Brain damage

ANATOMY OR SYSTEM AFFECTED: Brain, nervous system

DEFINITION: Mild, moderate, or traumatic brain injury, which occurs when cells that make up the brain die

CAUSES: Accidents (automobile collisions, falls, sports injuries); strokes

SYMPTOMS: Motor control problems, paralysis, balance and sensory problems; often speech and language difficulties, memory loss, concentration and attention problems; if extensive, loss of consciousness, coma, and death

DURATION: Acute

TREATMENTS: Depends on cause; may include surgery (hemorrhage, tumor) or drug therapy (swelling, blockage, infection)

Causes and Symptoms

Brain damage can occur as a result of several causes. Therefore, physicians have found it helpful to categorize the types of injuries that most often lead to the death of brain cells. The most common type that leads to brain damage is the closed head injury. It occurs when a problem, such as the disruption of blood flow to the brain, prevents vital oxygen and nutrients from reaching the cells that make up the brain. If the brain is deprived of oxygen and glucose for more than six or seven seconds, then a person usually becomes unconscious and brain cells begin to die.

Accidents such as automobile collisions, falls, and sports injuries can lead to brain damage by causing the brain to bleed inside the cranium. This kind of closed head injury frequently results in brain swelling that puts pressure on delicate structures, preventing them from working properly and sometimes leading to permanent damage. Strokes also result in brain damage either by blocking normal blood flow within the arteries that feed the brain or by causing a blood vessel to break and leak blood into surrounding tissue.

Increasing attention has been paid to athletes and members of the military who sustain repeated contact, such as boxers, football players, and soccer players. Repeated blows to the head can result in chronic traumatic encephalopathy (CTE), a progressive degenerative brain disease. Researchers say up to four million concussions occur in athletes annually in the United States, and about 17 percent of those with multiple concussions or mild traumatic brain injury develop CTE. So far, CTE can only be diagnosed after death by examining the brain.

When brain damage occurs, symptoms may include motor control problems, paralysis, and difficulty with balance and the integration of sensory information. In the case of an accident that leads to brain damage, it would not be uncommon to see cognitive functions affected, creating speech and language difficulties, memory loss, and problems with concentration and attention. Problems with motivation and the expression of emotions may develop, and to some degree a person’s personality can be altered because of brain damage. In cases of extensive damage, the result could be loss of consciousness, coma, and even death.

Treatment and Therapy

Treatment for brain damage begins with an assessment of the cause and extent of the injury. Several distinct technologies can be used to image not only the structures of the brain but the functioning of specific areas as well. If bleeding or swelling of the brain is suspected, then a computed tomography (CT) scan can be used to provide pictures of the brain to assess which structures are implicated. If a tumor or areas of localized damage is suspected, then magnetic resonance imaging (MRI) is more helpful because of its ability to create a clear, well-defined image.

Specialized neuropsychological tests are used to determine the extent of deficits in thinking—such as language processing, memory, and decision making—as well as in sensory perception and motor functioning. Visual diagnostics alone usually cannot determine the specific impact on mental processes and specific functions. Neuropsychological procedures, often administered in a particular array, or test battery, along with visual imaging, provide the best appreciation for how the damage affects brain function.

Since there are several different causes of brain damage, treatments can vary. Drug therapy can be used in instances where the brain is being damaged by swelling or when an artery inside the brain is partially blocked. High doses of antibiotics can be used when damage occurs as a result of a bacterial infection. If a weakened artery is found that is leaking blood into the brain or a tumor is detected using an MRI, then surgery could be recommended. In instances where no immediate treatment can be performed, specific rehabilitation therapies are used to stimulate surviving brain tissue that is near the injury to take over some of the functioning of the damaged tissue.

Perspective and Prospects

Although brain injuries have occurred since the beginning of humankind, the question of what the brain does and how it contributes to behavior has only been partially answered. There is evidence from human skull remains that small holes were drilled as a form of crude brain surgery as far back as 2000 BCE. The purpose of the procedure is unknown; however, it could have helped an injured person by relieving brain swelling. Prior to the first century CE, it was not widely accepted that the brain was the center for reasoning, emotions, and movement. During early human history, the heart was believed to control the thoughts and emotions. The Roman physician Galen of Pergamum (130–201 CE) was influential in bringing forth the notion that the brain, and not the heart, gave rise to behavior. He learned much about the brain and its impact on behavior by observing injured gladiators who survived fierce battles in the Roman coliseum.

Prospects for future therapies to compensate for brain damage include stem cell tissue transplantation to stimulate new brain cell development. Better drugs are being developed for stroke victims whose blood has leaked into the brain and had begun killing nearby cells. Also, brain imaging technologies are continuing to be refined to produce clearer pictures that allow practitioners to make more accurate diagnoses. In 2013 US president Barack Obama launched the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative to promote neuroscience research including efforts to better understand and treat brain damage and related brain disorders.

Bibliography:

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Gronwall, Dorothy, Philip Wrightson, and Peter Waddell. Head Injury: The Facts—A Guide for Families and Care-Givers. 2d ed. New York: Oxford UP, 1998.

Inserra, Christopher J., and Bradley W. DeVrieze. "Chronic Traumatic Encephalopathy." StatPearls, 8 Aug. 2022, www.ncbi.nlm.nih.gov/books/NBK470535/. Accessed 28 Mar. 2024.

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