The Brain: A Delicate 3.4 Pounds

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Traumatic brain injuries are a subset of acquired brain injures, which are not the result of trauma, but occur after birth: hypoxic brain injuries (lack of oxygen to the brain), and anoxic brain injuries (no oxygen to the brain).

In a diffuse axonal brain injury (a type of closed traumatic brain injury) the skull is not broken, but the brain is violently jarred and collides with the skull, causing tissue swelling. Since there is no opening to relieve the swelling, there is increased pressure in the brain, damaging neurons, the core cells of the nervous system. As a result, the communication network between neurons is impaired (think of a downed cable or telephone wire), and basic functions like speech, and  breathing might be affected.

A concussion is caused from direct impact to the head by an object, or sudden movement or momentum from shaking, like in whiplash. Neurons stretch and blood vessels tear, which can cause contusions – bruises on the brain. The individual may or may not lose consciousness. Shaken Baby Syndrome, also known as Abusive Head Trauma and Shaken Impact Syndrome – is a form of whiplash where the aggressor vigorously shakes the baby. Most of these cases occur when babies are between 6 and 8 weeks old, since that is when they cry the most. The trauma may cause them to experience vomiting, seizures, irritability, and poor feeding.

In an open brain injury, the skull is fractured. If it’s pierced, say, from a gunshot or knife, the skull splinters, and fragments can hit brain tissue, causing further tissue damage (a penetrating injury). Even though cell damage can occur in an open injury, there is less chance of brain swelling and therefore increased pressure. That’s why doctors consider them less dangerous than closed head injuries. But, because there is an opening in the skull, bleeding into the brain can occur. And the individual is at high risk for infection, most commonly meningitis – an infection of the membranes surrounding the brain and spinal column.

Frontal lobe injuries affect the front part of the brain. The frontal lobe controls motor skills, thoughts, emotions,and personality. The left side of the lobe controls verbal communication, and the right side controls non-verbal communication – the arty side of our brains. The right lobe also plays a role in negative emotions, while the left lobe involves positive emotions. The area of the frontal lobe that is damaged will dictate how your emotions and personality are affected. Once a cautious person, you may now find yourself to be more impulsive.

So I suppose it shouldn’t come as a surprise that the brain is susceptible to injury. Weighing a slight 3.4 pounds, and encompassing more than 1 billion neurons with an infinite number of connections, the brain is a delicate mass of tissue floating in a fluid environment, much like a fetus in a uterus.

http://www.msktc.org/tbi/factsheets/Understanding-TBI/What-Happens-During-Injury-And-In-Early-Stages-Of-Recovery

http://www.braininjuryinstitute.org/Brain-Injury-Types/Open-Head-Injury.html

http://kidshealth.org/parent/medical/brain/shaken.html

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Post-Traumatic Stress Disorder: Blame it on Genetics and Personal History

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How do you predict who will suffer from PTSD after a traumatic event and who will not? Most people who experience a traumatic event actually do not suffer from PTSD: about 56% of people will experience a traumatic event in their lifetime, but only 8% will develop PTSD.

Research studies show that individuals with a variant of two genes – TPH1 and TPH2 – are more likely to develop symptoms. These genes, which control levels of serotonin – a chemical in the nervous system that regulates mood, sleep, and alertness – are altered in PTSD sufferers.

Genetics aside, other factors increase the risk for PTSD:

Having experienced other trauma earlier in life, including childhood abuse or neglect.

Having other mental health problems, such as anxiety or depression Lacking a good support system of family and friends Having biological (blood) relatives with mental health problems, including PTSD or depression.

Gender: Because there is more societal pressure on females to take care of others, we are twice as likely than men to suffer from anxiety disorders, such as PTSD.

Personality: People who are worriers, and cannot tolerate unpredictability. These traits may have a biological basis. It’s possible that the amygdala, the part of the brain that controls emotion, is oversensitive in worriers.

Have you been diagnosed with PTSD? If so, it may come as a relief to know that you can blame your symptoms on factors beyond your control.

