Human Brain & Mind
  • Brain Injury

    Brain injuries re often suffered by children, adolescents and young adults. In the US, 1.4 million serious brain injuries are documented every year; about 50,000 people die from the injury; several million recover from unreported brain injuries but suffer long term disabilities. Major brain injuries can involve skull fractures, destruction of brain tissue, bleeding around and into the brain and brain swelling. The US CDC estimates the total cost of acute care and rehabilitation for victims of major brain injuries is $9 billion to $10 billion per year, not including costs to families and society. The brain damage left by even apparently mild injury can change any and all brain functions in bewildering combinations. Memory loss, behavioral and emotional changes are common. The hypothalamic pituitary system is often damaged causing hormone deficiencies that compromise recovery . Growth hormone is often deficient and must be replaced.

    Gardner et al stated: "Adults in their mid-50s and older who sustain a traumatic brain injury (TBI) from a fall or other mishap are at increased risk for dementia. More than 60% of all hospital admissions for TBI are in people aged 55 years and older … TBI may trigger a progressive neurodegenerative cascade, accelerate an established neurodegenerative cascade, or result in a static brain injury that reduces cognitive reserve". DeKosky stated: "The known structural damage to the brain after TBI, notably of diffuse axonal injury and disruption of neural circuitry, would surely impair function of an older brain and reduce cognitive reserve, as pointed out by Gardner et al. It is likely that the increased emergence of dementia over the ensuing years was due in part to this structural damage and lessened cognitive reserve, leading more quickly to clinical manifestations and a diagnosis of dementia." ( Raquel C.Gardner et al. Dementia Risk After Traumatic Brain Injury vs Nonbrain Trauma. The Role of Age and Severity. JAMA Neurol. Published online October 27, 2014)


    Fachran et al summarized the concept of concussion. "Mild traumatic brain injury (mTBI), commonly referred to as 'concussion', affects over 1.7 million in the USA annually with costs of nearly US$17 billion. Despite the name, these injuries are by no means mild, with approximately 15% of patients suffering persistent symptoms beyond 3 months. This 'miserable minority' affects a large number of individuals in the prime of life and, until recently, no consistent correlation existed between clinical symptoms and radiological evidence of structural damage to the brain… If we focus on patient symptoms, we find that individual concussion patients present with different symptomatology, usually with an overall dominant symptom cluster. Dominant symptom clusters fall into six categories: sleep–wake disturbances, migraine, anxiety, vestibulopathy, ocular dysfunction and cervicalgia.

    Sharp and Jenkins wrote a definitive critique of physician lack of concern about mild brain injury: “ It is time to stop using the term concussion as it has no clear definition and no pathological meaning. This confusion is increasingly problematic as the management of 'concussed' individuals is a pressing concern. Historically, it has been used to describe patients briefly disabled following a head injury, with the assumption that this was due to a transient disorder of brain function without long-term sequelae. However, the symptoms of concussion are highly variable in duration, and can persist for many years with no reliable early predictors of outcome. Using vague terminology for post-traumatic problems leads to misconceptions and biases in the diagnostic process, producing poor clinical guidelines and confused policy. We propose that the term concussion should be avoided. Instead neurologists and other healthcare professionals should classify the severity of traumatic brain injury and then attempt to precisely diagnose the underlying cause of post-traumatic symptoms."

    Brain injuries in amateur and professional athletes are common and may cause permanent neurological disability, sometimes many years after the athletes retire from sport. The main mechanism of brain injury is acceleration and deceleration. A hockey player who is knocked down, falls backward hitting his helmeted head on the ice will suffer a deceleration injury to his brain. The helmet prevents a skull fracture, but does not protect the brain from crashing into the hard skull and oscillating back and forth until all the energy of motion is dissipated. A boxer punched on the cheek will suffer a rotational acceleration-deceleration injury to his brain as his head rotates suddenly and stops suddenly. These injuries cause microscopic damage, often diffusely in the brain with unpredictable consequences. Repeated “minor” concussions can produce disabling brain dysfunction years later.

    (Saeed Fakhran, Joseph Delic, Lea Alhilali. Evolution of MRI of Brain Injury in Concussion Patients. Future Neurology. 2014;9(5):517-520

    Concussion Is Confusing Us All. Pract Neurol. 2015;15(3):172-186.)

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    Stephen Gislason MD is the author of the Human Brain. 2018 edition. 238 Pages.

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