As neurosurgeons one of the commonest issues that we see and treat are Head injuries. These can range from mild concussions to severe traumatic brain injuries (TBIs). The economic burden and emotional devastation that they cause are immeasurable and in a country like ours, it is almost heart breaking.

Head injuries can affect not just the physical well-being of individuals but also their cognitive functions, emotional health, and overall quality of life. This makes it crucial to understand the importance of prevention, personal protection, and the available treatment options for head injuries.

Before we delve deep into this, it’s a good time to get some basic principles of how the brain functions out of the way. We are pretty much born with all the brain cells we’re ever going to need. Unlike many other organs, the brain does not form new cells. There is some evidence that it can but for all practical purposes of a normal life, it doesnt. What the brain does do, however is constantly modify the way neurons connect with each other. Using a particular set of skills strengthens that particular pathway, kind of like how muscle memory works. Or even languages, in terms of getting better at speaking one the more we use it. The conclusions that we draw from these facts are that if a part of the brain is destroyed or injured, either because of trauma, or a stroke, or even surgery, or a tumor, the brain effectively loses whatever functionality that part was providing. The other inference is that it is maybe possible for the brain to recover some function based on the principles of neuroplasticity.

Neuroplasticity is the ability of the brain to change, usually in response to and external challenge, in order to restore, regain or modify its functioning as best as possible. It is based on 2 main principles, collateral sprouting – or changes in the synaptic connections between cells, including the formation of new connections and functional reorganization, where the brain, over time is able to take over the functions of the damaged portion.

This brings us to the fact that brain, though spectacular, can’t repair itself back to a 100%. Probably why it’s encased in thick bone.

Prevention: The First Line of Defense

Prevention is the most effective strategy when it comes to head injuries.

There’s no two ways of looking at this.

Understanding the risks and how to avoid them can significantly reduce the incidence of TBIs. We see them in fairly common situations, the most common being road traffic accidents. Wearing seat belts while driving, using helmets during sports or motorcycle rides are the easiest way to prevent any significant injury.

Sports professionals, particularly those involved in contact sports like soccer, american football and rugby, and boxing and MMA are at a higher risk of repeated head injuries, which can lead to conditions like second impact syndrome or chronic traumatic encephalopathy (CTE). A famous example is Muhammed Ali. The slowing of movements, almost similar to Parkinson’s with significant memory losses was termed dementia pugilistica. This is of course now called CTE.

Personal protective equipment, especially helmets, plays a vital role in safeguarding against head injuries. Helmets are designed to absorb the shock of a blow and reduce the risk of fractures or brain injuries. However, while helmets are highly effective in preventing severe TBIs, they may be less effective against concussions, which are caused by the brain moving within the skull. This is an issue that we face mainly with contact sports where the helmets don’t quite protect against repeated brain injury. The important part here though is the fact that anyone on any kind of 2 wheeler – be it rider or pillion, be it a bicycle or a motorbike, needs a helmet at all times. There’s no predicting when an accident can happen. And its always better to be safe than sorry. The same reason we would ask for bottled water instead of tap or filtered.

When a head injury occurs, prompt medical attention is critical. The treatment for head injuries varies depending on the severity. Mild injuries like concussions usually require a short period of medical observation and then rest and gradual return to normal activities. Severe injuries might need immediate surgery to relieve pressure in the brain or repair skull fractures, and possibly a long course of intensive care. The role of surgery is as mentioned, only to relieve pressure in the skull. This increased pressure may be caused due to a blood clot, or hematoma, or due to brain swelling. The blood clots, in turn, maybe between the bone and the coverings of the brain – Epidural hematoma, just below this covering but outside the brain – Subdural hematoma and within the brain itself – cerebral contusion/intraparenchymal hematoma. These clots are further characterized by where in the brain they are and the size. This information is usually got from a CT scan. Now based on the size of the clot, type of clot and clinical condition of the patient, a decision for urgent surgery maybe taken in order to relieve the pressure on the brain and reduce the risk to life. Persistently elevated intracranial pressures can lead to secondary brain injury and even death.

The next step is to gradually get these patients out of the intensive care setup. Patients are usually sedated to reduce brain activity and give it a chance to rest and monitored. The monitoring is to ensure that the damaged brain receives adequate blood, oxygen and nutrition and to prevent further damage. As patients gradually improve the sedation is withdrawn and they are weaned off the ICU supports. At times this may require additional procedures like a small tube into the lungs – a tracheostomy or a feeding tube directly into the stomach – feeding gastrostomy, especially in patients in coma.

Rehabilitation is also an essential part of treatment for head injuries. Once patients are out of the ICU and are medically stable, the next phase of recovery is intensive rehabilitation. This can include physical therapy, occupational therapy, speech therapy, and counseling, cognitive retraining, etc. The immediate post hospitalization rehab is best done at in-patient rehabilitation centres. To begin with most rehab is physical, as patients show gradual improvement the focus moves to functional rehabilitation, speech, occupational therapy and training to be independent for daily activities. Furthermore the rehabilitation transitions to cognitive retraining to help restore memory and other higher mental functions. The goal is to help individuals regain as much function as possible and support them in adapting to any changes in their abilities.

Head injuries are a serious public health issue, but with proper education, the use of personal protective equipment, and advancements in medical treatment, we can significantly reduce their occurrence and impact. It is imperative that we continue to promote awareness about the risks of head injuries and the importance of prevention and protection. Should injuries occur, knowing the treatment options and seeking immediate care can make a significant difference in recovery and long-term health outcomes.

Did you get hit on the head?
Tagged on: