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Head Injury

Head injury can be either Acquired Brain Injury or Traumatic Brain Injury.

Types of acquired brain injury (ABI):


Traumatic Brain Injury


Statistics


UK [1]

  • It is estimated that in the UK each year, approximately 1 million people attend the Accident and Emergency Department following a head injury.
  • Over 50% of people are less than 30 years old. They occur more often in males than females. About 25% are admitted. Of the 25% that are admitted, 85% will have sustained a mild head injury, 10% a moderate head injury and 5% a severe head injury.
  • The majority of injuries result from road traffic accidents and a smaller proportion are due to domestic or industrial accidents, sporting incidents or violence.


Types

A brain injury is caused at least initially by outside force, but includes the complications which can follow, such as damage caused by lack of oxygen, and rising pressure and swelling in the brain. A traumatic brain injury can be seen as a chain of events beginning with the first injury which occurs in the seconds after the accident, and being made worse by a second injury which happens in the minutes and hours after this, depending on when skilled medical intervention occurs.

The First Injury

There are three sorts of first injury - Closed, Open and Crush.

Closed Head Injuries
Closed head injuries are the most common type, and are so called because no break of the skin or open wound is visible. These often happen as a result of rapid acceleration or deceleration, for example when a car hits a brick wall, or a car is hit from behind at traffic lights. The head is rocked back and forth or rotated, and the brain must follow the movement of the skull. It can twist, and the billions of nerve fibres which make up the brain can be twisted, stretched and even torn in the process. Even mild injuries of this sort can produce damage which is quite widespread throughout the brain. This is defined as diffuse brain injury. The front of the skull has sharp bony ridges with which the brain can also collide, causing more damage. Arteries and veins running through the brain can be damaged, allowing blood to leak.

Open or Penetrating Wounds
These are not so common. In this type of injury the skull is opened and the brain exposed and damaged. This could be due to a bullet wound, or collision with a sharp object such as a motor cycle brake lever, or being hit by a pickaxe. If the damage is limited to one specific area, outcomes can be quite good, even though the accident may have seemed horrific. In many cases, however, this type of injury may be combined with an acceleration type injury as well.

Crushing Injuries
In this type of injury, the head might be caught between two hard objects, such as the wheel of a car and the road. This is the least common type of injury, and often damages the base of the skull and nerves of the brain stem rather than the brain itself. There may be no loss of consciousness.

The Second Injury

This happens when the brain is starved of oxygen, which makes damage from the first injury worse. It can happen for several reasons. Examples are choking on vomit after an accident, blood blocking a person's airway, or by the position which someone is lying in obstructing their airway. If other injuries are present, as they often are, serious blood loss can affect blood flow to the brain. As a result, the amount of oxygen reaching the brain can be reduced. Understanding the relationship between the first injury and the effects of lack of oxygen has led to improvements in the kind of emergency treatment administered at the site of an accident by paramedics. They will make sure breathing is maintained and blood pressure is brought back to normal levels by emergency transfusions.

The Third Injury

This can take place at any time after the first and second injury, in the days and sometimes weeks which follow, and could be as a result of bleeding, bruising or swelling in the brain or because blood clots have developed. Blood leaking from torn blood vessels and other body fluids leaking into the area cause the brain to swell. This is a serious problem because the skull is a fixed space, and there is no room for expansion. It causes complications in two ways. Firstly, the walls of the skull are hard and unyielding, and damage the soft brain when it squeezes against them. Secondly, when the brain swells it can squeeze the blood vessels, limiting the brain's blood circulation. This can be fatal, so intracranial pressure is monitored very carefully once the patient is in hospital. Measures to reduce the risk of raised pressure include putting the patient on a ventilator to ensure a good supply of oxygen, and controlling the amount of water and salts in the body to cut down on the flow of fluid into the brain.

