With brain injuries, it is less about the injury and more about where it occurs in the brain. The National Neuroscience Institute explains why.
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.
Associate Professor Ng Wai Hoe, Medical Director,
National Neuroscience Institute (NNI) and Academic Chair, SingHealth Duke-NUS Neuroscience ACP, 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.”
Read on to find out how head injuries affect infants and the ways to stay protected.