A hematoma is a tumor-like collection of blood located outside a blood vessel. In the brain haematomas can form in the subdural space and the epidural space. A subdural hematoma is basically bleeding into the space between the brain cover (dura mater) and the brain itself. There are blood vessels running through the brain and in the spaces between the outside of the brain and the inside of the skull. Epidural hematomas bleed quickly and compress the brain rapidly while subdural hematomas bleed much more slowly. Both types of bleeding can have serious implications.

Something had changed, she was dizzy and confused. She lay down in bed and became incoherent. The 911 was called. My mom was rushed by ambulance to the hospital 10 minutes away. She was rushed to John’s Hopkins Neuro-CCU by helicopter. Brain damage can occur in a variety of ways, but is considered to be any type of injury to the structure of the brain that disrupts or prevents normal brain function or healthy brain development. Brain damage can occur after birth (acquired, non-traumatic or traumatic brain injuries) or before birth (congenital brain injuries).

To help you gain more insight into brain damage, it is first important to understand the different types of injuries and how they can occur. Let's begin by taking a look at congenital brain injuries. These types of injuries can be caused by a trauma, genetic defect, infection, poisoning, anoxia, or hypoxia. Down syndrome is another type of birth disorder that is caused by the presence of an extra chromosome in each cell.

Traumatic brain injuries can be either closed head injuries, or open head injuries. Closed head injuries do not involve objects penetrating the skull. Open head injuries involve objects penetrating the skull and directly impacting the brain. It is often quite difficult to diagnose traumatic brain injuries because the symptoms can range a great deal and may be accompanied by other conditions. Imaging tests, monitoring of the length of time of unconsciousness, and the Glasgow Coma Scale are common tools used to diagnose these conditions.

Neurologists and neurosurgeons cringe when they hear sports-reporters make comments like, "Johnny had a CAT scan and it showed that he didn't have a concussion." The truth is that CAT scans don't show concussions. They do show other serious consequences of head injuries, like bleeding within the brain, or hemorrhages that compress the brain. But concussions--while no less real--are invisible to brain-imaging tests like CAT scans and MRIs. There can also be physical damage to the brain's cells. Because brain-cells are so tiny, brain scans don't detect them. Injuries causing more severe concussions can tear apart the cells' axons (the long filaments that carry coded messages over long distances within the brain). As you can imagine, these rips in the very fabric of the brain can cause lasting impairments in brain function or require long periods of time for recovery.

A rare but particularly scary phenomenon has been called the "second impact syndrome" in which a second concussion occurring within days or weeks of an earlier concussion can produce catastrophic consequences--including death--way out of proportion to the apparent severity of the re-injury. When should an athlete hang up his or her cleats and retire from the sport? How many concussions are too many? No one has a definite answer to either question. As Clint Eastwood's "Dirty Harry" might ask, "Are you feeling lucky?" Three concussions in the same season--or even in an entire sports career--should certainly raise concern about long-term damage to the brain.

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