Blood clots occur when blood has leaked from damaged veins and arteries and then pools into a clot. They can press on the surrounding brain tissue which can damage it, and they also raise pressure in the brain. Clots can occur in the brain itself (an intercerebral clot) or in the space between the brain and the skull (a subdural or an extradural clot). Blood clots, also called haematomas, can occur after quite minor injuries, and this is why patients are often kept under observation in hospital until the risk of a clot forming is likely to be over.

Severity of the Injury

After a traumatic brain injury, whether or not the person was actually unconscious, a state occurs where the person seems to be aware of things around them but is confused and disorientated. They are not able to remember everyday things or conversations, and often do or say bizarre things. This is called Post-Traumatic Amnesia (PTA), and is a stage through which the person will pass. The length of PTA is important as it gives an indication of the severity of the injury. Used in combination with length of time in coma, these two give the best measure of eventual outcome.

Minor Head Injury
A brief period of unconsciousness, or just feeling sick and dizzy, may result from a person banging their head getting into the car, walking into the top of a low door way, or slipping over in the street. It is estimated that 75% of all head injuries fall into this category. The effects of a minor head injury can be anything but minor to the person concerned. They can include nausea, headaches, dizziness, impaired concentration, memory problems, extreme tiredness, intolerance to light and noise, and can lead to anxiety and depression. When problems like this persist, they are often called post-concussion syndrome.

Moderate Head Injury
A moderate head injury is defined as loss of consciousness for between 15 minutes and 6 hours, and a period of post-traumatic amnesia of up to 24 hours. Like those with a minor head injury, patients with moderate head injury are likely to suffer from a number of residual symptoms. The most commonly reported symptoms include tiredness, headaches and dizziness (physical effects), difficulties with thinking, attention, memory, planning, organising, concentration and word-finding problems (cognitive effects) and irritability (an emotional and behavioural problem).

Severe Head Injury
A severe head injury is usually defined as being a condition where the patient has been in a coma for 6 hours or more, or a post-traumatic amnesia of 24 hours or more. Depending on the length of time in coma, these patients tend to have more serious physical deficits.

Persistent Vegetative State

A small number of people sustain a head injury so severe that they remain in a state of coma for months and years without recovering sufficient consciousness to make any form of communication, but can breathe without mechanical assistance. They may have sleeping and waking cycles allowing them to be fed, but they do not speak, follow commands or have any understanding of what has been said.


Causes

  • Road traffic accidents account for 40% to 50% of all injuries, and are most commonly associated with severe injuries
  • Domestic and industrial accidents account for 20 to 30%
  • Sports and recreational injuries account for 10 to 15%
  • Assaults account for 10% - although this percentage rises in urban areas with respect to other causes
  • Cycling injuries account for approximately 20% of all head injuries in children


Effects

Physical effects of brain injury can include:

  • Movement, balance and co-ordination
  • Dyspraxia - disorder of deliberate voluntary actions or sequences of actions
  • Loss of sensation i.e. loss of touch, taste, smell, hearing and sight
  • Tiredness
  • Headaches
  • Speaking and swallowing disorders
  • Epilepsy
  • Bladder and bowel incontinence

Cognitive effects of brain injury can include:

  • Memory
  • Attention and concentration
  • Speed of information processing
  • Executive functions - planning, organising, problem solving
  • Visuo-spatial and perceptual difficulties
  • Language skills

Emotional and behavioural problems of brain injury can include:

  • Agitation
  • Explosive anger and irritability
  • Lack of awareness and insight
  • Impulsivity and disinhibition
  • Emotional lability
  • Self-centredness
  • Apathy and poor motivation
  • Depression
  • Anxiety
  • Inflexibility and obsessionality
  • Sexual problems

The above information was supplied by Headway - the brain injury association.


Haemorrhage

Statistics

  • Approximately 8,500 people in the UK suffer a brain haemorrhage each year. More than half of these people are of working age and sometimes young children are affected by this life threatening condition which hits out of the blue
  • There are 5,000 new cases of primary brain tumour each year in the UK. Unfortunately brain tumours know no age barriers, they account for 25% of all childhood cancer deaths
  • Approximately 1 million people are treated in hospital for head injury each year. 45% of severe head injury victims do not return to work. It is the most common cause of death in teenagers. Stroke affects one in ten people, it kills one in five
  • These along with other conditions affecting the brain mean that an estimated 3 million people in Britain are suffering from brain related disorders


What is it?

