The brain is a complex organ, and head injuries can be mild, moderate or severe. Sometimes, an injury that looks serious may actually be mild, or vice versa.

Professor Ng Wai Hoe, Senior Consultant, Department of Neurosurgery, National Neuroscience Institute (NNI), a member of the SingHealth group, likens the brain to real estate. “It’s all about location. If you have a small blood clot in a critical area, you can lose function and may even become paralysed. But if you have a large blood clot in an area which is not considered prime, there may be no functional deficit and you might make a full recovery over time,” he said.

When a serious head injury occurs, time is key. The sooner a patient gets into surgery, the better his chances.

But surgeons cannot fix brain injuries the way they can fix broken bones. Surgery aims to prevent further damage from arising from the initial injury. After surgery, one can only allow the brain to recover gradually on its own time.

Brain swellings and blood clots can take lives. Removal of clots and damage may result in a patient losing key functions such as speech or hearing, but with rehabilitation, he may regain some of these. Brain swelling, which can cause further damage if not checked, is eased by removing a section of the skull. The bone can be replaced when the swelling subsides.

THE VERY YOUNG AND THE ELDERLY ARE PRONE TO HEAD INJURIES

A patient in critical condition may be put into an induced coma so that his brain can slowly recover. This was the treatment given to retired racing car driver Michael Schumacher, who sustained a major head injury in a skiing accident.

At NNI, most of the serious head injuries seen are caused by road traffic accidents. However, Prof Ng said that in the last decade, the probability of people getting serious head injuries from motor vehicles accidents had lessened. “Passengers are now well-secured in vehicles with seat belts, and are better protected with airbags.” NNI also sees head injuries resulting from falls at home and at industrial worksites.

Prof Ng said that in Singapore and most countries, brain injury is a major cause of death and disability, particularly in the young. But he expects head injuries among the elderly to increase. He recounted treating five patients aged 85 to 101 in a single day, all of whom had fallen at home and hit their heads. “Seeing so many elderly patients wasn’t the case five to 10 years ago."

He said the elderly are prone to brain injuries because they are often frail, have more problems with coordination and hence are more likely to fall. “As you age, your brain shrinks and atrophies, and that makes it more susceptible to injury.”
The very young are also prone to head injuries, as their heads are larger in proportion to the rest of their bodies. “Like a poppy on a stalk, the head of a young child is relatively heavier, and his brain stem and upper cervical spine can be easily traumatised,” ​said Prof Ng.​​​​

This is why Shaken Baby Syndrome – in which an infant gets a devastating brain injury from being shaken violently – is so serious. “Many either die or are condemned to a vegetative state.”

The one ray of hope is that a child with a serious head injury can recover faster than an adult.“This is known medically as neuroplasticity. The brain is still ‘plastic’ and has a remarkable ability to recover.” This means that in a two-year old whose speech is affected by a head injury, another part of the brain can take over because his speech centres have not fully developed. And an infant’s fontanelle – the soft spot on top of the head – allows for brain swelling.

Where head injury is concerned, the mantra is really “protect and prevent”.

Protection is key

Prof Ng advised those who engage in sports during which head injuries may occur, such as cycling or in-line skating, to wear helmets. “It’s not foolproof. I have seen motorcyclists with smashed helmets and injured brains. But helmets can reduce the impact and absorb a significant amount of shock.”

He also advised those in vehicles to wear safety belts, a​nd if possible to shield their heads with their arms or bodies when an impact is imminent. He said that this is crucial, and it is why someone may die from a fall at home while another walks away from a bike crash.

“If you mitigate impact by, say, breaking a fall with your arm, the injury may not be severe. But if your head is unprotected, and this happens frequently with the elderly and people under the influence of alcohol or drugs, a direct impact can be fatal,” Prof Ng said.

Don’t dismiss a blow or bump to the head

After a head injury is sustained, seek medical attention if:

  • The person is drowsy, irritable, confused or behaves differently.
  • There is nausea or vomiting.
  • There is weakness or numbness in any part of the body.
  • These symptoms may not appear initially, but if they occur within 12 to 24 hours after impact (the danger period for brain trauma), see a doctor without further delay.​

​Ref. Q15