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Head Injury and Brain Trauma |
Head injuries are extremely common and range from mild
to severe concussion, to major cra-nial trauma with coma.
The most common causes are falling, assault, motor-vehicle
accidents, other transportation accidents, and miscellaneous
causes. The death rate is about 10 per 100,000 injuries, but
causes a disproportionate number of deaths in young patients.
The types of brain injuries that oc-cur are contusions (mild
surface bleeding on the brain), hematoma (a larger blood collection
in one of the brain spaces), bleeding around the brain (subdural
and epidural), diffuse brain swelling, stroke and hydrocephalus.
When patients receive a head injury, they are generally given
a grade called a Glasgow Coma Score, which is predictive of
survival.
The damage caused by brain injury occurs both immediately,
as well as in the following days to weeks, and long term.
Immediate injuries include unconsciousness, potential motor
symptoms such as weakness, and various sensory deficits. Following
the acute phase, patients may suffer subacute inju-ries such
as hydrocephalus (water accumulation in the brain), secondary
bleeding, early seizures, de-crease in respiratory status,
and other effects. Finally, there are late effects of head
injury. The com-mon problems include memory loss, dizziness,
and poor concentration, and these typically will resolve after
6-12 months. More uncommon late effects include development
of epilepsy, late-onset hydro-cephalus, and occasionally movement
disorders.
Head injuries are generally treated acutely by ICU specialists,
neurosurgeons, neurologists and primary care doctors. Long-term
treatment includes all of these doctors as well as neurologists,
phys-iatrists and psychologists.
Symptoms
- After a minor head injury, a patient may experience dizziness,
vertigo, poor balance, and head-ache.
- Neck pain, back pain.
- Poor memory, poor executive function.
- Depression.
- Major head injuries are discussed above.
Treatment Available
- Antidepressants, for the most common problem, which is
long-term depression.
- Antiseizure medications to prevent seizures, although
this is usually used in the short term only.
- Various pain relievers for headache, including beta blockers,
calcium channel blockers, and triptan agents.
- Medications for muscle spasms.
- Treatment to help with insomnia.
- Psychological counseling, cognitive rehabilitation, physical
and occupational therapy all are quite useful.
- Surgical procedures such as shunting, removal of clot,
and pressure monitoring (major trauma)
Research
- Studies to determine the roles of high-dose steroids in
the acute phase.
- Understanding the roles of shunting procedures.
- Long-term rehabilitation studies.
- Community reintegration approaches.
- Web Sites:
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