Paralysis Resource Guide - (Page 11) CONDITIONS process (neurotoxins, infection, tumors, metabolic abnormalities, etc.), or a closed head injury such as shaken baby syndrome or rapid acceleration/deceleration of the head. The outer surface of the skull is smooth, but the inner surface is jagged – this is the cause of significant damage in closed head injuries as the brain tissue rebounds inside the skull over rough bony structures. With traumatic injury, brain damage may occur at the time of impact or may develop later due to swelling (cerebral edema) and bleeding into the brain (intracerebral hemorrhage) or bleeding around the brain (epidural or subdural hemorrhage). If the head is hit with sufficient force, the brain turns and twists on its axis (the brainstem), interrupting normal nerve pathways and causing a loss of consciousness. If this unconsciousness persists over a long period of time, the injured person ARTWORK CREATED FOR THE NIH CONSENSUS is considered to be in a DEVELOPMENT CONFERENCE ON REHABILITATION OF coma, a disruption of PERSONS WITH TRAUMATIC BRAIN INJURY, OCTOBER nerve messages going 1998, SPONSORED BY THE NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT AND THE from the brainstem to NIH OFFICE OF MEDICAL APPLICATIONS OF RESEARCH. the cortex. FOR FULL STATEMENT SEE WWW.CONSENSUS.NIH.GOV A closed head injury often occurs without leaving obvious external signs, however the difference between closed and penetrating injuries can be significant. A bullet wound to the head, for example, might destroy a large area of the brain but the result may be minor if the area is not a critical one. Closed head injuries often result in more damage and extensive neurologic deficits, including partial to complete paralysis; cognitive, 11 http://www.consensus.nih.gov
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