Traumatic Brain Injury

Traumatic Brain Injury

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We just don’t cure, we care

Having a loved one survive a traumatic brain injury is joy laced with apprehension. For, a brain injury is not just a wound that will heal with the formation of scar tissue. Trauma to the brain may also have serious ramifications on a person’s physical, mental and emotional health.

Stem cell therapy combined with our comprehensive physical therapies is a revolutionary treatment that has provided relief to many a patient from distress. Several patients show a marked improvement in performing day to day activities independently, limb coordination, mental functions and posture etc.

A blow, jolt, or bump from an external mechanical source that causes damage to the brain can lead to a traumatic brain injury. TBI is not a degenerative or congenital condition. The damage sustained by the brain can lead to permanent or temporary impairment of faculties associated with the area of the brain affected. Complications include damage caused by lack of oxygen, rising internal pressure and swelling in the brain.

On the basis of mechanism of the injury, TBI can be closed or penetrating. A closed or non-penetrating or blunt injury occurs when the brain tissue is not exposed. In a penetrating or open head injury, the skull is pierced and the dura mater (outermost membrane protecting the brain) is breached.

Traumatic brain injury is caused by falls, accidents, and violence. Sports and recreation are the leading cause of such falls and accidents. In very young children, mostly TBI is caused by sudden falls.

In the absence of a mechanical force, a combination of acceleration and deceleration can also cause TBI. Most commonly, the head striking or hitting against something is a leading cause of traumatic brain injury. In babies, violent shaking can lead to shaken baby syndrome. There is more incidence of TBI in men than in women.

The causes can be enlisted as:

  • Falls- Falling out of bed, slipping in the bath, falling down steps, falling from ladders and related falls
  • Vehicle collisions- road accidents of cars, motorbikes or bicycles. Pedestrians hurt in such accidents are a common cause of traumatic brain injury.
  • Violence- Gunshot wounds, domestic violence or child abuse can lead to traumatic brain injury
  • Extreme Sports- Sports such as soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other high-impact or extreme sports can also cause TBI
A TBI is a chain of a number of injuries:
  • The first injury occurs moment after the trauma
  • The second injury may occur from anywhere in minutes to hours after the initial injury. Medical intervention is therefore critical to prevent any further damage
  • A third injury can occur at any time after the first and second injuries and can cause further complications.

A traumatic brain injury can take anything from days to weeks to manifest. Most commonly occurring symptoms associated with a mild TBI are nausea, dizziness, ringing in the ears, exhaustion, lack of motor coordination, difficulty balancing, lightheadedness, blurred vision and a bad taste in the mouth.

A severe injury carries much more serious symptoms such as a continuous gnawing headache, vomiting, seizures, incoherent speech, a feeling of numbness in the limbs and problem waking up from sleep. There may be a general loss of coordination between the limbs, dilated pupils difficulty in finding words, disordered speech. In the long term, severe TBI may lead to inappropriate social behavior, lack of judgement, attention deficit, and delayed reflex.

Severe injury to the brain can leave a person in a complete vegetative state. In several cases TBI leads to disability and death, especially in children and youngsters.

The most severe cases are when the pressure inside the skull (intracranial pressure) soars. This can result in paralysis, unconsciousness and a blown pupil.

Children who have sustained TBI cry persistently, remain listless and irritated and reject food.

While some symptoms may appear immediately after the traumatic event, others may manifest gradually over days or weeks or months.

The following symptoms may appear within the first few hours to days after a head injury:

  • Convulsions and seizures
  • Dilation of one or both pupils
  • Weakness and numbness in the toes and fingers
  • Loss of coordination
  • Agitation, combativeness or other unusual behavior
  • Slurred speech
  • Coma

If treatment is initiated within an hour of sustaining the injury, chances of recovery are improved greatly. Moderate to severe injuries have to be treated in Intensive Care Units.

In the acute stage, the primary concern is to prevent further injury to the brain and stabilize the patient’s condition. A number of other complications such as cardiac arrhythmia and pulmonary edema may accompany TBI in which case treatment should be given accordingly.

Surgery can be performed to remove foreign objects inside the brain.

In the chronic stage, a multi-disciplinary approach is used to help the patient adapt to disability. This includes rehabilitation through psychiatric treatment, physiotherapy, speech and language therapy and occupational therapy.

Apart from this certain medication may also be given to manage psychiatric problems and post-traumatic epilepsy.

Emergency care for moderate to severe traumatic brain injuries focuses on ensuring that the patient gets adequate oxygen through blood supply to the brain, maintains a stable blood pressure and does not sustain any further injury to the head or neck.

Medicines like anti-diuretics, anti-seizure drugs and coma inducing drugs are usually given to limit secondary damage that immediately follows the first injury. The patient may also require emergency surgery to remove blood clots and repair skull fractures.

These therapies may improve the patient’s quality of life but they do not repair the damage sustained to the nervous system.

Stem Cell Therapy

Medical technology may be advancing by leaps and bounds but a number of patients with head injury are left disabled after a traumatic brain injury with no scope for treatment. Stem cell therapy may just be a ray of hope for such patients.

Stem cells have the capability to regenerate brain cells, a property known as neuroplasticity. Research shows bone marrow derived stem cells have the potential to create brain cells. Cellular therapy is aimed at regeneration of brain cells by neuro-restorative mechanisms and reinforcing ongoing neuroplasticity. Stem cells move to the damaged areas of brain and initiate a repair and promote the enhancing of new blood vessels, neurogenesis, initiate sprouting of new axons and initiate a new communication networks between the neurons which may help in repairing the damage caused by a head injury.

Thus stem cell therapy provides a newer and effective treatment options for head injuries that help to repair the damage that occurs at the tissue levels.

Following this therapy improvements have been reported in higher mental functions, trunk activity, posture, upper and lower limb activity, coordination, motor skills and activities of daily living.

Dr. Alok Sharma

Consultant Neurosurgeon

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