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Expert Advice on Preventing, Diagnosing and Treating Head Injuries

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Recently, both local and national news broadcasts have featured headlining stories illustrating the serious, and often fatal, consequences of a medical condition commonly referred to as traumatic brain injury. Two months ago, Tony Award-winning actress Natasha Richardson made news headlines across the country after passing away as a result of a head injury she sustained while skiing in Quebec.

Similarly, recent news broadcasts indicate that numerous soldiers are returning home from Iraq claiming to suffer from migraines which they learn, upon being seen by a medical professional, are actually a symptom of underlying traumatic brain injury sustained as a result of the soldiers’ exposure to high-impact blasts in the battlefield. Such injury among soldiers in Iraq has become so common that it is now known as the “signature injury” of the Iraq War.

In an effort to inform people of the causes, symptoms, and treatments underlying traumatic brain injury, we have gathered a panel of three University of Maryland Medical Center head trauma experts. In this article, these experts -- Dr. Bizhan Aarabi, the director of neurotrauma at the R Adams Cowley Shock Trauma Center; Dr. Yvette Rooks, a family and community medicine physician who also specializes in sports medicine; and Dr. Getachew Teshome, the medical director of UMMC’s pediatric emergency department -- discuss the seriousness of traumatic brain injury and stress the need for immediate medical attention for those individuals who may be suffering from the condition.

The Problem

The principle cause for concern in patients suffering from traumatic brain injury is simply that the injury is often unrecognized by both the individuals who sustain the actual head trauma and the individuals who witness the event.

“I think head trauma is one of those things that go unnoticed because you can’t see it,” Dr. Rooks said. “There’s no fracture or bleeding, and, as a result, these injuries are not reported because people want to go back to whatever they were doing before they were injured.”

This was true in the case of Natasha Richardson, who had no symptoms of traumatic brain injury until she began experiencing headaches an hour after her fall, as well as in the case of the soldiers returning home from Iraq, whose migraines did not appear until weeks after the high-impact blasts had occurred.

Because there are usually no external indications that an individual has sustained traumatic brain injury, Dr. Aarabi notes that the problem physicians often encounter in their attempts to treat this condition is that patients themselves do not seek treatment.

“The problem with traumatic brain injury is that the majority of people who believe they have only suffered minor head trauma never see a physician,” he said.

Who’s At Risk?

Our experts say that young people are most at risk of sustaining traumatic brain injury. Dr. Teshome specifically notes that the risk among children 0 to 14 years of age is perhaps the greatest, with traumatic brain injury accounting for approximately 435,000 emergency department visits and 37,000 hospitalizations each year between 1995 and 2001. One reason young people are more at risk is due to the fact that they tend to engage in more activities that put their heads at a higher risk for sustaining injury – such as contact sports like football, lacrosse, and soccer.

Use Your Head: Wear a Helmet

So what can you do to lower your risk? Wear a helmet when engaging in any activity -- such biking, skiing and skateboarding -- where head injuries are common.

“Based upon the data currently being released, neurosurgeons find that helmets offer a 60% chance of preventing traumatic brain injury to individuals engaged in ‘high-risk’ activities,” Dr. Aarabi said. Such “high-risk” activities include playing team sports like football, baseball and lacrosse, and individual sports like skiing, biking, skateboarding and snowboarding, to name a few.

Why is helmet use so important? “During a fall or crash, helmets absorb much of the force of impact that would otherwise be directed to the head because the thick plastic foam inside their hard outer shells is able to cushion the blow,” Dr. Teshome said. “If helmets are not worn, even a low-speed fall could result in serious head injury.”

If It Happens To You

If you or someone you know sustains any type of head injury, you should immediately seek medical attention, even if you think it’s nothing serious. The first few minutes are the most crucial for doctors in assessing the overall extent of the injury. Severe symptoms such as recurrent vomiting, seizures, loss of consciousness, severe headaches, lack of coordination, or post-traumatic amnesia are clear indications that traumatic brain injury has occurred, and should be immediately addressed by a doctor.

To properly diagnose traumatic brain injury, your doctor will need you to provide a thorough history of your injury, in addition to which he or she will perform a physical exam. During that exam, your physician will check for any external signs of traumatic brain injury, which can include external injuries such as bruises, cuts, raccoon eyes, or bleeding from ears.

The history and exam enable your doctor to assess whether or not you need to undergo diagnostic imaging, such as a CAT scan or a MRI. Dr. Teshome notes, however, that special precautions should be taken in the case of children suffering from head injuries.

“Many people assume that all children who have sustained head injuries should get a CAT scan to make sure they are ok, but in reality, doctors should engage in individual discussions with each child’s parents before making a decision to obtain a CAT scan,” Dr. Teshome said. “Such a decision for children with minor head trauma must balance the importance of identifying significant, but rare, injuries with the risks of radiation exposure related to CT.”

Future Prevention

UMMC is doing a lot to raise awareness of traumatic brain injury through several initiatives. These include the “Think First” program, which targets high school and college students in regards to the dangers of diving into shallow water when they go swimming. UMMC’s pediatric emergency department also provides preventive health information to parents on the importance of wearing helmets when engaging in specific high-risk activities.

“The most important thing we as neurosurgeons at UMMC Shock Trauma can do to raise awareness of head trauma is personally communicate with the families of our patients,” Dr. Aarabi said. “We need to teach them about the dangers behind traumatic brain injury and instruct them on the various ways to prevent such injuries in the future.”

This page was last updated on: June 5, 2009.

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