependent after neurorehabilitation.

Neurologists use diagnostic tools to determine which structures are affected and the severity of the injury.

Physical and neurological examinations are the first steps. Nausea, worsening headaches, neck stiffness, dizziness, excessive sweating, or irritability can be warning signs of a brain injury. Symptoms may appear up to 48 hours after the accident. If you notice such symptoms after a fall, a specialist evaluation is absolutely necessary.

A two-view X-ray provides information about the integrity of the bony structures. This allows for the detection of skull or vertebral fractures.

Computed tomography (CT) scans are highly sensitive for imaging the brain and spinal cord. Surgeons often use them to plan surgeries.

Magnetic resonance imaging (MRI) can be used to diagnose swelling, bleeding, soft tissue involvement, or cerebrospinal fluid accumulation.

Depending on the structures involved, angiography for visualizing blood vessels or Doppler sonography may be helpful.

Electrophysiological neuromonitoring tools are also used. Electrophysiological diagnostic procedures include the EEG (electroencephalogram) and the EMG (electromyography).

A CT scan of the brain is used when a rapid diagnosis is necessary @ My Ocean studio /AdobeStock

Neurosurgeons specializing in neurotraumatology and spinal surgery can be found in large hospitals or specialized centers. These facilities are equipped with the necessary diagnostic tools (CT, MRI) and modern equipment for microsurgical procedures.

Follow-up care is provided by rehabilitation clinics staffed with specialists in neurological therapies. The German Society for Neurotraumatology and Clinical Neurorehabilitation represents this medical specialty.

The prognosis for patients with traumatic injuries to the central nervous system is quite good, despite the lengthy nature of treatment.

Advanced diagnostic methods ensure more accurate assessments of the severity and progression of the condition. A brain injury can lead to long-term neurological impairments that require outpatient care or support from family members.