Reversal Of This Process Is Still Possible

In addition to the injury, there are also other insults to the brain that are just as important as the initial impact and may even be worse. Factors such as lack of oxygen and significant blood loss also can occur and happen quickly. Some studies have found that 1 in 3 patients with a severe traumatic brain injury has low blood pressure very soon after the injury. Not unexpectedly, that doubles the chances of a poor outcome or death. Generally, after an individual is stabilized, we assess for increased pressure in the brain. If it’s present, we may need to remove a clot. A severe injury to the brain causes swelling, which increases pressure, but it may be delayed. The earlier we can get a handle on the pressure, the better. We also have come to realize that pressure may rise very quickly in people whose brains have been ravaged by penetrating injuries. Initially, the clot may not appear to cause problems, but such an injury can lead to a severe headache and an altered state of responsiveness, resulting in a deep coma. An individual who has a traumatic brain injury is often prepped for possible surgery if he or she has an epidural or subdural hematoma, particularly if there’s also a decrease in consciousness, weakness in an arm or leg, or trouble speaking. The area underlying the site of the clot may produce seizures because it’s been injured as well.

Feet in the Clouds

Some people who have traumatic brain injuries, especially older individuals, may never be the same. Traumatic brain injury often is associated with a deep, unresponsive coma, and family members may arrive to find their loved one with a multitude of bruises, splints and bandages, and drains if brain surgery has been performed. To control agitation, a loved one may be heavily sedated, which can induce an even deeper coma. In other words, these patients may look much worse than they really are. In the days ahead, the physician may lighten the sedation intermittently to look for responses. Family members must be prepared not to make too much of what they see, especially before they’ve had a chance to speak with the attending physician. Undoubtedly, the worst trauma to the brain is what’s called a penetrating injury, from a bullet or some sharp object such as a nail from a nail gun. When a sharp object passes through the brain and exits on the other side, the injury isn’t survivable. When it remains on one side of the brain, there’s a chance of survival. If a young person has a penetrating brain injury, the degree of the injury and results of the initial examination will determine the outcome. Oxygen is carried by a protein in blood called hemoglobin. Hemoglobin must be present in sizable quantities so that oxygen can bind to it.

Aren't You Glad You're You?

Limited oxygen to the brain can occur when hemoglobin binding is reduced because oxygen levels are impaired by lung disease or when oxygen competes with carbon monoxide and loses, such as what happens in carbon monoxide poisoning. The medical term for lack of oxygen is anoxia. Anoxia also occurs when hemoglobin binding is normal, but shock inhibits blood flow to the brain. Unquestionably, a severe reduction in blood oxygen may damage the brain. Low oxygen often is associated with a marked drop in blood pressure or lack of a pulse for a brief period. Thus, the individual experiences a double hit of low oxygen and low blood pressure. Low oxygen alone is rarely a cause of brain injury. There’s usually some other contributing factor that can be singled out as the main culprit. Some areas of the brain are dependent on several blood vessels, each of which plays a part in the cascade of events. The areas affected are deep inside the brain and quite crucial for connections to the major command center located at the surface of the brain, known as the cortex. Blood flow within the body is regulated by the brain. The brain supplies more blood when the pressure is too low and less when the pressure becomes too high.

Hostile To The Commonplace

This is known as cerebral autoregulation, in which the brain automatically adjusts to demand. A brief reduction in blood flow or pressure results in widening of the arteries. A brief increase in blood flow or pressure produces narrowing of the arteries. Autoregulation differs among individuals. Prolonged periods of low blood pressure can be absolutely devastating for many people, but others have experienced few harmful effects. Adequate oxygen to the brain via blood flow is critical. Here are some sobering facts. Oxygen stores are depleted within 20 seconds after the heart stops beating. The impact on brain neurons is dire, causing a rapid lack of fuel supply and the creation of a dead core. Only a small area of the brain is affected, some reversal of this process is still possible. Restoring blood flow can reverse this state. It’s less clear if restoration is possible when there’s widespread lack of blood flow during cardiac arrest or resuscitation. Even with the best techniques, resuscitation may provide only a fraction of the blood flow essential to the brain. That’s because certain areas of the brain are very vulnerable, and less than 10 minutes of interrupted blood pressure and fuel supply are enough to produce cell death. The cortex is the outer surface of the brain involved in thinking, feeling and movement. The spinal cord also is vulnerable. The brain isn’t just the thinking parts, most often shown in drawings but also the brainstem. The brainstem is the most vital part of the brain and also the last to go. That resilience is the result of an evolutionary process. The brainstem is of crucial importance. That’s not where my consciousness comes from. The brainstem holds the critical nerve centers that make brain life possible. In the brainstem lie the structures that wake us up, the nervous centers that control the pupils inside your eyes, and all of the muscles that move your eyes.