Subarachnoid haemorrhage is a potentially life threatening condition which affects a person suddenly and spontaneously without any warning. The haemorrhage is a leakage of blood over the surface of the brain from a major blood vessel. The leakage occurs at a weakness in the wall of the blood vessel. When the weak vessel wall begins to bulge outwards, it forms an aneurysm. The aneurysm can then burst at any time and nothing can be done to prevent this. Indeed, a person with an unruptured aneurysm is unaware of its existence. The condition only becomes apparent after the subarachnoid haemorrhage has occurred. The haemorrhage then causes the sufferer to develop a very sudden and severe headache which can sometimes be accompanied by nausea, vomiting, neck stiffness and perhaps collapse, seizure and loss of consciousness depending upon the severity of the bleed.


Effects

Subarachnoid haemorrhage can be a very difficult experience to accept even after recovery as it is a condition which happens suddenly and without notice. Memories of the initial experience may be vague. Sometimes patients experience great fear and worry about the possibility of suffering another subarachnoid haemorrhage in the future. People also sometimes ponder about what it is they could have done to prevent this from happening. If people are unaware of an aneurysm there is nothing they can usefully do to prevent a haemorrhage. It is known that if a parent has suffered a subarachnoid haemorrhage, or if you smoke, then the risks are higher but otherwise the question as to why a particular individual develops an aneurysm in their head remains unanswered.

Day to day activities
The return to daily life is of course of utmost importance to the person who has suffered a subarachnoid haemorrhage and the extent to which this can be achieved depends upon the severity of the haemorrhage.

There are certain common problems which many people can encounter in their return to daily life following subarachnoid haemorrhage:

During the early part of recovery, people commonly find that the greatest physical problem is that they tire very easily and every daily activity seems to demand a great effort. Over the following weeks and months, it is expected that tiredness will gradually ease. Physical exercise including sexual activity may be resumed as soon as the individual feels they wish to do so. Sexual feelings, however are sometimes dormant initially.

Physical disability
Some people having suffered a subarachnoid haemorrhage can be left with a physical disability such as a weakness in the limbs of one side of the body. The weakness varies in severity from person to person. The way in which the weakness responds to physiotherapy also varies from person to person.

Headaches
Headaches are a common problem and although sometimes they can resolve after a period of weeks or months after the haemorrhage, in a few cases they persist. A subarachnoid haemorrhage will not occur from the weak spot again as it has been made safe.

Speech
After a subarachnoid haemorrhage, some people find that they have speech problems such as a difficulty in finding the correct word. The problem varies in severity.

Memory
After a subarachnoid haemorrhage, some people find they have become very forgetful. Such a disturbance in memory can be subtle or more noticeable, temporary or sometimes the deficit is permanent. There can also simply be loss of memory of what happened immediately after the haemorrhage up to a few weeks afterwards.

Emotional problems
After leaving the security of the hospital, a person may experience intense feelings of fear, loss of confidence, feelings of isolation and even depression. These feelings may be related to a fear of suffering another subarachnoid haemorrhage. If at the same time a person also suffers from other symptoms such as a headache or a tingling sensation in their scalp then he or she may interpret these symptoms as the onset of another haemorrhage. They may also worry that something "has gone wrong" inside their head. This emotional experience is very important as it may well affect recovery. These feelings are commonly experienced by those who have suffered a subarachnoid haemorrhage. They are not unnatural and they will eventually fade as time passes and recovery takes place. In addition to emotions such as fear, isolation, loss of confidence and depression, some people also experience frustration, anger and guilt.

The above information was supplied by BASIC (Brain And Spinal Injury Charity).


Tumour


What is it?

