In blunt head trauma, which feature is true regarding the dura?

• A. Dura is lacerated
• B. There is no impact to the skull
• C. There is immediate brain herniation
• D. Dura remains intact

Answer: (D)

Blunt head trauma typically involves forces delivered to the skull without a penetrating wound, and the dura mater is a very tough, adherent layer that forms the outer protective covering. Because of its strength, the dura usually remains intact unless there is a penetrating injury or an extremely high-energy impact that tears it. When injury occurs, problems often come from bleeding beneath the dura (between the skull and dura) or from brain injury itself, not from the dura tearing. So even in conditions like epidural or subdural hematomas, the boundary between skull and brain—the dura—remains continuous, though it may be displaced or the brain behind it compressed. Immediate brain herniation is not an automatic consequence of blunt trauma and depends on how rapidly pressure increases. Saying there is no impact to the skull is incorrect, since blunt trauma by definition involves impact to the skull.