 

http://www.ncbi.nlm.nih.gov/books/NBK49142

http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/risk-factors/con-20022540

http://www.nimh.nih.gov/statistics/1AD_PTSD_ADULT.shtml

http://newsroom.ucla.edu/releases/ucla-study-identifies-first-genes-231248

http://psychnews.psychiatryonline.org/newsArticle.aspx?articleid=1130400

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Post-Traumatic Stress Disorder: A Re-Wired Brain

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When exposed to danger, it’s natural to be afraid. Our bodies are triggered to make a split-second decision to either face the danger, or run from it: the “flight-or-fight” response. This is a healthy reaction. But in those with PTSD, they continue to be afraid and feel stressed long after the danger has passed – in my case, the speeding car at the Santa Monica Farmers’ Market. Symptoms, like avoiding places that trigger memories of the event, nightmares, depression, and hyper-vigilance – heightened awareness of your surroundings – may interfere with day-to-day-life. In hyper-vigilance, there is a perpetual scanning of the environment for sights, sounds, smells, or anything that is a reminder of threat or trauma. Just because you have been in a car accident, for instance, doesn’t mean you’ll be hyper-vigilant only for screeching brakes or beeping horns.

A month after my psychologist told me I had PTSD, I called her, wondering if I should go to the emergency room because my toe was red – I thought I had a life-threatening infection (I’m a nurse, and sometimes nurses know too much). I wouldn’t sleep in my bedroom on the third floor of my apartment because I was afraid of dying in a fire (I worked as a burn nurse years ago).

Months later, when shopping at an outside market with my father, I suddenly felt short of breath and couldn’t swallow. I told him he needed to drive me to the emergency room because I thought I was having a heart attack. I was a physically fit, non-smoking, lover-of-veggies thirty seven year old. I was not at risk for a heart attack. I called 911 three more times in the next few months, because I thought I was having allergic reaction: first to chocolate, then shellfish, then a bug bite. Miraculously, each time the EMT’s arrived, my rapid pulse slowed and my quivering body relaxed. I was suffering from panic attacks.

Before the accident, I had been known for my calm demeanor, and my no-worry attitude in my family. When working in the neonatal intensive care unit, I had been known for my in-control, I-can-handle-this disposition, even when a baby’s heart rate plummeted to near zero. After the accident, I felt as if there was a circuit breaker inside my brain that tripped at random moments, sending sparks into my nervous system. I didn’t know exactly where the breaker was located, or how to stop it from tripping. I reasoned that my brain had been re-wired. My reasoning was accurate – recently, I learned that researchers have found differences in the structure and circuitry of the brain between those with PTSD and those without it.

http://www.ptsd.va.gov/professional/treatment/overview/clinicians-guide-to-medications-for-ptsd.asp

 

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Traumatic Brain Injuries 101

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Traumatic Brain Injuries 101 In the United States, 52,000 deaths occur each year from a traumatic brain injury (TBI), and 5.3 million people live with disabilities due to a TBI. But a TBI does not necessarily result from a major trauma, like skiing into a tree or plummeting off a roof. You can sustain a TBI from bumping your head on a kitchen cabinet door, or when you and your five year old smack foreheads while wrestling. Penetrating injuries – from a bullet, or other objects that enter the skull – can also cause TBI’s. But the most common causes are from auto accidents and falls.

TBIs range from mild to severe. Mild injuries – concussions – are the most common. Symptoms include confusion, irritability, nausea, fatigue, amnesia around the event, and loss of consciousness up to 30 minutes. But it’s possible to suffer a mild TBI and not lose consciousness. Also, being diagnosed with a mild TBI does not mean the consequences are mild, such as decreased concentration and attention, getting lost and confused, headaches, dizziness, depression, mood swings, sleep disturbances, and difficulty with balance. Many people experience these symptoms for years, which is what happened to me. I still suffer from poor concentration, depression, difficulty multi-tasking, planning and even judging distance. When driving, for instance, I have trouble thinking ahead (at least that’s what my husband tells me). But it’s true. My brain can’t process all the stimuli coming at me: other cars, beeping horns, bicycles, and joggers. It doesn’t have enough room to focus on getting in the left lane soon enough so I can take a left turn.

In moderate TBI’s, the individual loses consciousness from 30 minutes to 24 hours, and in severe TBIs, longer than 24 hours. Symptoms are worse for people diagnosed with moderate to severe TBIs. They tend to exhibit obvious behavioral issues like aggression, and suffer greater physical impairments, like decreased ability to smell (anosmia), ringing in the ears (tinnitus), paralysis, and slurred speech.

But the challenge is in diagnosing TBIs, especially mild ones (like I said earlier, mild from a trauma perspective, not from a consequence perspective. I’ll address the nuances of this in a future post). My TBI was diagnosed in 2006, three years after I sustained the injury. During the immediate hours after the accident, the doctors where concerned with my other injuries – stopping the bleeding from my ruptured spleen and stabilizing my fractured pelvis. So I struggled in the workplace for two years, and at home, blaming my symptoms wholly on PTSD.

http://www.northeastern.edu/nutraumaticbraininjury/consequences-of-tbi/

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