A brain tumour is an "abnormal multiplication of brain cells", whereas usual human tissue grows by cells multiplying at a regular rate. This causes a swelling in the brain that compresses or destroys the healthy cells and - because the skull is so rigid - increases the pressure on the brain tissue. This change in the structure of the brain can cause a variety of symptoms, some are fatal. A common symptom is fitting (seizures). Other than harmful radiation, or a chemical known as vinyl chloride, there are no known common causes of brain tumours.


Types

Brain tumours can be grouped according to whether they are benign or malignant, or according to whether they originated in the brain or came to it (usually throught the blood stream) from another part of the body.

Benign tumours
Benign tumours are not cancerous - these tumours do not invade or destroy the tissue in which they first appear. Neither do they spread to other parts of the body.

Malignant tumours
Malignant, or cancerous, tumours invade and destroy the tissue in which they originate. They can spread to other parts of the body via the blood stream and lymphatic system. If untreated, such tumours cause progressive deterioration and death.

One can also classify brain tumours by their point of origin.

Primary brain tumours
These are tumours which originated from within the brain. Fortunately, these tumours rarely metastatise (the distant spread of a malignant tumour from its site of origin) to other parts of the body.

Secondary brain tumours
Unlike primary tumours, these are tumours which arrived in the brain (usually through the blood stream) from another part of the body.


Effects

The effects of a brain tumour are many and varied. Some of these effects may appear before the reason for them is known. Sometimes the reasons for them may never be known. Sometimes the known.

Emotional effects
Several generalised symptoms may be experienced. (Family and close friends may also experience some of these problems.) These can be due to the emotional stress caused by treatments, or surgery, or by the tumour itself. A lack of appetite, depression, irritability, fatigue, sleeplessness, an erratic memory and restlessness are common complaints. Nausea, bladder problems or constipation can also occur.

Effects due to the tumour
There is a limited amount of space inside the skull; therefore, the growth of anything that does not normally belong there causes changes in normal brain functions. These changes may be temporary or permanent, depending on the cause. Tumours may cause direct damage to brain cells, shifting of the brain due to growth, or cause pressure that affects areas distant from the tumour, resulting in changes in their funcion too.

Frontal tumours can cause disinterest in the effected persons surroundings, mood swings, changes in moral and ethical judgement and intellectual impairment. Short term memory (memory of recent events) may be affected.

Parietal tumours can result in sensory illusions (such as feelings of 'pins and needles'), inability to recognise objects by touch, inability to distinguish right from left and difficulty reading.

Temporal tumours which are frequently 'silent' unless they reach a significant size, can cause a dreamy 'deja vu' state. Also, aphasia, or the loss of ability to understand language, is usually associated with this area.

Occipital tumours can cause disturbance in vision and visual memory. There may be double vision, visual hallucinations or partial loss of vision.

Optic nerve tumours reduce visual accuracy and can lead to blindness.

Cerebello -pontine angle tumours (such as acoustic neuromas) cause pressure on the cranial nerve. Ringing in the ears or hearing loss (especially in using the telephone) can occur.

Brain stem tumours can affect tongue movements and cause difficulty with swallowing or speaking. Unusual eye movements can cause dizziness or unsteadiness in walking.

Hypothalmic and Pituitary tumours can effect appetite and food intake. Pituitary Tumours can cause excess or underactivity of some hormones. This can effect women's menstrual cycle and sometimes cause breast milk. Growth hormones and thyroid hormones may also be affected.

Posterior fossa tumours (such as choroid plexus, fourth ventricle and cerebellar tumours) may cause tremors or a lack of co-ordination in walking. Nausea (feeling sick) may also occur.

Some effects are due to side effects of treatment
Whilst a headache is the most common discomfort associated with brain tumours, some discomfort may be caused by the procedures necessary to treat the tumour. There may be a pain following tumour removal or discomfort from the side effects of chemotherapy. Radiotherapy is a painless procedure but can have uncomfortable side effects, such as skin problems or nausea. Swelling of the brain may occur prior to surgery and following radiotherapy and it may cause temporary difficulty in walking or thinking clearly. As the swelling decreases these side effects should fade. Steroid medications are often prescribed to reduce the swelling. However, as with many medicines, steroids have some side effects that may cause problems. These problems may include: weakness of the legs, an increase in appetite, indigestion, thirst, frequency passing urine, the inability to sleep at night or agitation and anxiety. One of the positive effects of steroid therapy can be temporary control of headaches.

