About Brain Injury

Traumatic brain injuries can result in bruised brain tissue, bleeding inside the brain, large or small lacerations in the brain, and nerve damage due to shearing forces. The brain can also experience a number of secondary types of damage, like swelling, fever, seizures, or an imbalance of neurological chemicals. A traumatic brain injury may either be a penetrating injury or a closed head injury.

Penetrating head injuries occur when an object, like shrapnel, enters the brain and causes damage in a specific area.

Closed head injuries occur when there's a blow to the head, which can happen during a fall, car accident, sporting event, or any number of different ways.

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Basic Signs and Symptoms of TBI

Basic Signs and Symptoms of TBI
I think the first issue you want to look at in terms of whether or not somebody has a brain injury is whether or not they're essentially unconscious, whether or not they're disoriented, whether they're bleeding from the head. Those are the most overt signs that you want to look for. If the child is bleeding or vomiting or dizzy--anything like that where you see any neurological sign, you want to seek immediate medical attention. I think then, for the period thereafter, you want to be looking for more subtle signs. Is the child developing headaches? Do you notice the child all of a sudden is becoming more anxious in some kinds of situations? Do you notice the child is beginning to have concentration difficulties, remembering difficulties? Is the child becoming more agitated? Getting angry or having temper outbursts for no apparent reason?

Why Is Depression the Number One Symptom After a Brain Injury?

Why Is Depression the Number One Symptom After a Brain Injury?
The most common mental illness that would occur after a brain injury is depression, which can occur, depending on the study, from anywhere from 20% to 60% of individuals after traumatic brain injury. It can occur in the first few months, but it can even occur--you know--months or even, studies have shown, years after the actual traumatic brain injury. Why is it more common? You know, we don't know. It may be that the areas of the brain that get injured are those that are more involved in producing depression. And certainly some studies show a correlation between the area of the brain that's injured and then subsequent depression. It could be that the chemical systems involved, the neurotransmitters involved during brain injury that get disrupted affect mood more than, maybe, some other behaviors. We have to appreciate that depression is a common disorder and it's one of the most common psychiatric disorders. So, certainly depression can be as a result of physiologic dysfunction of the areas of the brain, but we also know that other things make individuals depressed whether or not they have had a traumatic brain injury. So, being in a traumatic circumstance, having loss of certain functions, having problems with your social system and support, being unemployed, being in chronic pain--all can produce depression in addition to the effects of having the brain injury.

The Future of Diagnosing Traumatic Brain Injury

The Future of Diagnosing Traumatic Brain Injury
Traumatic brain injury will be diagnosed I think very differently 5 years from now. I hazard to make any predictions beyond 5 years, so if we can restrict ourselves to 5 years, I think that blood-based biomarkers will be used routinely, that we will use these biomarkers to minimize or reduce exposure to unnecessary radiation, because we're discovering now that a whole body CT exposes you to the same amount of radiation a Hiroshima victim experienced. And the increases in cancer rates, especially among developing kids, the pediatric population, is really starting to present an unacceptable risk for unnecessary CTs or MRIs. But we will use enhanced imaging technologies that will help to reduce radiation exposure such as magnetic resonance imaging. It's very clear right now that a significant amount of brain damage that occurs that is not detectable on CT is reliably detectable with an MRI but is never seen because we don't use MRIs. I think we'll see radical improvements in the technology for acute diagnosis of TBI and a more rational classification of TBI, because TBI is not one disease. It won't require one treatment. I think we'll make significant inroads into predicting the kinds of consequences that this poor fellow you and I talked about earlier who had what was thought to be a mild TBI and it took him months to years to recover. We will be able to give people some more accurate prediction. Okay, you have a brain injury. Based on your biomarker level and other information, unfortunately, you're going to expect to have a long period of memory deficits, and it's probably going to get into rehab. Don't be confused. Most of these people experience these deficits, and they're undiagnosed, and they don't know why they're having them. But I think the most important advances will be made in extending this technology very, very quickly to acute brain injury in general, and I'll give you some specific examples. Sports concussion is an obvious one, of course. Taking a blood test on the football field, and these tests will become a point of care test that you can go take in the locker room. Football players, like fighter pilots, are notoriously needle phobic, and you don't want to take a blood draw from me and many other more thuggish people who don't behave well in the face of needles. You want to do pinprick draws. Think of a pregnancy test or a glucose test where these things become very user-friendly and readily accessible.

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