|
N e w s a n d
A l e r t s
I N D E X
Minor' head injuries
can turn serious rapidly
Health Library: MayoClinic.com
State failing those with brain injuries,
advocates say
'Minor'
head injuries can turn serious rapidly, experts say
By
Danielle Dellorto
CNN
Medical Producer
March 18, 2009
(CNN)
-- A blow to the head that at first seems minor and does not result
in immediate pain or other symptoms can in fact turn out to be a
life-threatening brain injury, experts tell CNN.
It's very common for someone who's had a fall or been
in a car accident to appear perfectly lucid just after the impact
but then to suddenly, rapidly deteriorate, Dr. Carmelo Graffagnino,
director of Duke University Medical Center's Neurosciences Critical
Care Unit, told CNN.
Actress
Natasha Richardson was
talking and joking after she fell Monday during a beginner
ski lesson, according to
officials at the Canadian resort where she was staying. But soon
after she returned to her room she complained of head pain and was
taken to a nearby hospital, then to a larger medical center in
Montreal. She was flown by private jet Tuesday to a New York
hospital. She died Wednesday, according to a family statement.
"A patient can appear so deceivingly normal at
first," said Graffagnino, director of Duke University Medical
Center's Neurosciences Critical Care Unit. "But they actually have a
brain bleed and as the pressure builds up, they'll experience
classic symptoms of a traumatic brain injury."
Such injuries are known as epidural hemorrhage. Blood
gets trapped between the skull and the hard layer of skin between
the bone and brain, known as the dura mater. As the blood flows from
the ruptured artery, the fluid builds and punctures the dura.
Patients are often unaware they've fractured their
skull. In these cases, the fracture generally occurs just above the
ear, in the temporal bone. "There is an artery that runs above the
skull and can get torn and begin to bleed above the lining of the
brain." Graffagnino says.
"At that point all the pressure is pushed on the
brain, causing it to swell but there is often no room for it to move
inside the skull cavity. And as the pressure continues, it reduces
blood flow to the brain and a patient would begin to feel the
symptoms."
The condition is commonly referred to as "talk and
die" syndrome among neuroscience physicians and surgeons, because
the patient can decline so rapidly.
Graffagnino says the initial fall or injury doesn't
have to be hard at all. The delay in symptoms can range from five
minutes to three hours after the accident.
If an individual isn't medically evaluated after a
car accident, sports injury, or just a slip in the driveway,
recognizing the signs brain injury early is critical. Nausea, severe
headache, glossy eyes, sudden sleepiness, are all common symptoms.
Getting to a hospital within the first few hours is critical to
prevent permanent brain damage, experts say. An emergency room team
can quickly determine the severity of your injury. An emergency
craniotomy -- opening of the skull -- surgery is often needed to
stop the bleeding and control brain swelling.
Immediate treatment is essential after a brain injury
because the initial damage caused by swelling often is irreversible.
"One of the things we teach to trauma teams, is if a
group of people are in a car crash and someone dies, we have to
assume everyone else has serious injuries--even if they look good,
and say they feel totally fine," Graffagnino said.
return to INDEX
Health Library
MayoClinic.com:
Traumatic brain injury
Certain medications can increase a person's risk for
hemorrhages, especially for the elderly. Doctors say even a small
bump on the head can be dangerous for patients taking blood
thinners, among other prescription drugs.
"Talk and die" syndrome also can result from a
subdural bleed, which develops between the brain and the dura. These
bleeds can "squish the brain," Graffagnino said, and cause injury at
a slower rate. A person can often feel normal for several days
before feeling any symptoms.
"You don't have to see external injury to have injury
to the brain," said Dr Philip Stieg, chair of neurosurgery at NYP/Weill
Cornell. To evaluate a person's response after a minor trauma, Stieg
recommends checking the size of their pupils and asking questions
such as the patient's name and what year it is. In the hours
following, Stieg recommends monitoring the person's cognitive skills
and to "bring them in to get a CAT scan" if there is a change in
behavior.
The brain also can be bruised after an accident,
leaving patients with no symptoms or signs of a bleed at first
glance. But the nerves surrounding the bruise can begin to stretch,
causing what is known as an axonal injury. "The brain is like
Jell-O. Imagine if you dropped a bowl of Jell-O on the floor and it
looks intact at first but when you examine it really close, you can
see it has teeny tiny cracks all in it," Graffagnino said. "Well the
brain can have these tiny cracks that don't show up on initial CAT
scan but will develop into problems down the line."
Once surgeons stop a brain bleed, the next step is to
monitor brain activity and check for permanent damage. A patient
typically spends up to a month in a neuro-ICU. Patients who survive
often spend the next several years in physical and cognitive therapy
to regain function, according to experts.
"The most important thing to do to lower your risk is
to wear a helmet when you can, and don't brush off an injury because
you feel 'fine' at first," Graffagnino said. "The thing that's going
to save a life is for friends and relatives to recognize the first
glimmer of a symptom. The quicker we can stop the bleed, the
better."
return to INDEX
THE CHARLESTON GAZETTE
July 11, 2009
State failing those with brain injuries,
advocates say
By
Alison Knezevich
Staff writer
CHARLESTON, W.Va. -- B.J. Berkhouse can't remember everything that
happened the night his life changed. But he knows the date.
"Six-seven-eight," he said in a slow, slurred voice.
June 7, 2008.
That's when he went downtown for a birthday party. Around 1 a.m., a
drunken driver drove onto the sidewalk of Capitol Street and struck
him. For three weeks, Berkhouse lay in a coma. He suffered facial
fractures, a stroke and a traumatic brain injury.