Seizures are caused by irritation to the brain. They may be one of the first symptoms of a brain tumour or may occur for the first time following treatment such as surgery, which temporarily disturbs the normal function of brain cells. Most seizures can be controlled with anticonvulsant medications. Some of the drugs used have side effects. Some seizures can be difficult to control. However, those following surgery frequently decrease with time.

The above information was supplied by the British Brain Tumour Association.


Encephalitis

Statistics

  • The only published figures are from America. They suggest that 7.4/100,000 people per year are affected
  • The high risk age groups are birth - 7 , 16-25 and over 55’s


What is it?

Encephalitis is inflammation of the brain. It should not be confused with meningitis which is inflammation of the meninges, a lining which surrounds the brain. Encephalitis is seasonal in some parts of the world but not in this country. People can get encephalitis more than once, but this is very, very rare.


Types

Essentially there are 2 types: acute viral encephalitis and acute disseminated encephalomyelitis (known as ADEM) . Both are caused by a viral infection. In acute viral encephalitis it is the virus which causes damage to nerve cells. In ADEM it is the immune system which causes damage to the myelin sheath of nerve cells.


Causes

The viruses responsible are many and varied. They include measles, mumps, chicken pox, influenza and herpes simplex (the cold sore virus). In most cases the virus involved is not identified. In most people a barrier (the blood-brain barrier) will stop viruses entering the brain. Why this fails in a very few people is not known. Viruses are spread by coughing, sneezing and "close contact" kissing but they should not be regarded as truly airborne or water borne. It is a mistake to assume that these organisms can be blown in the wind or float in the water because they cannot live outside the human body. Not every virus goes on to cause medical problems and some can lie dormant in the body without harm for many years. Stress seems to be a common factor. It is known that stress can depress the immune system and the immune system controls the blood-brain barrier.


Symptoms

Encephalitis often begins with a flu like illness with headache and vomiting. Symptoms indicating that this is a more serious illness follow later and demonstrate an "altered consciousness". These might include confusion, drowsiness, seizures (fits) and coma. Other symptoms can be aversion to bright lights, inability to speak or control movement, sensory changes, uncharacteristic behaviour and other depending on the area of the brain under attack.


Effects

There will be a wide variation in exactly in how encephalitis affects the person in the long term. Tiredness, recurring headaches, difficulties with memory, concentration and balance are often reported as are temper tantrums, mood swings, aggression and clumsiness. Epilepsy, as well as being a feature of the acute illness, may develop weeks or months after the illness has subsided. Physical problems may include weakness down one side of the body, loss of sensations and of control of bodily functions and movement. Speech and language problems are also common features. Speed of thought and reaction may be reduced.

The above information was supplied by the Encephalitis Support Group.


Meningitis

What is meningitis and septicaemia?

Meningitis is inflammation of the meninges, the lining surrounding the brain. It can be caused by many different organisms including bacteria, viruses and fungi.

Septicaemia is blood poisoning caused by bacteria entering the bloodstream and multiplying uncontrollably.


Types of meningitis

There are two main types of meningitis in the UK:

Signs and symptoms

Meningitis and meningococcal septicaemia may not always be easy to spot at first, because the symptoms can be similar to those of flu. They may develop over one or two days, but sometimes develop in a matter of hours. The incubation period for bacterial meningitis is between 2 and 10 days and for viral meningitis it can be up to 3 weeks. Symptoms do not appear in any particular order and some may not appear at all. It is important to remember that other symptoms may occur.

