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”.