Nervous system: Brain and spinal cord injuries


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Antonia Syrnioti, MD

Sam Gillespie, BSc

David G. Walker

Patricia Nguyen, MScBMC

Damage to the head or spine that causes the brain or spinal cord to stop working properly is called a brain or spinal cord injury, respectively.

In most cases, these are traumatic, meaning that they result from an external, physical force, like a fall, a car crash, or a gunshot wound.

They can also be non-traumatic, which is the case when the brain or spinal cord are not receiving enough oxygen, such as when breathing or heart problems prevent enough oxygen from reaching the brain or spinal column or when blood vessels supplying the brain or spinal cord are compressed by something like a tumor.

Now, the symptoms of a brain or spinal cord injury can show up at the time of the injury or even hours to days later. In general, these vary depending on the region damaged and the severity of the injury.

Starting with brain injuries, symptoms may include confusion, headaches, nausea, vomiting, weakness, numbness, and vision or auditory problems.

More serious cases can even result in death. Clients can also experience life-long effects, and these may involve the motor function, causing muscle weakness or paralysis; various mental functions, causing thinking, memory, language, behavior, or emotional problems; or the level of consciousness, resulting in a coma.

This is a state like deep sleep but without a sleep-wake cycle. There’s a profoundly decreased alertness or responsiveness to their environment, like sound or touch.

Duration of a coma may vary from weeks to months, or rarely, go on for several years. After that time, the client might gradually come out of a coma or progress to a persistent vegetative state.

In this case, there’s a sleep-wake cycle, but the client still remains unaware and unresponsive to their surroundings and is unable to speak or follow commands.

They might show signs of movement, like opening the eyes or grimacing; however, these are only involuntary actions that are not a response to the environment.

Now, in a spinal cord injury, nerve signals can’t be transmitted between the brain and the rest of the body. The higher the level of injury, the more function is lost.


The brain and spinal cord make up the central nervous system, which controls the body's movements, senses, and thoughts. Injuries to these body parts can have devastating and sometimes permanent consequences. Brain and spinal cord injuries can be traumatic, resulting from an external physical force, or nontraumatic, due to lack of blood flow to the brain or spinal cord, as seen in stroke.

Symptoms of the injury vary depending on the location and extent. A brain injury can cause several symptoms, like confusion or headaches, or in more serious cases, result in death. Long-term consequences may include problems with movement, mental functions, coma, and persistent vegetative state.

A spinal cord injury at the lumbar level might result in paraplegia, or paralysis in the legs and lower trunk, whereas an injury at the neck will result in tetraplegia, which is paralysis in the arms, trunk, and legs. Both types of paralysis can be partial or complete, and can be associated with sensation problems and loss of bowel and bladder control.

Clients with a brain or spinal cord injury may have special needs, including assistance with self-care, movement, personal hygiene, communication, and nutrition. When caring for such people, it's crucial to remember to help prevent pressure ulcers with proper and regular skin care and assisting with position changes. Also, remember to practice safety measures to prevent falls, and prevent aspiration by making sure they remain upright during and after meals.


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