more than half a million people each year sustain a traumatic brain injury, or TBI. These brain injuries are caused when the brain, which floats in cerebral fluid, smashes against the hard wall of the skull following an impact. They are often caused by motor vehicle or sports traumas, but also can be caused by physical abuse or violence – including shaking a small child or infant – or, surprisingly, by mundane household or workplace accidents.People are also probably surprised at the profound effects that brain injury may have on someone's life and, just as importantly, what those effects might have on the patient's family.
Children with brain injuries may lack the communication skills to report headaches, sensory problems, confusion and similar symptoms. Instead, they may refuse to eat and appear listless or cranky. Their sleep patterns and school performance may change, and they may lose interest in favorite toys or activities.
Neurotrauma is a critical public health problem that deserves the attention of the world's health community. Estimates of brain and spinal cord injury occurrence indicate that these injuries cause enormous losses to individuals, families, and communities. They result in a large number of deaths and impairments leading to permanent disabilities. Research has also shown that traumatic brain injury (TBI) usually requires long-term care and therefore incurs economic cost to health systems.
Problems associated with traumatic brain injuries often come in two stages. The original impact may bruise portions of the brain or directly sever nerve connections. The second stage of the injury occurs when the tissue at the injury site begins to swell.
Family involvement in brain injury rehabilitation is paramount.Individuals who have experienced brain injury are likely to have difficulty with memory, communication, thinking and reasoning skills. They also may have problems maintaining appropriate behavior in social situations.
Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. TBI can result from a closed head injury or a penetrating head injury and is one of two subsets of acquired brain injury (ABI).Often, patients with a traumatic brain injury experience chronic motor and cognitive impairment, in addition to seizures, and sensory and visual deficits, which affect mental and physical functioning.
The most common cause of amnesia is a traumatic brain injury (TBI).Traumatic brain injuries can happen in a lot of ways and can be severe enough to cause a coma (prolonged unconsciousness), or a person may just be stunned without even being knocked out (like in some concussions).Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. Outcome can be anything from complete recovery to permanent disability or death.
A brain injury may also occur when a projectile, such as a bullet, rock or fragment of a fractured skull, actually penetrates the brain. This type of injury is far less common than is the closed-head variety.The common symptoms following a mild traumatic brain injury are usually self limited and resolve without any treatment. They include:
* Problems with balance
* Headache
* Fatigue, becoming easily tired, or needing extra sleep
* Irritability and restlessness
* Behavior and personality changes
* Difficulty with concentration and forgetfulness
Other long-term problems that can develop after a TBI include Parkinson's disease and other motor problems, Alzheimer's disease, dementia pugilistica, and post-traumatic dementia.The estimated relative risk of seizures after penetrating war injuries is very high.High serum levels of neuron-specific enolase (NSE) and S-100B protein are known to be associated with ischemic brain injury and poor outcome after cardiac arrest. Therapeutic hypothermia has been shown to improve neurological outcome after cardiac arrest.
Approximately half of severely head-injured patients will need surgery to remove or repair hematomas or contusions.Patients may also need surgery to treat injuries in other parts of the body. These patients usually go to the intensive care unit after surgery.
The severity of the injury is correlated with the interval during which the risk of seizures is increased. The risk of late seizures after severe traumatic brain injury fell rapidly but persisted throughout the follow-up period in our study. Thus, even unprovoked seizures occurring more than 10 years after a severe traumatic brain injury can be attributed in large part to the injury.Traumatic brain injury initiates several metabolic processes that can exacerbate the injury. There is evidence that hypothermia may limit some of these deleterious metabolic responses.
In adult patients with traumatic brain injury, treatment with the pregnancy-supporting hormone progesterone may improve outcomes -- especially in cases of moderate injury -- according to a report in the Annals of Emergency Medicine.
"I'd like physicians to appreciate the excitement and hope of finally identifying an agent for the treatment of traumatic brain injury -- and possibly other neurological injuries such as stroke, spinal cord injury, and multiple sclerosis," Dr. David W. Wright told Reuters Health. "No current therapy exists that improves the outcome of brain injury patients."
Wright from the School of Medicine at Emory University, Atlanta, and colleagues conducted a trial to assess the safety and potential benefit of administering intravenous progesterone to 100 patients with brain injury. Patients were randomly assigned to receive progesterone or inactive "placebo."
Brain pressure remained stable in progesterone-treated patients, the authors report, whereas it tended to increase in the placebo group. Increases in brain pressure raise the risk of brain damage.
Progesterone patients remained in coma longer than placebo patients, the report indicates, but just 13 percent of progesterone-treated patients died within 30 days of injury compared with 30.4 percent of placebo patients.
The reduction in death risk seen with progesterone was most prominent among patients with more severe brain injury, the investigators state.
On the other hand, at 30 days, survivors of severe brain injury who had received placebo were slightly less disabled than those who had received progesterone, the report indicates. Patients with moderate traumatic brain injury who had received progesterone were significantly less disabled than those who had received placebo.
Side effects were comparable between the progesterone and placebo groups, the researchers note.
"We are trying to gather enough data to make sense of the 1 year outcomes," Wright said. "So far, we have only been able to assess about 40 percent of the enrolled subjects."
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