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Senior Correspondent

Q. What is the leading cause of brain injuries?

About 1.4 million people suffer a Traumatic Brain Injury (TBI) each year in the United States. Half of all TBIs are caused by accidents involving automobiles, motorcycles, bicycles, and pedestrians.

These accidents are the major cause of TBI in people under age 75. Falls cause the majority of TBIs in people 75 and older; this group has the highest rates of TBI-related hospitalizations and death.

[A note to older people who suffer a blow to the head: If you are taking a blood thinner such as Coumadin, get immediate attention from a healthcare provider to check for internal bleeding.]

TBIs fall into several categories:

Concussion, which is an injury produced by a violent blow or impact. A concussion is followed by a temporary, sometimes prolonged, loss of function. If you suffer a concussion, you may pass out, feel dazed and may lose vision, balance or memory for a while after the injury.

Contusion, which is a bruise of the brain. This means there is some bleeding in the brain, causing swelling.

Skull fracture. Sometimes the edges of broken skull bones cut into the brain and cause bleeding or other injury.

Hematoma, which is bleeding in the brain that collects and clots, forming a bump.

Symptoms of a serious head injury may be include: headaches, vomiting, nausea, sleepiness, convulsions, dilated pupils, slurred speech, weakness or numbness in the arms or legs, loss of coordination, confusion, agitation, bloody or clear fluids emanating from ears or nose, blurred vision or seeing double, dizziness, respiratory failure, paralysis, slow pulse, ringing in the ears, inappropriate emotional responses, and loss of bowel or bladder control.

Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible. Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize an individual with TBI and focus on preventing further injury.

Patients with mild to moderate injuries may receive skull and neck X-rays to check for bone fractures or spinal instability. For moderate to severe cases, tests such as a computerized tomography (CT) or a magnetic resonance imaging (MRI) scan are required. Approximately half of severely head-injured patients will need surgery to remove or repair hematomas or contusions.

Moderately to severely injured patients receive rehabilitation that involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support.

Treatment and outcome depend on the severity and location of the injury, the patient’s health and age, and the time it took to get the proper medical treatment. Healing of the brain takes time and a lot of rest.

After an injury, about 40 percent of TBI patients suffer from postconcussion syndrome (PCS). Symptoms include headache, vertigo, memory problems, trouble concentrating, sleeping problems, restlessness, irritability, apathy, depression, and anxiety. These symptoms may last for a few weeks after the head injury.
Treatment for PCS may include drugs and therapy.

Many TBI patients have sensory problems, especially problems with vision. Also, TBI patients often have difficulty with hand-eye coordination. Other sensory deficits may include problems with hearing, smell, taste, or touch. Some TBI patients develop tinnitus, a ringing or roaring in the ears. Language and communication problems are common disabilities in TBI patients.

Most TBI patients have emotional or behavioral problems that fit under the broad category of psychiatric health.

In addition to the immediate post-injury complications, other long-term problems can develop after a TBI. These include Parkinson's disease and other motor problems, Alzheimer's disease, and post-traumatic dementia.

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