Brain Injury

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Brain Injury and Your Brain

Your brain is a complex, marvelous, unique connection of nerves, blood vessels and tissues. Its texture is similar to custard in a bowl – soft, pliable and slippery. Yet, it is the center of your nervous system and it receives, processes and sends messages to every cell and every part of your body. The information received is from any of our seven senses: sight (visual), sound (auditory), touch (tactile), smell (olfactory), movement (kinesthetic), taste (gustatory) and intuition (spiritual). The incoming information is initially processed in the protective/reactive (survival) areas of the brain. These areas work in a reactive mode to help regulate our bodies and keep us safe. The autonomic system, without thought, controls actions from regulating the beating of our heart, to adjusting the temperature in our body, in order to help us stop in our tracks and freeze in a dangerous situation. The frontal area of our brain allows for decision-making, and is the responsive, thoughtful part of our brain that acts as the braking system to prevent over-reactivity. Thus, for incoming information to move along and be processed, integrated and then sent out (response), the brain must function fluidly. When it does, it is called brain regulation. This means that the brain and its vast network are flexible, resilient, and self-regulating.

However, when there is a brain injury, the system becomes dysregulated or, in other words, the brain becomes stuck in specific brainwave patterns. Thus, it is no longer resilient and flexible, and often becomes over-reactive (hyper arousal – anxiety). When this happens, to protect itself the brain shuts down causing depression, fatigue, inattentiveness.

The Linear and Nonlinear Brain

Linear and Nonlinear brain graphical representation of what the left and right hemispheres do.

The more complex the task, the more brain areas need to be recruited and engaged simultaneously to successfully complete the job.

Communication between areas of the brain is critical for coordination of neuronal activity that underlies higher cognitive function and complex decision making.

After a brain injury, the brain quarantines the injured area and allocates resources toward recovery and healing.
When a person experiences trauma, communication between brain areas is interrupted to prevent additional stress on the organism.

Understanding Brain Tissue and Brain Scanning

It is valuable to have a basic understanding of the different brain scans and what parts of the brain they can observe. Most brain scans focus on “grey matter,” which is the physical brain structure that does much of the information processing. There are three main scanning methods for grey matter, a CT scan, an MRI scan, and an SWI scan. A CT Scan (Computerized Tomography) is the standard of care following a concussion and is one of the lowest-resolution scans of grey matter. It is commonly used because it is relatively cheap and widely available.

CT Scan

CT Scan courtesy of Pixabay

A CT scan uses many layers of X-rays to show the structure of the brain, detecting obvious brain injury as well as large tumors or hemorrhages. It can miss small issues, so if a doctor wants greater detail and resolution they may decide to have a better scan.

MRI Scan

T3 MRI image courtesy of www.german-diagnostic.md

The next level of detail is an MRI (Magnetic Resonance Imaging). The science behind this scan is complex, but essentially it generates a strong magnetic field around the brain and can distinguish different tissue types by how they respond to the field. The MRI measures the same grey matter that the CT scan does, giving doctors an image of the structure of the brain with a bit better detail. There are two types, a T3 or T4 MRI. The T4 is the higher quality scan.

SWI Scan

SWI Image courtesy of www.healthcare.siemens.it

All three of these scans focus on the grey matter of the brain, which is valuable to look at but is only one part of the brain structure. There is also a vascular system of many blood vessels and capillaries that feed brain tissue with blood. To envision this system you can see the images below.

Brain vasculature image courtesy of hive76.org

Brain vasculature image courtesy of Dr. Mukhtar -Khan Resident Neurosurgeon FCPS www.slideshare.net/kuzagar-brain-vascular-supply

The brain vasculature (capillaries, arteries, and veins) can be torn by trauma or by internal issues like a tumor. The results of the bleed may show up on any of the three scans previously discussed, though they will not directly show the vascular system.

The White Matter System

Image courtesy of blog eyewire.org

The white matter system can also be torn or affected by any kind of brain injury but will not show up on an SWI or MRI, let alone a CT scan, because those scans are looking at the grey matter. The scan for white matter is called a DTI (Diffusion Tensor Imaging) which is an adapted MRI that observes neuron pathways, the white matter superhighways.

In the above image you can see the brain viewed from the side (left image) and the front (right image). With this type of image doctors can begin to identify areas where the brain’s communication superhighway has been damaged.

Educational Videos

Below are two educational videos: One shows the formation of a white matter connection and the other shows the amazing and lightning fast white matter network as it communicates in

Brain Injury Vs. Head Injury

In order to better understand brain injury, it is important to differentiate it from a head injury. A head injury does not necessarily mean injury to the brain, nor does a brain injury necessarily come from a head injury. You can bump your head hard enough to cause injury to the skull, yet not to the brain. Whereas, in an accident involving whiplash, although the skull may not be injured, the brain is jostled back and forth inside the skull in a force strong enough to cause shearing and tearing of the nerves in the brain.

Symptoms of a Brain Injury

The following list of Post Concussion symptoms may also be experienced by individuals who have had a Concussion, Blast Injury, or Stroke/Aneurysm, because all of these injuries are types of brain injuries. That is not to say that because you have any of these symptoms, you have a brain injury.

Fatigue
Sleep disturbances
Hearing problems
Headaches
Blurred vision
Dizziness
Nightmares/Flashbacks
Nausea and vomiting
Falling asleep unexpectedly
Hand or leg tremors
Sensitivity to light and/or sound
Sexual dysfunction or loss of sex drive
Gait imbalance
Ringing in the ears
Loss of taste and smell

Confrontational attitude
Explosive temper
Fearfulness
Impatience
Thoughtlessness
Hypervigilance

Depression
Agitation
Apathy
Irritability
Fear of “going crazy”
Frustration or anger
Guilt or shame
Feelings of helplessness
Anxiety
Frequent mood changes

Distractibility
Disorientation
Temporary Amnesia
Problems with Speaking
Poor Judgment
Slow Thinking
Inability to Focus Attention
Problems Remembering What You Heard
Word Finding Problems
Feelings of Confusion
Long or Short Term Memory Problems

Types of Brain Injury

By definition, a brain injury is any damage or injury occurring in the brain. Specific forms of brain injury include:

Brain Damage

The destruction or degeneration of brain cells.

Concussion

Also known as a mild Traumatic Brain Injury (mTBI), is a Brain Injury where there is a loss of consciousness (or awareness of one’s environment) for up to 1 hour. After 24 hours, it is called a Coma.

Traumatic Brain Injury (TBI)

Damage that occurs when an outside force traumatically injures the brain.

Stroke or Brain Aneurysm

A vascular event causing damage in the brain.

Acquired Brain Injury (ABI)

Is used to describe any damage to the brain not present at birth. A type of ABI called traumatic brain injury (TBI) includes any damage to the brain caused by an external force

Blast Injury

Is caused by bombs and explosives mostly seen in combat. The blast injury patterns following such events are a product of the composition and amount of the materials involved, the surrounding environment, delivery method (if a bomb), the distance between the victim and the blast, and any intervening protective barriers or environmental hazards. The predominant post explosion injuries among survivors involve standard penetrating and blunt trauma.

Mild, Moderate, and Severe Traumatic Brain Injuries

The terms mild, moderate, and severe are not used the same way as other areas in medicine, or in life. The term mild typically means not so bad, such as I have a mild cold or the “weather will be mild today.” However, these terms when relating to brain injury have nothing to do with the severity of injury. Rather, they refer to the length of time a person is unconscious or lacks awareness of their environment.

Mild: Zero to 60 minutes
Moderate: 1 – 24 hours
Severe: Greater than 24 hours.

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Brain Injury and Your Brain

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