Brain injuries

Brain injuries can occur in many ways. They could be caused by medical problems such as stroke or tumor. These are termed acquired brain injuries. But most frequently, brain injuries occur as a result of a forceful jolt or blow to the head. This type of brain injury is referred to as traumatic brain injury. Individuals suffer traumatic brain injuries due to different causes, including traffic accidents, fights, gunshots, and sports-related injuries. The worst part is that most of these brain injuries go undiagnosed or are misdiagnosed, due to this it can be hard to tell what you are going through. Additionally, concussion and other brain injuries that aren't treated can lead to even more serious problems including memory problems depression or sensory loss.

What Happened When A Brain Injury Goes Untreated?

Untreated concussions can have major long-term health consequences ranging from physical challenges to psychological and emotional troubles. Depression is one of the first symptoms that people experience. Mood swings and irritability are frequent, and the patient can become irritated often, particularly throughout the rehabilitation phase.

All of these changes may result in emotions of sadness and depression which can have a continuing negative influence on the patient. Following a traumatic brain injury, accident victims also endure stress in their relationships, since their partner and loved, ones may need to adjust as well.

Apart from depression, individuals can show the following symptoms(1):

• Feeling dizzy or lightheaded

• Fatigue

• Being forgetful

• Frequently occurring headaches

• Poor coordination

• Weakness

• Swallowing problems

• Loss of sensations

Furthermore, severe symptoms may include visual or hearing loss, as well as loss of speech or stuttering.

Patients with traumatic brain injury can also experience additional mental issues, for example, difficulty in reading, writing, or recalling information. Additionally, behavioral changes can also develop years after the injury or accident (2).

Furthermore, if you suffered an injury from a car accident or falls, there is a great chance that you can develop chronic traumatic encephalopathy in life. Other conditions that can develop following a brain injury later in life are: depression, seizures, dementia, Alzheimer's disease, and post-traumatic stress disorder. However, if you lose consciousness in an event, you can develop cognitive changes later in life including memory loss.

Moreover, timing also matters after an injury, if the brain trauma is immediately managed within one hour, then the patient can be saved from worst outcomes. For example, a study showed that those brain injuries that were immediately managed within one hour did not reveal the worst outcomes. On the other hand, patients who arrived later after a traumatic brain jury after one hour died the 28th day (3).

It is also important to mention here, we cannot dismiss the claim on the grounds that the person is functioning well despite the fact he had a certain brain injury. If the person who has claimed for disability has been verified by the doctors that he indeed experienced brain damage, no matter how healthy or functional he seems to be his claim is valid.

Effect of brain injuries on an individual work performance

As you can imagine, the symptoms associated with TBI can be life-altering and influence several aspects of a person's life.

For example, research has shown that brain injuries can make it difficult to focus, pay attention, or coordinate. Working performance, productivity, and attendance can all be affected as a result of brain injury (4).

Similarly, younger patients with brain injuries can have difficulty concentrating, reading, remembering information, or taking examinations. Concussion and TBI sufferers sometimes cannot come to school for weeks or months.

TBI can also induce significant physical symptoms such as vertigo, difficulty balancing, and even heart rate anomalies in athletes. All of these issues lead to an absence from sports.

Additionally, it is worth noting that a person might face disabilities for example coordination issues after brain damage without any effect on their memory.

How does it heal? The brain is a dynamic organ that has a natural ability to adapt and change with time. Even after the brain injury occurs, it has the ability to set up new connections between neurons that convey the information within our brain. However, research shows that the brain only can make neurons in some specific areas, the function and extent of the creation of new neurons is still under investigation

Normally, a brain is covered by protective layers named meninges. Following a head injury, meninges receive some assistance from their friends: cells of the immune system that mobilize to help in healing. In a recent study, researchers from the “National Institutes of Health” observed that various immune cells perform precisely scheduled tasks to repair the brain's damaged lining. The meninges protect both the spinal cord and the brain from any type of harm. Damage to the meninges can result in cell death in the affected brain tissue. Within the first day of damage, immune cells termed inflammatory monocytes from the blood reach the core of the wounded meningeal tissue and begin removing dead cells. These cells were helped a few days later by another blood monocyte, which works around the lesion's edge to assist in the reconstruction of damaged blood arteries. It is worth noting, these blood vessels will completely heal and will start functioning within a week (5).

Furthermore, evidence indicates that MRI can reveal brain atrophy, which occurs when damaged or dead brain tissue is reabsorbed long after the event of brain injury. Since damaged brain tissue cannot fully heal following a TBI, but clinicians can identify TBI-related alterations years after the event.

HOW TO TEST FOR TBI

Healthcare practitioners use numerous tests and techniques to diagnose TBI. These include imaging tests, for example, computerized tomography and Magneti resonance imaging, Glasgow Coma scale, speech and language tests, cognition tests, lung function tests, testing for breathing abilities, and blood tests including GFAP and UCH-L19(6).

References

1. Uomoto, J. M., & Esselman, P. C. (1995). Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. Am J Psychiatry, 152(10).

2. Kirkwood, M., Janusz, J., Yeates, K. O., Taylor, H. G., Wade, S. L., Stancin, T., & Drotar, D. (2000). Prevalence and correlates of depressive symptoms following traumatic brain injuries in children. Child Neuropsychology, 6(3), 195-208.

3. Newgard, C. D., Meier, E. N., Bulger, E. M., Buick, J., Sheehan, K., Lin, S., ... & ROC Investigators. (2015). Revisiting the “golden hour”: an evaluation of out-of-hospital time in shock and traumatic brain injury. Annals of emergency medicine, 66(1), 30-41.

4. Webb, C. R., Wrigley, M., Yoels, W., & Fine, P. R. (1995). Explaining quality of life for persons with traumatic brain injuries 2 years after injury. Archives of Physical Medicine and Rehabilitation, 76(12), 1113-1119.

5. Russo MV et al. Distinct myeloid cell subsets promote meningeal remodeling and vascular repair after mild traumatic brain injury. Nature Immunology. April 16, 2018.

6. Brain Injury Association of America. (n.d.). Diagnosing brain injury. Retrieved March 20, 2020, from https://www.biausa.org/brain-injury/about-brain-injury/diagnosis/neuroimaging.