Severe Brain Damage Information

Help for Severe Brain Damage Survivors and Family Members

By Gordon S. Johnson, Jr.

The goal of these next pages is to provide a primer on severe brain damage, including coma, brain bleeds, hemorrhage, subdural hematoma and severe diffuse axonal damage.

My approach to teaching about severe brain damage and coma is to provide information in several layers.  We start with the emotional support for the loved ones of someone with severe brain damage, see Help for Coma in Chicago. Part of that support is the information herein on what is actually happening inside the skull, right now, while you wait for coma emergence.

On this Severe Brain Damage Primer we will address the basic types of issues of severe Closed Head Injury pathology, including the specific diagnosis of injury, intracranial pressure and specifically help to understand the following:

  • Skull Fracture

  • Intracranial Lesions

  • Subdural hematoma

  • Epidural hematoma

  • Contusions and Intracerebral Hematoma

  • Severe Axonal Damage

  • Brain Stem Damage

  • Subarachnoid Hemorrhage

  • Midline Shift

Skull Fractures

A skull fracture is a broken bone in the skull, not a per se severe brain damage.  While it may not be the most severe of injuries, it often involves additional catastrophic damage to the brain.  It takes considerable force to break a bone, particularly the skull, which is designed to protect and absorb considerable force.  Depending on the vector and the degree of the external force, there may be sufficient trauma to damage the brain as well.  CT scans and even X-ray are able to identify the fracture to the bone of the skull. Yet those tools alone  may not show the full extent of severe brain damage.

The skull is there to protect the brain and can do so, even in cases when it is fractured. Breaking the skull can absorb substantial biomechanical force, to some degree protecting the brain from the direct impact.  At times, the skull may be fractured with little gross damage to brain structures. Still, the risk of an associated hematoma (brain bruise) can be increased as much as four hundred fold after a skull fracture.

The Role of Dura In Understanding Severe TBI Pathology

When the skull breaks, the energy is likely to be transferred by direct contact to the adjacent areas of brain tissue. The brain is encased in the “dura,” almost like a tight fitting bag. It is the dura which first makes contact with the skull in an injury event.


Gordon Johnson

Attorney Gordon Johnson is one of the nations leading brain injury advocates. He is Past-Chair of the TBILG, a national group of more than 150 brain injury advocates. He has spoken at numerous brain injury seminars and is the author of some of the most read brain injury web pages on the internet.

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