Understanding traumatic brain injury

Understanding traumatic brain injuryThere’s been a lot of coverage in the news media in the past several years about traumatic brain injuries as they relate to combat veterans returning from Iraq and Afghanistan.

What you may not know is that at TBI can occur to “regular” people, too.

A TBI is caused by trauma and may occur after your head strikes an object, when something penetrates the skull, or as a result of repeated concussions, such as might be experienced in contact sports.

While many TBIs occur as a result of serious motor vehicle crashes, falls, firearms, and assaults are other causes.

Each year more than 1.5 million Americans suffer a TBI, many of them minor. However, between 80,000 to 90,000 people each year are left with long-term effects including paralysis, vision loss, hearing impairment, memory deficits and cognitive behavioral changes. In severely injured patients, death, coma, or a persistent vegetative state may result.

Understanding brain injury
Common injuries include skull factures, contusions, hematomas and hemorrhages.

Skull fractures can affect any part of the cranium, but the top of the head is most often involved. Skull fractures at the base of the skull usually require significant force and can also be associated with neurologic or vascular injury.

Fractures through the temporal bone, which houses the structures of the inner ear, can produce deafness or facial weakness. Depressed or complex open skull fractures, especially those in which the lining of the brain has been breached, may require surgery to repair the deformity.

Small contusions, or bruises, to the brain may cause some functional impairment, but they usually do not require operative treatment.

Instead, drying agents reduce the brain swelling, or surgeons may place a drain within the fluid spaces of the brain (ventricles) to remove excess fluid and monitor pressure.

Patients with a large blood clot on or in the brain may require surgery to alleviate pressure. If the pressure is severe, parts of the brain may place increasing pressure on vital tissues within the skull, a situation that can lead to death.

An epidural hematoma is a collection of blood located underneath the bones of the skull but outside the lining, dura, of the brain. These can result from a skull fracture that damages a cranial artery, causing bleeding in the space. Patients may experience a brief blackout at the time of injury but regain full consciousness thereafter. As the bleeding continues, they can experience a worsening headache, slip into a coma and even die. Prompt surgical care, even for patients with a large EDH, can result in a successful outcome.

A subdural hematoma also lies on the surface of the brain, just underneath the lining. Subdural hematomas often result from a tear or rupture of the veins that run between the brain and the dura. These are more common in older patients because, as we age, our brains shrink, making veins more susceptible to injury.

An intracerebral hemorrhage arises within the substance of the brain. The smallest of these may represent contusions or “bruises,” while the largest can tear apart normal brain tissue. Although neurosurgeons cannot repair the damage done by the clot itself, removing the ICH through a craniotomy will relieve pressure on the rest of the brain and prevent herniation.

TBIs can cause many symptoms, depending on their severity and which part of the brain they affect. Possible symptoms include:

• Loss of consciousness
• Headache
• Dizziness
• Fatigue
• Confusion, memory problems and trouble thinking
• Personality and mood changes; agitation
• Nausea or vomiting
• Seizures
• Change in sleep patterns; difficulty awakening
• Problems with coordination; weakness or numbness in the arms or legs

Severe brain injury may require surgery followed by rehabilitation. During rehab, therapists help patients regain abilities and skills that were lost due to the injury.

Ondrej Choutka, M.D., specializes in the surgical treatment of neurological disorders and disease, including cerebral aneurysm, skull base surgery, arterial venous malformation, brain tumors, trigeminal neuralgia, peripheral nerves, stroke and Moyamoya disease.
His office can be reached by calling (606) 329-1770.

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