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Phillip Hughes: How is the brain injured? | Phillip Hughes: How is the brain injured? |
(about 20 hours later) | |
Phillip Hughes collapsed after being hit by a cricket ball at the top of his neck and the base of the skull. | Phillip Hughes collapsed after being hit by a cricket ball at the top of his neck and the base of the skull. |
One of the major arteries into the brain split and caused massive bleeding. | One of the major arteries into the brain split and caused massive bleeding. |
The brain is a very delicate and vulnerable organ, which is surrounded by the skull - a defensive wall of bone - and a cushioning fluid. | The brain is a very delicate and vulnerable organ, which is surrounded by the skull - a defensive wall of bone - and a cushioning fluid. |
But it is not a simple case of the brain having specific weak spots. | But it is not a simple case of the brain having specific weak spots. |
"The brain is protected by the skull, but the upper neck is vulnerable," said Peter Hutchinson, a professor of neurosurgery at University of Cambridge. | "The brain is protected by the skull, but the upper neck is vulnerable," said Peter Hutchinson, a professor of neurosurgery at University of Cambridge. |
He told the BBC: "We evolved to enable a neck with a lot of movement, but the consequence is a risk of injury to the vessels from excessive movement or direct trauma." | He told the BBC: "We evolved to enable a neck with a lot of movement, but the consequence is a risk of injury to the vessels from excessive movement or direct trauma." |
The vertebral arteries run up both sides of the neck and the blow from the ball caused a dissection, in which the artery ruptures. | The vertebral arteries run up both sides of the neck and the blow from the ball caused a dissection, in which the artery ruptures. |
Antonio Belli, professor of trauma neurosurgery at the University of Birmingham, said: "The vertebral arteries supply the brain stem, which controls breathing and heart rhythm, so I think that could be why he stopped breathing immediately." | |
Types of injury | Types of injury |
While vertebral artery dissections are rare, there are two common types of brain injury known as "focal" and "diffuse". | While vertebral artery dissections are rare, there are two common types of brain injury known as "focal" and "diffuse". |
Focal injuries tend to be caused by falls and assaults. They are the result of a damage to one area of the brain, which results in a blood clot. | Focal injuries tend to be caused by falls and assaults. They are the result of a damage to one area of the brain, which results in a blood clot. |
This occupies space and causes pressure on the surrounding brain, starving the organ of oxygen leading to brain cells dying. It is treated by removing the clot. | This occupies space and causes pressure on the surrounding brain, starving the organ of oxygen leading to brain cells dying. It is treated by removing the clot. |
However, damage may not be confined to just the site of the impact - known as a "coup injury". | However, damage may not be confined to just the site of the impact - known as a "coup injury". |
The brain floats inside the skull so can collide with the side of the skull opposite the impact causing a "contra-coup injury". | The brain floats inside the skull so can collide with the side of the skull opposite the impact causing a "contra-coup injury". |
The front of Olympic rower James Cracknell's brain was damaged when he was struck on the back of the head while cycling. | The front of Olympic rower James Cracknell's brain was damaged when he was struck on the back of the head while cycling. |
Widespread | Widespread |
The other class of injury is largely the result of high speed road accidents. | The other class of injury is largely the result of high speed road accidents. |
In diffuse injuries the damage is spread across the brain, which becomes swollen. | In diffuse injuries the damage is spread across the brain, which becomes swollen. |
The pressure builds in the tight confines of the skull and the flow of blood can be impaired. | The pressure builds in the tight confines of the skull and the flow of blood can be impaired. |
Treatment requires lowering the pressure in the brain. | Treatment requires lowering the pressure in the brain. |
It is also possible to damage the brain without a direct blow to the head. | It is also possible to damage the brain without a direct blow to the head. |
The brain sits in fluid inside the skull and can bounce around if there is enough force. | The brain sits in fluid inside the skull and can bounce around if there is enough force. |
In something like severe whiplash the brain can be shaken around the skull, even though no blow is delivered. | In something like severe whiplash the brain can be shaken around the skull, even though no blow is delivered. |
Mr Belli told the BBC: "Often what does the damage is not the direct impact, but rotational forces. | Mr Belli told the BBC: "Often what does the damage is not the direct impact, but rotational forces. |
"You could argue from an evolutionary point of view, we're well designed to withstand a direct blow, but not engineered well to withstand the rotational forces in a road traffic accident." | "You could argue from an evolutionary point of view, we're well designed to withstand a direct blow, but not engineered well to withstand the rotational forces in a road traffic accident." |
Thinner walls | Thinner walls |
The skull itself does have stronger and weaker parts. | The skull itself does have stronger and weaker parts. |
A region called the pterion, close to the ears, is the thinnest part of the skull so is most vulnerable to fracture. | A region called the pterion, close to the ears, is the thinnest part of the skull so is most vulnerable to fracture. |
But the relatively reinforced forehead and back of the skull can still be damaged. | But the relatively reinforced forehead and back of the skull can still be damaged. |
"They may be thicker parts of the skull, but you can still fracture them if you transmit enough force," Prof Hutchinson noted. | "They may be thicker parts of the skull, but you can still fracture them if you transmit enough force," Prof Hutchinson noted. |
"There isn't a safe point or a weak point, you get a lot of damage from the way the force travels through the head," added Mr Belli. | "There isn't a safe point or a weak point, you get a lot of damage from the way the force travels through the head," added Mr Belli. |
Lasting damage | Lasting damage |
Damage varies hugely from one patient to another - one patient who has a seemingly severe injury can show better recovery than injuries which appear minor. | Damage varies hugely from one patient to another - one patient who has a seemingly severe injury can show better recovery than injuries which appear minor. |
Prof Hutchinson said it the lasting damage depended on where the damage was caused as "some areas are more critical". | Prof Hutchinson said it the lasting damage depended on where the damage was caused as "some areas are more critical". |
"Bleeding in the motor cortex can result in paralysis while damage to the visual cortex would result in blindness." | "Bleeding in the motor cortex can result in paralysis while damage to the visual cortex would result in blindness." |
He said sport was not taking head injury seriously enough, but changes in American football were driving reform. | He said sport was not taking head injury seriously enough, but changes in American football were driving reform. |
"In terms of sport, the most controversial is boxing because it is a deliberate act, horse riding creates a lot of serious injuries, and rugby increasingly so. | "In terms of sport, the most controversial is boxing because it is a deliberate act, horse riding creates a lot of serious injuries, and rugby increasingly so. |
"There are racing drivers who have had an accident in the early part of the weekend, raced the whole weekend and not remembered a thing." | "There are racing drivers who have had an accident in the early part of the weekend, raced the whole weekend and not remembered a thing." |
"People need to be aware of brain injury." | "People need to be aware of brain injury." |
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