Invisible threat from brain injuries


Blows to the head can be silent killers for which swift diagnosis is often the only recourse, say doctors.

Even if there is no damage to the outside of the head, the impact may inflict catastrophic damage to the brain inside, they say.

Because a shock that smashes the brain, a 1.3-kg organ with the consistency of soft jelly, against the hard protective shell of the skull, can damage nerves, brain cells and blood vessels. Blood clots and bruising then result, which in turn causes pressure to build up and squeeze the brain, worsening the damage and amplifying the risk of permanent disability or death.

Doctors looking at suspected brain trauma can call on X-rays or high-tech 3-D scanners as diagnostic tools, but treatment options are relatively few. Drugs may ease rising pressure in the brain, but sometimes surgery is required.

In the case of Formula 1 star Michael Schumacher — diagnosed after his skiing accident Dec. 26 — neurosurgeons first operated to tackle bleeding and bruising, and then placed him in an artificial coma after a postoperative scan showed “widespread lesions” on both sides of the brain.

The lesions “are not good news,” said French expert Jean-Luc Truelle, a retired professor of neurology at the Foch Hospital in the Paris suburbs. “It shows that there is bleeding across the brain’s function centers.”

Tried and tested, the coma reduces the patient’s temperature to around 35 degrees Celslus to reduce swelling. By being unconscious, the brain is also switched off to sounds, light and other triggers that cause the organ to use up oxygen as it processes the stimuli.

It can take up to 48 hours for symptoms of brain injury to emerge, which is why anyone who suffers even a mild concussion should seek medical attention, said Truelle.

According to a 2007 Australasian study in the Journal of Clinical Neuroscience, around 1 in every 40 cases of head injury documented over a 10-year period at a major trauma center were of so-called “talk-and-die” syndrome.

This means the patients initially felt OK after the incident but subsequently deteriorated and died from intracranial causes.