In adults and older children (not all symptoms may be present):

  • high temperature, fever possibly with cold hands and feet
  • vomiting
  • sometimes diarrhoea
  • severe headache
  • neck stiffness (unable to touch the chin to the chest)
  • dislike of bright lights
  • drowsiness
  • joint or muscle pains, sometimes stomach cramps with septicaemia
  • fits
  • the person may be confused or disorientated

In babies and infants (not all symptoms may be present):

  • high temperature, fever possibly with cold hands and feet
  • vomiting or refusing feeds
  • high pitched moaning, whimpering cry
  • blank, staring expression
  • pale blotchy complexion
  • baby may be floppy, may dislike being handled, be fretful
  • neck retraction with arching of back
  • difficult to wake or lethargic
  • the fontanelle (soft spot on babies heads) may be tense or bulging

Both adults and children may have a rash:

Septicaemic rash
Some bacteria which cause meningitis can often cause septicaemia (blood poisoning). Septicaemia is particularly associated with the meningococcal bacteria. Patients with septicaemia often develop a rash which may start anywhere on the body as a cluster of tiny blood spots, which look like pin-pricks in the skin. If untreated, these blood spots will join to give the appearance of fresh bruises. The rash should be taken seriously.

Who is at risk?
The under 5s, the 14-25s and the over 55s are more at risk.

How is it spread?
The bacteria are very common and live naturally in the back of the nose and throat. It is spread by people coughing, sneezing and intimate kissing. The bacteria do not live for very long outside the body, so can’t be picked up from water supplies, swimming pools or buildings. People of any age can carry the bacteria for days, weeks or months without becoming ill and carrying the bacteria can help to make people more immune to meningitis. Occasionally, they overcome the body’s defences and cause meningitis and meningococcal septicaemia.


Bacterial Meningitis

Bacterial meningitis is fairly uncommon, but it can be extremely serious. It is fatal in one in 10 cases and one in seven survivors is left with a serious disability, such as deafness or brain injury.

The two main bacterial forms
In the UK there are now two main types of bacterial meningitis which cause most of the reported bacterial cases. They are meningococcal and pneumococcal meningitis.

Meningococcal Meningitis
Meningococcal meningitis (caused by the bacterium Neisseria meningitidis) is the most common bacterial form in the UK, accounting for more than half the cases. There are five main Groups: A, B, C, W135 and Y. Group B is the most common followed by group C. Most cases are isolated incidents, but clusters of cases (ie two or more cases) of meningococcal meningitis can occur. It is not always clear why these clusters happen, but they do not seem to be related to environmental factors, eg air conditioning, water supplies.

Pneumococcal Meningitis
Caused by the bacterium Streptococcus pneumoniae, pneumococcal meningitis usually occurs in older adults and young children. It causes about a tenth of bacterial meningitis cases, has a high fatality rate (about 20%) and is associated with a higher risk of permanent neurological damage e.g. deafness and epilepsy. The bacteria are commonly found in the respiratory tract and may be transferred via the bloodstream or as a result of an infection of the middle ear or sometimes through a tiny fracture or defect in the linings of the brain. Very rarely this fracture or defect may result in recurring cases of pneumococcal meningitis and surgery may be needed to repair the defect.

Where the bacteria are found and how they are spread
The bacteria which cause both meningococcal and pneumococcal meningitis are very common and live naturally in the back of the nose and throat, or the upper respiratory tract. People of any age can carry the bacteria for days, weeks or months without becoming ill. In fact, being a carrier helps to boost natural immunity. At any one time, around 10 to 25 per cent of the population are carriers of meningococcal bacteria. Only rarely do the bacteria overcome the body’s defences and cause meningitis. The bacteria are passed from person to person by prolonged close contact and by coughing, sneezing and intimate kissing (saliva exchange). They cannot live for long outside the body, so they cannot be picked up from water supplies, swimming pools, buildings or factories. The incubation period is between two and ten days.

Who is at risk?
Anyone, anywhere can contract meningitis, but those most at risk are children under five, teenagers and young adults, and older people. Most cases are isolated and not related to another case or an “outbreak”.


