Loss of consciousness following head injury

The mechanism of loss of consciousness after mild blows to head is poorly understood. Some researchers suggest, based on animal work, that activation of cholinergic nuclei in the pons results in loss of consciousness. (7)

Loss of consciousness lasting for more than a few minutes is likely to be due to damage either to cortical areas necessary for consciousness, or the subcortical arousal systems. Raised intracranial pressure, partly as a result of compromising cerebral circulation, causes coma. Large or multiple haematomas are likely to be associated with a period of coma, particularly if they are associated with cerebral oedema.

Some patients, however, show prolonged coma with little to be found on brain scan apart from some evidence of generalized cerebral oedema. In these patients diffuse axonal injury may be the cause of their coma, possibly by damaging the white matter tracts that carry arousal signals from the brainstem to the cortex.

Remember that the head injury may have been caused by an accident triggered by a loss of consciousness, for example due to hypoglycaemia, alcohol intoxication, or an epileptic fit. Systemic effects (e.g. hypoxaemia or fat emboli) may exacerbate unconsciousness due to head trauma, as may drug intoxication.

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