Head Trauma
Head trauma results from a violent force applied to the head. A 'closed head injury' occurs from blunt trauma such as hitting one's head on a car dashboard. A penetrating head injury occurs when the brain is pierced by an object such as depressed bone fragments or a bullet. Motor vehicle accidents (including motorcycles) are the leading cause of head trauma, followed by falls, sports injuries, violent crimes and child abuse. Each year, approximately a million people seek medical treatment for a head injury. Seniors over 75 and very young children are more prone to head injury through falls; males between 15 and 24 are the most vulnerable to head trauma due to their tendency to engage in high-risk behavior.
Symptoms
The nature and extent of the symptoms depends upon the extent of the injury, and the area of the brain that is affected. The cardinal feature is an alteration in the patient's level of consciousness. This may be associated with other motor or sensory deficits. Such deficits may be temporary or permanent. Deficits may include difficulty speaking, walking, swallowing; poor coordination and balance; changes in memory, inability to smell and hear, and faulty thinking (cognitive) skills.
The initial treatment of head trauma includes the treatment of brain tissue swelling in response to the injury. This swelling usually continues for 72 hours and then begins to resolve.The period of swelling usually makes the extent of the long-term damage difficult to assess in the weeks immediately following the injury.
Testing
Assessing brain damage is a long-term and continuous process that involves a number of medical professionals. It begins immediately after the injury has occurred, and may continue throughout rehabilitation, which could last anywhere from several months to a year. (Evaluations include those for: attention, memory, cognition, speech, hearing and the ability to perform 'activities of daily living' such as getting dressed and preparing meals.)
* CT (Computed Tomography) scan: This is a combination of an x-ray device and a computer. X-rays are taken of the brain, and this information is fed into a computer which transforms the data into a picture. CT scanning is usually the first test for patients with symptoms of traumatic brain injury and often detects brain hematomas (collection of blood in the brain or within the brain coverings), brain contusions and brain swelling.
* MRI (Magnetic Resonance Imaging): This procedure uses a tunnel-shaped piece of equipment that contains a magnetic field and radio energy; no x-rays are involved. Magnetic signals are fed into a computer which assembles a picture. Because the MRI ignores bone which can obstruct CT images, this device provides a clearer picture of tumors located near the bone, and can provide a wider variety of image angles. It can detect edema (swelling), but has difficulty distinguishing edema from a tumor. MRI imaging takes longer than a CT scan, and is very noisy. Patients with cardiac monitors, pacemakers or surgical clips cannot take an MRI because of conflicts with the magnetic fields. MRI scanning also detects evidence of all types and degrees of brain injury.
Treatment
Pressure in the brain due to swelling is very serious because the brain is contained within the hard shell of the skull and cannot expand beyond it. Too much pressure can crowd and damage critical structures, including those that govern breathing and heart rate. In some cases, an intra-cranial pressure (ICP) device is inserted to measure the pressure to assist in its treatment. The ICP is connected to a monitor and evaluates pressure changes over time.
Neurosurgery for head trauma is dependent on the extent of the skull fracture and/or the amount of blood that has collected in the brain, and the extent to which these derangements have impacted the neurological examination. It could involve craniotomy for removal of blood clots in the brain tissue or subdural or epidural spaces, bone fragments or foreign objects.
Medical management is used to reduce, to the greatest extent possible, the effects of head injury. This supportive care may include medications, oxygen support, IV therapy and rehabilitation services.
Once you have been stabilized, long-term rehabilitation is an important part of recovery. You will be assigned a team of therapists to help recover your pre-injury abilities and/or to teach you how to compensate for any functions that have been lost or permanently altered. Your program will be tailored to your physical and emotional state and should reflect your background and interests. Family members can be extremely helpful in assisting with rehabilitation.
Research
Research in the U.S. continues on identifying the many cognitive and communication problems caused by brain trauma. There is also a lot of work being done in the area of assessing and treating children who suffer brain trauma, as their brains are significantly different from those of adults. Ongoing clinical trials are testing the effectiveness of certain medications on recovering language, speech and cognition.
Prevention
Most head injuries are the result of accidents. The best form of prevention, then, is to take reasonable precautions. Do not dive if you are unfamiliar with the depth of an area, drive carefully and always wear your seatbelt; make sure you wear a helmet when cycling and roller blading. Follow the rules of the sport or activity in which you are participating.
Support Groups/ Resources
Many patients and families find great comfort and support in talking with other patients, families and caregivers who have had (or are having) similar experiences. Support group meetings are free of charge, and are facilitated by a trained peer or qualified professional.
The following numbers should help you get more information and/or find a group nearest you:
The Brain Injury Association, Inc.:
1-800-444-6443
The Brain Injury Association of Virginia:
(804) 355-5748
The National Institute of Mental Health:
(301) 443-4513
The National Institute of Child Health and Human Development:
(301) 496-5133
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