Last month, Melissa Newman was sentenced to a year in jail after
pleading guilty to DUI causing injury and other charges related to
the accident.
For Berkhouse and his family, the ordeal is far from over. A week
ago, the 31-year-old left his home state for intensive
rehabilitation at Lakeview Virginia NeuroCare in Charlottesville,
Va.
"You can't stay here and get better," said Berkhouse's girlfriend,
Lindsay Bolar. "You have to go out of state."
Advocates say the state Department of Health and Human Resources has
failed people with traumatic brain injury -- even after decades of
legal battles.
This spring, Kanawha Circuit Judge Duke Bloom began a series of
hearings related to a decades-old case involving DHHR's services for
people with traumatic brain injuries and overcrowding at the state's
two psychiatric hospitals.
Many advocates believe court action is the only way to make DHHR
step up its efforts, said Mike Davis, president of the
Brain Injury
Association of West Virginia.
"Health and Human Resources hasn't done what they are supposed to
do," he said. "People are suffering because of this."
'Nobody
expects it'
With traumatic brain injury, those who have never experienced
disability are thrust into an overwhelming situation, said Clarice
Hausch, director of
West Virginia
Advocates. Car wrecks and falls cause the injury most
often.
"The damage is instant," Hausch said. "And nobody expects it."
The injury can range from mild to severe. It can cause depression,
personality changes, memory loss, blurred vision, speech problems
and loss of coordination.
The Brain Injury Association of West Virginia estimates that of the
state residents who survive a traumatic brain injury each year, 600
will have a long-term disability.
Before the accident, Berkhouse worked as a SkyWest Airlines customer
service representative at Yeager Airport. The job let him travel,
and the diehard Mountaineer football fan went to as many games as he
could.
He used to play softball and flag football. Now, he must learn to
walk again.
At home, there's so much time to think, Berkhouse said.
"I have to learn how to lay here," he said recently, sitting in a
wheelchair next to a hospital bed in his mother's Mink Shoals living
room. "I have my computer and video games, and that's how I get
through the day."
He forgets things easily. Before he left for Virginia, he couldn't
be left alone in the house.
His mother, Geneal, is grateful she is healthy enough to care for
him.
But at 75, she said, "it's hard on me with my age."
Berkhouse had no health insurance when he got hit, so he relied on
Medicaid. After he attended 20 rehabilitative therapy sessions, he
got a letter saying Medicaid wouldn't pay for any more of them.
From the beginning, his family, friends and co-workers rallied
around him. They sold hot dogs and baked goods. They organized pig
roasts and horseshoe tournaments.
The fundraisers brought in $30,000. But the Berkhouse family still
needs to raise $20,000 to pay for everything he'll need at the
Virginia center, his mother said.
For years, advocates have pushed for a Medicaid waiver program for
people with traumatic brain injuries. That would let people get
services -- such as personal-care aides and case management-- in
their homes and communities, rather than being institutionalized.
"The community-based services that a lot of people need are not
24/7," Hausch said. "But without those supports, they end up in a
facility, where the cost is 24/7."
Twenty-five other states have a waiver program for those with
traumatic brain injuries, said Davis, adding that the issue is
becoming even more critical as veterans with the injury return home
from war.
West Virginia has a Medicaid waiver program for people with mental
retardation and developmental disabilities. But people who sustain a
TBI after they turn 22 aren't eligible for that program.
'Things are never the same'
The recent hearings in Bloom's courtroom stem from a lawsuit dating
back the early 1980s about how West Virginia administers
mental-health care.
Later this month, petitioning attorneys will meet with DHHR
attorneys to mediate issues related to services for those with brain
injuries, said West Virginia Advocates staff attorney Teresa Brown.
Bloom has also ordered a court monitor to track the state's progress
on psychiatric hospital conditions and TBI services.
"It seems like everybody's working together to come to a successful
conclusion here," Brown said.
But advocates and DHHR have gone through mediation before, and the
advocates say DHHR never followed through on its agreements --
including securing funding for services for those with brain
injuries and applying for a federal Medicaid waiver.
In 1998, the state developed "a very, very good" plan to help
brain-injury victims, Hausch said: "The things in that plan have
never been implemented."
Then, under a 2001 consent order, the DHHR agreed to apply for a
federal Medicaid waiver for those with brain injuries. It never did.
In 2007, the DHHR again agreed to explore a waiver program.
The state's shortcomings have left brain-injury survivors with
almost nowhere to turn, Hausch said. Many end up in nursing homes or
state psychiatric hospitals.
"We have a very limited number of specific traumatic brain injury
services in West Virginia, because there's no source for providers
to get paid," Hausch said. "That's why you so often see people go
out of state."
DHHR spokesman John Law said the department couldn't comment on
brain injury issues until court proceedings wrap up.
"That is still a matter of mediation before the judge, so we really
can't comment specifically," Law said.
In Virginia, Berkhouse is adjusting well, his mother said last week:
"They're really working with him."
Berkhouse has a lot going for him, said Davis of the Brain Injury
Association.
"He's very motivated to do something," Davis said. "He's young. He's
survived a terrible ordeal."
But Davis is quick to say there's no such thing as "lucky" when it
comes to traumatic brain injuries.
In 1980, a drunk driver hit him and his 8-year-old son, Todd, as
they traveled down U.S. 119 in Elkview. Todd Davis suffered massive
head injuries. Nearly 30 years later, he functions on the level of a
4- to 5-year-old child.
"I don't believe there's any such thing as being fortunate with this
injury," Mike Davis said. "It just absolutely changes people's lives
forever, and things are never the same."
return to INDEX |
