askthedoctor Brain Injury Info
Traumatic brain injury has gained media attention because of its prevalence among those wounded by explosive devices in Afghanistan and Iraq. By Rear Adm. Joyce Johnson, D.O.
T
Traumatic Brain Injury Is Serious
■ Prevention of trau- matic brain injury is important. It’s especially crucial to prevent recur- ring head injuries.
raumatic brain injury (TBI) in- cludes several types of head injury — contusions, hematomas, skull
fractures, diffuse axonal (nerve) injuries, and concussions. In addition to combat, TBI can result from a fall, car accident, sports injury, or violent incident. TBI affects more than 1.5 million people in the U.S. each year. Contusions are bruises in the brain; ef-
fects vary by a contusion’s size and location. Hematomas occur when there is bleed-
ing in the brain. Epidural hematomas are between the skull and tissue around the brain, subdural hematomas are between the layers of tissue around the brain, and intra- cerebral hematomas are inside the brain. If a large blood vessel breaks, symptoms occur suddenly, but if a leak is small, it could go unrecognized for several weeks. A skull fracture is a break in the skull. An
open fracture occurs when an object pen- etrates the skull. A closed skull fracture can be harder to recognize. A linear skull frac- ture, or crack in the skull, might cause little damage. A depressed skull fracture, or dent in the skull, can tear sensitive tissues inside the skull and cause significant damage. Diffuse axonal injuries occur when the
brain is tugged or pushed around inside the skull. Sudden movements of the brain can tear tiny nerve fibers (axons) and the myelin sheaths that surround them. If someone remains unconscious for more than six hours following brain trauma, suspect diffuse axonal injury. Concussions are temporary brain in- juries that resolve after a few minutes or
4 6 MI L I T A R Y O F F I C E R AU G U S T 2 0 1 0
hours. Concussions often involve confusion and loss of memory; many also cause loss of consciousness. Though concussions have temporary symptoms, permanent brain in- jury can result from multiple concussions, especially over a short period of time. Seek immediate medical care if someone
vomits, has a seizure, loses consciousness (even for a few seconds), has muscle weak- ness, or has trouble walking after a head in- jury. Confusion and memory problems also can be signs of an injury requiring medical evaluation. Seek immediate medical atten- tion for a severe headache or stiff neck after a head injury, even if the onset is a day or more later. Note that head injury often is as- sociated with spinal and other injuries. Evaluation of TBI includes a CT scan or
an MRI of the head to look for abnormali- ties, including bleeding. Treatment of TBI depends on the specific nature of the brain injury — some bleeding might require sur- gical intervention to remove a blood clot that is putting pressure on other parts of the brain. Other treatment involves man- aging signs and symptoms, for example treating seizures or increased intracranial pressure. Impairment from a TBI can be temporary or permanent, minimal or se- vere. Patients with long-term symptoms might require years of rehabilitation.
MO
— Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. Find more health and wellness resources at www
.moaa.org/wellness. For submission information, see page 20.
PHOTO: STEVE BARRETT
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92