Trauma: Blunt Trauma to the Head

Did you catch the UFC Fight Night over last weekend? Lyoto Machida knocked out his buddy Mark Munos with a vicious kick to the head! That was amazing! Glad to see Machida still on his game!

While watching this, I couldn't help but think about possible head traumas that could have resulted from this. A kick like this can generate over 1000 lbs of force, which is more than enough to cause devastating damage to someone's body and internal organs. So what can happen if you get kicked in the head with this amount of force?

One possibility is concussion (will discuss further in another post). This occurs when a force is exerted against the head and causes the brain to move or shift within the skull. Due to limited and non-expandable nature of the skull, brain is sensitive to any increase in pressure or movement. Between the brain and the skull, there is a thin layer of fluid called cerebrospinal fluid (csf) which serves as

a watery cushion for the brain and spinal cord, and there are layers of membrane (pia mater, arachnoid, and dura mater) that surrounds the brain within the skull. 

The CSF is between the pia mater and the arachnoid layer, aka the subarachnoid space. It is made from the ependymal cells of choroid plexus, walls of the ventricles, and circulating blood vessels, and flows into the lateral ventricles. It then flows through the foramen of Monroe (interventricular foramen) into the third ventricle, which then flows through the aqueduct of Sylvius (cerebral aqueduct) into the fourth ventricle. It then splits to flow through foramen of Magendie (median aperture) to surround the spinal cord, and also through foramen of Luschka (lateral aperture) to surround the brain in the subarachnoid space. It then flows into the sinuses in subdural space via arachnoid villi, which is then reabsorbed back into the circulation and starts the cycle all over again continuously. 

All of these things plus the skull help to protect the brain pretty effectively in most cases. However, big enough trauma to the head, such as hard kick to the head or big collisions in football or any other collision sports, can cause enough "shifting" of the brain to cause some damage. When it moves within its limited confines, it can "stretch" and cause axonal damages, or stretching of the nerves in the brain. This can lead to some bad consequences. Initially, the concussed person may present with headache, loss of consciousness, dizziness, confusion, amnesia, loss of coordination, blurry vision, and disorientation, but they can also present with something more serious, such as seizures, coma, or even death. Moreover, there can be long-lasting damage after many concussions, which is a big topic of research in the field of sports medicine currently (look up Chronic traumatic encephalopathy if curious).

Another injury that can occur is bleeding or hematoma, with or without skull fracture. There are two major types of hematoma that can occur with blunt trauma. One is epidural hematoma, which is collection of blood between dura and skull, most commonly caused by rupture of middle meningeal artery from blunt trauma to the head. The person may present with possible initial lucid intervals (in and out of symptoms) for few hours after the injury, which includes severe headache, decreased consciousness, and nausea, and can eventually lead to worsening of symptoms plus paralysis of one side of body, seizures, and blown pupil. This is an emergency, and needs to be surgically drained and decompressed as soon as possible. Another type is subdural hematoma, which is collection of blood between the dura and arachnoid meningeal layer, caused by rupture of bridging veins following trauma. This is more common among elderly people who fall and bump their head, but it is possible from a stronger blunt trauma like a kick to the head. The person may present with slowly progressing headache, change in mental status, weakness of one side of body, and increased deep tendon reflexes. This is not as emergent as the epidural hematoma, and thus the treatment plan depends in the situation and size of the hematoma, and can involved surgical drainage and decompression or supportive care.

There are numerous other possible injuries that can occur from blunt trauma to the head. Fortunately, it seems like Munos recovered pretty well, and he did not have any serious injuries, although I would not be surprised if he did get a small concussion. This brings up another reason why I stick to jiu jitsu: no head kicking.

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