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Brain Injury - A Ticking Time Bomb

posted by SK Brain Injury    |   November 26, 2011 13:40

It was sad to read about the death of a fellow Zimbabwean, Mbongeni Ndlovu, 28, who died in Oldham, UK. He died from severe head injuries following an alleged assault.

He was taken by ambulance to the Royal Oldham Hospital but police say he refused to co-operate, with suggestions that he may have discharged himself.

The most important question from this tragic story is whether or not there were missed opportunities to save him? His death caused imponderable grief to his family and friends. It also touched the hearts of many people who did not know him before.

Head injury is a ticking time bomb. The main danger of a head injury is bleeding and brain swelling. The earlier the patient is treated, the better the prognosis. Therefore, it is important to recognise the sinister symptoms that could suggest a severe head injury which needs investigations such as head scanning (head CT scan). These include a period of loss of consciousness, drowsiness, worsening headaches, confusion, strange behaviour, speech problems, vomiting particularly in the morning, dizziness,  loss of balance, weakness of an arm or leg, blurring of vision, seeing double, blood oozing from the ear, clear fluid leaking from an ear or nose, deafness and breathing problems.

In view of the fact that the symptoms of a severe head injury may not develop straight away, the victim of a head injury should have someone with them for at least the first 48 hours after the event. Often, assault charges are changed to murder when the assault did not appear to have caused grievous harm at the time of report, then resulted in death from a head injury days to weeks later. Hospitals do not usually discharge someone without some advice and some patients are kept in hospital if there is no one at home to monitor them.

It is advisable not to take alcohol and drugs that cause drowsiness, for example sleeping tablets and strong pain killers. These could confuse the picture.

There are many cases where a victim had contact with either the police or hospital prior to succumbing to a head injury. This appears to be the case with Mbongeni Ndlovu.

In some cases, the sinister symptoms of a severe head injury may not be present at the time of contact, but the mode of injury should arouse suspicion. Lack of co-operation by a victim is frustrating to law enforcement officers, however this could be the only significant symptom suggestive of a severe head injury. When the victim has alcohol on board, their lack of co-operation, violence, confusion, unsteadiness and slurred speech may be attributed to alcohol, only for the victim to be found dead at home or in a prison cell.

In UK, there are reports of a small number of cases (6% of all the deaths in police custody) where the actions of the police were directly attributable to the detainee’s death. Unfortunately, the statistics for head injuries in police custody in Zimbabwe could not be obtained. This is a controversial subject and the police are often accused of brutality, impetuous behaviour, racism and cover-ups.

In some of the cases, the presence of either drugs or alcohol may have played a part by increasing the person’s readiness to resist arrest and reducing their susceptibility to pain. After the hullabaloo and trauma of an arrest, the police should have a duty of care to their detainee and refer him for an assessment by a doctor if a head injury is suspected.

A knock on the head is common and usually there is nothing to worry about. The most common causes of severe head injuries are road traffic accidents, falls and assault. Although head injuries are common, death from head injury is low. Very few patients with head injuries (1-2%) require admission to hospital. Only a minority of patients, about 0.2% of all patients attending accident and emergency departments, with a head injury will die as a result.

The majority of all people who sustain a head injury are male and assaults account for a significant number of those who sustain a head injury (30-50%) and alcohol is involved in a significant number of cases.

If you sustain a head injury and you develop some of the symptoms I have described above, you need to be seen by a doctor urgently.  Your health is your priority, so take care of yourself.

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Rates of Head Injury in Children is Dropping, Death rates Stay the Same

posted by SK Brain Injury    |   November 7, 2011 11:28

The number of children hospitalized for head injuries has decreased in recent years, a new study finds.

However, the rate of death from such injuries has remained about the same, even though doctors are using aggressive treatments to try to save these kids, the study found.

Newborns and African American children were at particularly high risk of dying after a head injury, the researchers said. To prevent such injuries, future research should try to determine why this is, and whether other groups are also at increased risk.

"The more we expose these high risk groups, the more we expose the vulnerable age groups and race disparities," the better able we are to tackle and prevent these injuries, said study researcher Dr. Justin Lee, a surgical resident at Baystate Children's Hospital in Springfield, Mass.

