[Kim Jaeho's Life Story] <269> Prevention and Management of Traumatic Brain Injury

Our brain is the organ that controls all processes regulating our body and mind, including thought and memory, emotion, sensation, movement, breathing, temperature regulation, and hunger. When a brain disorder occurs, the specific area affected determines which functions are disrupted, potentially leading to serious complications.

Due to the critical importance of the brain, it is, surprisingly, better protected than any other organ or system in the body by multiple layers: the skull, meninges, cerebrospinal fluid, and the blood-brain barrier.

The skull, commonly referred to as the cranium, is a vital bone that surrounds and protects the vulnerable brain tissue. Just inside the skull, the meninges?also known as the meninx or cranial meninges?envelop the brain and central nervous system. The meninges consist of three thin layers: the dura mater (outermost), the arachnoid mater (also called the spider web membrane), and the pia mater (innermost). These layers protect the brain and central nervous system.

Cerebrospinal fluid, which is similar to plasma with red and white blood cells removed, flows through the space between the brain and the meninges. It acts as a cushion to buffer the brain against shock and helps evenly distribute pressure inside the skull. It also supplies nutrients from the blood to the brain and removes waste products from the brain.

The blood-brain barrier, which is distributed along the blood vessels surrounding brain cells, protects the brain from harmful substances in the blood, including bacteria. It is a selectively permeable barrier that allows only substances necessary for brain function to pass through. By regulating which drugs and chemicals can enter the brain, it plays a crucial role in maintaining the brain's chemical balance and protecting brain health.

Damage to these protective mechanisms or any problem affecting the brain constitutes a brain disorder. There are hundreds of brain disorders, including vascular diseases such as stroke, brain tumors, infectious diseases such as poliomyelitis, degenerative diseases such as Alzheimer's disease, and brain injuries caused by trauma. This column will focus on brain injuries caused by trauma.

Traumatic brain injury refers to damage to the brain caused by an external force impacting the head. The majority of brain injuries are caused by traumatic brain injuries resulting from various accidents, including traffic accidents, industrial accidents, falls, and sports injuries. The incidence of traumatic brain injury is increasing.

There are three forms of traumatic brain injury: concussion, skull fracture, and cerebral hemorrhage.

Concussion, skull fracture, and cerebral hemorrhage are the three main forms of traumatic brain injury. A concussion occurs when a relatively mild impact to the head causes no structural changes such as swelling or bleeding, but results in simultaneous dysfunction of nerve cells. This leads to a temporary reduction or loss of brain functions such as consciousness, cognition, sensation, and movement for a few seconds to a few minutes. Typically, concussions recover naturally.

Next, a skull fracture is when the skull cracks or breaks. When the skull is fractured, it can cause concussion, cerebral hemorrhage, or other brain injuries, which may result in severe impairment of brain function and increase the risk of future brain exposure to danger.

Cerebral hemorrhage occurs when a blood vessel in the brain ruptures, causing blood to leak into the brain. The causes can be divided into those arising from internal factors such as hypertension or cerebral aneurysm, and those caused by trauma. Especially, if epileptiform discharges are confirmed on EEG, structural abnormalities are observed on brain MRI, there is a family history of epilepsy, or the first seizure presents as status epilepticus, the risk of recurrence is high and treatment is required.

Cerebral hemorrhage is a very dangerous condition that rapidly damages the brain, leading to symptoms such as headache, dizziness, paralysis, seizures, and vomiting. If the bleeding is severe, the patient may not regain consciousness and may die immediately.

How common is traumatic brain injury? According to the National Health Information Portal of the Korea Disease Control and Prevention Agency, traumatic brain injury affects 68 million people worldwide each year, making it a very common condition. In Korea, approximately 2.75 million cases occurred over a 10-year period (2008-2017).

By age group, the incidence is highest among children under 9 years old, although it is steadily decreasing. However, the incidence among the elderly aged 70-80 and above is steadily increasing. In particular, the number of traumatic brain injuries among those aged 80 and older increased by about 96%, from 18,510 cases in 2008 to 36,271 cases in 2017.

The mortality rate for traumatic brain injury in those aged 80 and older is 313 times higher than in children under 10. Traumatic brain injury is therefore a significant cause of death among the elderly. It can cause not only physical disabilities but also mental disabilities, placing an economic burden on families and society. For this reason, we must pay attention to traumatic brain injury.

The association between traumatic brain injury and the risk of early death was confirmed in a study reported by the U.S. medical news portal 'MedPage Today.' According to this study, people who experienced traumatic brain injury at an early age had almost twice (99%) the risk of death from all causes compared to those who did not experience brain injury. The average interval between brain injury and death was 4.7 years.

The main symptom of traumatic brain injury is loss of consciousness. Sometimes, there are no symptoms initially, but symptoms may appear several minutes or hours later. These can include headache, dizziness, decreased concentration, memory loss, fatigue, and vomiting. In severe cases, coma, convulsions, paralysis or weakness of the limbs may occur, and disabilities may persist even after regaining consciousness.

But are traumatic brain injuries being treated effectively? Mild brain injuries such as concussion may not require treatment other than rest and general painkillers. Treatment should focus on symptom relief and brain rest, and preventing future concussions is important.

Immediate treatment for people with severe brain injury focuses on preventing death. Surgery may be required to relieve intracranial pressure, remove debris or dead brain tissue, or treat skull fractures. However, such treatment does not regenerate already damaged nerve tissue, so sequelae from brain injury often remain, and the effectiveness of treatment, including surgery, is inevitably limited.

Therefore, if an accident occurs that raises concerns about brain injury?such as loss of consciousness, headache, nausea, or vomiting after a fall?it is necessary to receive emergency treatment promptly to prevent serious disability. Even better is to minimize the various accidents that cause brain injury in order to prevent traumatic brain injury altogether.

To prevent traffic accidents, the most common cause of traumatic brain injury, it is important to follow safety rules, including wearing a seat belt, and to practice defensive driving. One should also ensure that drugs or alcohol do not affect driving.

To prevent falls, it is important to observe safety rules carefully when working at heights, climbing up or down stairs, or hiking. Extra caution should be taken to prevent safety accidents. When riding a bicycle, motorcycle, or skateboard, or engaging in various sports activities, it is essential to wear a helmet appropriate for the activity.

To prevent safety accidents among young children, install window guards and safety gates, and remove hazards in hallways that could cause falls. To prevent traumatic brain injury from falls among housewives and the elderly, which has been increasing recently, install non-slip mats in bathrooms, handrails in bathtubs, showers, and on stairs, and improve balance and muscle strength through regular physical activity programs.

Independent researcher

This content was produced with the assistance of AI translation services.