From pro sports to youth teams, these days concussion is a hot topic. That means concussion awareness is on the rise—and deservedly so. A concussion is a mild brain injury. But it’s not the only possible consequence of a blow to the head. More severe consequences include moderate or severe traumatic brain injury (TBI) and/or subarachnoid hemorrhage, a bleeding in the protective layers around the brain.
In honor of Brain Injury Awareness Day on March 20, 2018, here are some of the most important things to know about brain injury, some recent advances in its diagnosis and treatment, and some stories of real people’s experiences with it.
The best treatment outcomes usually happen when a patient’s brain injury is detected early. So let’s look at what it takes to identify and treat a brain injury, starting with concussion and other TBIs.
A concussion or other TBI always comes with symptoms. But the symptoms may take hours or even days to show up. Therefore, after any blow to the head it is wise to check for symptoms immediately—and to keep referring to a checklist of possible effects for a few days.
Some effects will be clearly observable: loss of consciousness (present in less than 10 percent of people with concussion), vomiting, or loss of balance or coordination. Less obvious signs can include a “dazed” look or blank stare, mental confusion, physical or mental slowness, slurred speech or inability to remember the events before or during the injury. These signs don’t require a report from the injured person; they can be observed by alert coaches, coworkers, teachers, family members or bystanders.
There are also subjective symptoms that may need to be reported by the injured person. These include headache, feeling “off,” groggy, drowsy, confused or dizzy; experiencing blurry vision or double vision; having nausea; or being especially sensitive to light or sound.
If this seems like a broad list encompassing many possibilities, it is. People are different, brains are different and injuries are different. But there is actually one easy-to-remember, one-size-fits-all piece of advice about when to seek out a medical professional: “If in doubt, check it out.”
This was good advice for cheerleader Brittany Irwin. As captain of her high school cheerleading squad, she received two concussions and a few other blows to the head. Follow-up care for the concussions revealed that Brittany also had a rare developmental condition called Chiari I malformation. This malformation compressed part of Brittany’s brain, squeezing it down into the top of her spinal canal. It accounted for the headaches she had experienced for a few years and for some symptoms that were otherwise attributed to concussion. Pediatric neurosurgeon Dr. Richard Anderson surgically corrected the problem. Read Brittany’s whole story here.
However, even with the clearest of guidelines and the best of intentions, people may not always recognize concussion or TBI symptoms. Recent technological advances aim to fill in that gap. A new blood test for concussion has been approved by the FDA. This test, which should reduce the need for CT scans, can be performed within 12 hours of an injury and takes only a few hours to yield its results. In addition, a team at Columbia is developing an EEG helmet that they hope will identify sports concussions at the moment they happen. Instant identification would allow treatment to begin immediately.
Treatment for concussion often consists of rest that gives the brain a chance to heal itself fully. This is no small matter: If a second injury occurs before the brain is fully healed, the resulting damage to the brain can be much more severe. So it is important to avoid anything that makes symptoms worse by taxing the brain beyond its comfort level—be it mental concentration, bright lights, physical activity or other factors.
Neurosurgeon Dr. Michael Sisti’s patient Josephine Pucci knows how difficult that can be. As a Harvard undergraduate and aspiring Olympian, Josephine made the difficult decision to take a leave from her classes, put her training on hold and give her brain a chance to completely heal from a severe concussion. It was extraordinarily hard, but she did it—and played ice hockey in the 2014 Winter Olympics. We recently published an update to Josephine’s story—read it here.
Treatment for more severe forms of traumatic brain injury may require more than just rest. In the short term, treatments may include surgery to decrease the pressure within the skull from fluid buildup or from tissue swelling.
In other cases, TBI treatments may be lifelong. But these treatments are always improving, and our department is committed to staying abreast of developments, even helping to move them forward. Our doctors pass this commitment on to the residents (trainee neurosurgeons). One former resident, Dr. Charles Mikell, recently came back to give a Grand Rounds presentation for the department on new approaches to therapy for severe TBI.
Concussion is a form of mild TBI. That is, these conditions exist on a spectrum. Subarachnoid hemorrhage is a separate condition that can also occur with a blow to the head. Subarachnoid hemorrhage is an extreme medical emergency. Here, bleeding in the layers around the brain may increase the pressure inside the skull, squeezing the sensitive brain tissue. The main symptom of subarachnoid hemorrhage is an extremely severe headache that gets worse quickly and does not go away. Other symptoms may include nausea and vomiting or loss of consciousness.
Anyone experiencing “thunderclap headache” or the other symptoms, especially following a blow to the head, should be evaluated quickly. Neurosurgeons may work to repair head trauma or decrease pressure inside the skull.
This was necessary for Grace, a very young patient of Dr. Anderson’s. Grace fell down some stairs at a friend’s house. Her father, a medical student who knew the signs of TBI and subarachnoid hemorrhage, checked his daughter carefully. Grace displayed none of the signs, so the family began their trip home. Midway through the trip, Grace began vomiting. Her parents got her to CUMC, and Dr. Anderson performed a lifesaving operation to remove a blood clot on her brain. For Grace’s full story, and the list of head trauma symptoms that her parents use to educate other interested parents, visit here.
Even a “mild” brain injury is an injury to a vital organ. It is important to recognize such injuries promptly so they can be treated most effectively.
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