The study was presented Oct. 17 at the American Academy of Pediatrics meeting in Boston.

Head injuries in kids

Lee and colleagues used a database to identify cases of U.S. children who were hospitalized for traumatic brain injuries (TBI) between 2005 and 2008.

Examples of injuries included severe concussions, and injuries that cause bleeding inside the brain, Lee said.

The researchers found 175,261 pediatric traumatic brain injuries. Over the study period, the number of yearly injuries decreased from 50,088 to 36,884. This decrease is likely due to increased awareness about head injuries, and the use of helmets while bicycling, Lee said.

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However, the mortality rate remained at 3.5 percent for all three years.

The four main causes of injury were being hit by a car, being in a car that was in an accident, falling and biking accidents.

Some patients required aggressive operations, including removing part of their skull (a craniotomy), or placing a hollow bolt in their brain to monitor pressure in the skull, Lee said.

Newborns were 2.8 times more likely, and African American children were 1.4 times more likely, to die of their brain injury than other children.

It's possible lower access to health care may explain the increased risk of mortality in African American children, Lee said.

Prevention

By the time children require aggressive treatments for head injuries, they are already at a high risk of dying, Lee said.

"It's not that the procedures weren’t good enough to rescue them," Lee said. "It’s the mere fact that they even required those procedures, put them at a high risk of death," he said.

The findings suggest the key to reducing deaths from head injuries may lie not in better treatments, but in preventing these injuries in kids who are likely to suffer from them.

"It's not necessarily what we do inside the hospital," Lee said. "It's what happens pre-hospital. That is what's really going to determine the morality."

The new study has not yet been published in a scientific journal.

Pass it on: The number of head injuries in children is decreasing, but the rate of deaths from these injuries has not changed.

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Brain Injury Related ER Visits on the Rise

posted by SK Brain Injury    |   October 18, 2011 16:57

The Centers for Disease Control and Prevention reported that emergency room visits for sports and recreation-related brain injuries, including concussions, among young people have jumped 60% during the last decade.

Researchers think the primary reason is that more adults made the determination that youngsters needed to be seen by a doctor.

Researchers call the injuries traumatic brain injuries, or TBIs. From 2001 to 2009, the number rose from 153,375 to 248,418 nationwide.

There was no breakdown by state.

Injuries among males most often occurred playing football or bicycling. Females suffered injuries most often while playing soccer or basketball or while bicycling.

Bicycling, football, playground activities, basketball and soccer were the primary sports involved.

Kevin Walter, program director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin, said the CDC's numbers did not surprise him.

"There's more awareness these days that it can be a significant injury, and there are simply more concussions now because kids are getting involved with contact sports at an earlier age," he said.

According to the CDC report, most of the visits to hospital emergency rooms were by males (71%). A total of 70.5% of the visits were among young people ages 10 to 19. Children up to 9 years old tended to be injured while playing on the playground or while bicycling.

Researchers have found that young athletes who had a traumatic brain injury experience longer recovery times and are at greater risk of serious outcomes compared with adults.

"TBI symptoms may appear mild, but the injury can lead to significant lifelong impairment affecting an individual's memory, behavior, learning and/or emotions," the CDC reported.

"In reality, brain injuries are still underreported and unrecognized," Walter said.

Recently, the Wisconsin Assembly Education Committee heard testimony in favor of a bill that would require young athletes who might have suffered a concussion or head injury to leave the game or activity immediately.

That athlete could not return until he or she is evaluated by a health care provider trained in the evaluation and management of concussions or head injuries and has written permission to return to play.

The bill would cover any organized athletic activity for young people between the ages of 11 and 19.

The bill has bipartisan support.

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Brain Injuries - General Information

posted by SK Brain Injury    |   October 10, 2011 21:03

In the course of everyday life, most of us have suffered the pain of a solid bump on the head. Whether from a fall, a door or a low-hanging branch, that sharp shock is familiar. We can usually sit for a minute or put on some ice, and carry on. But from March 2003 to March 2004, more than 16,000 people were admitted to hospital in Canada with a head injury. Most of those injuries came from falls. The tally doesn't include people who were treated and released at doctors' offices or emergency departments

As well, an estimated 2,000 children a year suffer head injuries in tobogganing accidents. Health Canada has recommended that all children use a helmet when sledding. But no province has passed legislation requiring the use of a helmet while sliding down a snow-covered hill — although most have some kind of bicycle helmet law in place.