Viral Meningitis

Viral meningitis is more common than the bacterial form, but generally less serious although it can be very debilitating. It can be caused by many different viruses. Some are spread between people by coughing or sneezing, or through poor hygiene. Others can be found in sewage-polluted water. The incubation period can be up to three weeks. In mild cases of viral meningitis, people may not even go to their doctor. Therefore it is difficult to say exactly how many cases there are of viral meningitis. The symptoms can be similar to the bacterial form and someone with a severe case of viral meningitis will need to be admitted to hospital for tests to find out which form they are suffering from. Diarrhoea can also occur with mild viral meningitis.

Causes
The commonest causes of viral meningitis are coxsackie (these viruses are the commonest causes of viral meningitis and they can be found in the intestines of humans, and therefore in faeces and sewage-polluted water. Most cases occur in the summer months), and echoviruses (often known as enteroviruses). Meningitis can also develop as a result of infection with herpes simplex (the herpes virus is widespread and usually produces cold sores, but can very occasionally cause viral meningitis or encephalitis, which is inflammation of the brain itself), measles, polio or chickenpox. Meningitis used to be a complication of mumps, but has virtually been eliminated following the introduction of the MMR (Measles, Mumps and Rubella) vaccine.

Treatment
Viral meningitis cannot be helped by antibiotics and treatment is based on good nursing care. Recovery is normally complete, but headaches, tiredness and depression may persist for weeks or even months.

Meningococcal Septicaemia

Some bacteria that cause meningitis can also cause septicaemia (blood poisoning) as well as meningitis (inflammation of the lining of the brain). Septicaemia is particularly associated with the meningococcal form. About 80 per cent of people who have meningococcal infection have meningitis and the rest have septicaemia, which is a serious infection of the bloodstream. Of the 80 per cent who have meningococcal meningitis, around 55 per cent have both meningitis and septicaemia, leaving only 25 per cent suffering from meningitis alone. Septicaemia without meningitis is a more serious infection with a higher mortality rate.

Signs and Symptoms
Patients suffering from meningococcal septicaemia often develop a non-blanching rash, called a haemorrhagic rash. This starts as a cluster of tiny blood spots (petechiae), which look like pin-pricks in the skin. If untreated, these gradually get bigger and become multiple areas of obvious bleeding under the skin surface, like fresh bruises. These “bruises” then join together to form large areas of purple skin damage and discolouration. In some cases a maculopapular rash (which resembles a measles rash and blanches completely) or a mixture of the two types of rash may be seen. Septicaemia can develop quickly. In severe cases, the rash may spread as it is watched. The patient rapidly becomes unwell, becoming feverish and cold with cool hands and feet, followed by coma and sometimes death. Patients who become unwell more slowly may also develop some of the signs of meningitis.

Why some people get septicaemia and others get meningitis
If the meningococcus invades the body, it enters from the throat, passes into the bloodstream and travels via the blood to the meninges (the lining of the brain). In some cases, the bacteria multiply in the blood and this results in septicaemia before the bacteria can infect the meninges. When the bacteria multiply rapidly in the blood stream they release toxins (poisons) that may damage blood vessels, tissues and all the organs of the body. In other cases, infection in the blood and in the meninges develops at the same time, and these patients get both meningitis and septicaemia. In a minority of cases, it seems the body can stop the bacteria multiplying in the blood but not in the meninges, and these patients develop meningitis. Fatality rates for septicaemia are high – around 20 per cent.

The above information was supplied by the National Meningitis Trust.


(1) McMillan T & Greenwood, R (1991). Rehabilitation programmes for the brain-injured adult: current practice and future options in the UK. Discussion paper for the Department of Health Back

Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen’s Printer for Scotland.


Further information


Acknowledgements: This section has been developed with the help of Headway - the brain injury association; the Stroke Association; BASIC (Brain And Spinal Injury Charity); the British Brain Tumour Association; the Encephalitis Support Group and the National Meningitis Trust.


[1] Department for Work and Pensions [n.d.]. Head Injury - Introduction and clinical features. [accessed 29/11/12].

 



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