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,
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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