While helmets for hockey and lacrosse are regulated, others are not. A private member's bill introduced in the House of Commons would require all recreational snow sport helmets not approved by the Canadian Standards Association to be prohibited under the Hazardous Products Act.

When does a knock to the bean become a cause for concern and medical attention? Here are a few answers to common questions about head injuries.

What are the common causes of head injury?

Car accidents are a major cause of serious head injury. Other causes are falls, sports and assaults. You don't have to be hit on the top of the head — a blow to the jaw or side of the head can also cause a brain injury. People who have had previous head injuries are believed to suffer more serious repercussions when they have another. Another injury to the head before a person has fully recovered can lead to brain swelling.

What types of head injuries are there?

The four main types of head injuries are:

  • Concussion: a mild brain injury that is usually temporary.
  • Contusion: a bruise on the brain.
  • Fracture: broken skull bones.
  • Hematoma: a blood clot caused by a blow to the brain.

The head and brain can be injured whether or not the skull is actually damaged. A hard knock or jolt, even with no external sign of injury, is enough to cause a brain injury.

What are the symptoms?

Symptoms can range from none to mild pain at the site of the injury, bleeding or lack of consciousness. Indications that the injury needs medical attention include:

  • Loss of consciousness.
  • Continued headaches, and headaches that get worse.
  • Nausea and vomiting, particularly in adults.
  • Seizures.
  • Confusion.
  • Loss of memory of events surrounding injury.
  • Drowsiness or lack of responsiveness.
  • Blood or clear liquid from the ears, nose or mouth.
  • Unusually large pupils, or pupils of different sizes.
  • In infants, an inability to stop crying.

How should it be treated?

Many mild concussions don't require more than rest and monitoring. Someone else should watch for signs of more serious injury, though. Sometimes the symptoms of a serious concussion, a contusion or hematoma may not show up for days.

Monitor when the patient does not appear to have any signs of serious injury. Make sure the person with the injury is not confused or having trouble walking. Watch for symptoms listed above.

Call the doctor if the patient later experiences dizziness, repeated vomiting, difficulty concentrating, or changes in personality.

Call an ambulance if the patient has lost consciousness, or is having seizures, paralysis, or problems walking or talking. If it is a small child, call the doctor if you think the child is not behaving as usual.

If the person has a skull fracture, put a bandage on the wound but do not try to clean it out or disturb it in any way. If the injury is serious, call an ambulance and do not try to move the patient.

Someone with a serious head injury is likely to be admitted to the hospital for treatment and observation. Symptoms can take days to show themselves. Surgery may be required to relieve pressure on the brain, if there is swelling or bleeding.

When can normal activity resume?

This will depend on the seriousness of the injury. Be sure to wait until all symptoms are gone. After a mild concussion, some people can resume normal activity almost immediately. Ask a doctor how long to wait after symptoms are gone.

Can they be prevented?

Most injuries can be prevented by sitting quietly at home — but people don't want to live their lives that way. But a few simple steps can drastically reduce the risk:

  • Don't drink and drive.
  • Wear a helmet when biking, inline skating or snowboarding.
  • Wear a seatbelt in the car and make sure children are in safety seats.
  • Slip-proof your home, especially the bathroom.
  • Play sports responsibly, using the proper equipment.

Children and helmets

One of the challenges parents face in protecting their children from head injuries is persuading them to wear a helmet, even when an adult isn't watching over them.

Ellie Wannamaker, a member of the Canadian Physiotherapy Association who treats children with head injuries at Bloorview Kids Rehab in Toronto, has some tips.

  • Convince them that wearing a helmet is "cool" by pointing to people like cyclist Lance Armstrong or other popular athletes.
  • Have children participate in the selection of the helmet, If they like Spiderman and he's on the helmet, they're more likely to wear it.
  • Get the whole family to wear helmets. If parents don't wear them, children are less likely to stick with them through their teens and into adulthood.

Wannamaker says a general guideline is that children should wear a helmet whenever they are going faster than they can run — using roller skates, inline skates, bikes, skateboards, scooters, skis, snowboards, toboggans, etc.

 

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