Trauma is the 4th leading cause of death among all age groups. Head injury is commonly involved in trauma. Surprisingly, 70% of motor vehicle accidents involve some form of head injury.

Some of the most devastating brain conditions I’ve encountered in my years in health care involve traumatic brain injury. This applies to both the victim and the family. Let’s face it, with stroke, alzheimer’s or brain tumors, while the diagnosis may be sudden, it is usually does not come as much of a shock as seeing a loved one fighting for his life after head injury. Ironically, TBI affects a lot of children and young adults. It can be heartbreaking.

So What is TBI?

TBI stands for Traumatic Brain Injury. It can be caused by any external force that causes injury to the brain. A slip and a tumble. A tree branch falling on your head. A baseball bat to the head. A hammer. An angry fist. Anything! Most commonly, though, it is caused by 1 of 3 things: (1) motor vehicle accidents, (2) falls, (3) abuse. TBI is often used interchangeably with head injury, although that isn’t very accurate. Head injury is broader and covers injuries to the scalp and skull, while TBI is only specific to the brain.

TBI can be classified as mild, moderate or severe depending on the victim’s level of consciousness and the extent of injury involved. It can also be classified as either closed (such as with a box falling on your head) or penetrating (a knife to the head).

Terms Commonly Used with Brain Injury

Traumatic Brain Injury is a very broad term. Medical professionals hardly use that term to refer to individual patients at all. Usually they use more specific words for diagnoses. It all of course depends on where the injury is located and how bad it is. Let us dissect some commonly used ones:

Concussion: This is the most common type of mild brain injury and is usually associated with sports. A concussion is the “shaking” of the brain due to a sudden blow. This shaking causes the brain to temporarily malfunction. Many lose consciousness and don’t remember the event. Usually symptoms of concussion return after a few hours to a few weeks.

Contusion: Bruising of brain tissue. It’s bruised, but there isn’t any active bleeding. Great! But if bruising is extensive and the tissues swell, it can be dangerous, too.

Cerebral Hemorrhage: Bleeding in the brain. Blood in abnormal places can cause brain swelling and cell damage. Blood may end up in many parts of the brain.

• When it’s within the brain tissue itself, it’s called intraparenchymal hemorrhage.
• When in the ventricles (which is normally filled with cerebrospinal fluid), it’s called intraventricular hemorrhage.
• When it’s in the subarachnoid space (the space between the brain and a thin tissue layer covering the brain), it’s called subarachnoid hemorrhage.

Note: cerebral hemorrhage can also happen in bleeding strokes, or aneurysms that rupture. Blood in the brain can be due to all sorts of things.

Cerebral Hematoma. A blood clot in the brain. Blood clots that are small and don’t cause dangerous symptoms are naturally just observed, as they dissolve over time. However, large clots can press on other brain structures, increase brain pressure and cause cell death. These clots need to be removed as soon as possible. Two common brain clots are: epidural hematoma and subdural hematoma. They’re named according to where the clot is located with regard to the dura mater – a layer of tissue covering the brain.

Diffuse Axonal Injury.  Aha!  A nasty one.  As opposed to localized tissue injury, diffuse axonal injury (DAI) means widespread damage to many brain parts.  This is usually seen in severe TBI, when rapid shearing force from sudden motion injures many areas.  DAI is a common cause of coma or persistent vegetative state.  It is frequently caused by car accidents.

All these technical terms are exausting!

Yes, the brain can be. Sorry. I invite you to brush up on common brain structures to understand things better.  That way you can connect the symptoms with the injury.

So how do they know what kind of brain injury it is?

A CT scan can be done immediately. Or an MRI if the docs want more detail. Only scans can really tell if it’s a clot or a bleed.

What Signs and Symptoms can I expect with brain injury?

Remember the cardinal rule of any brain condition: it will always depend on where the injury is located and how severe it is.

Will we expect permanent disability? It will always depend on where and how much of the brain has been permanently  damaged.

How do I generally know the brain is affected? Simple. You know there’s something wrong with the brain if there’s any change in level of consciousness. What does that mean? It means the person is acting strange. Maybe he’s always sleepy and difficult to arouse. Maybe he’s disoriented. Maybe he’s talking funny, or suddenly acts clumsy, or doesn’t move one side at all. Maybe he’s having a really bad headache and has been vomiting. That… or he’s been completely knocked unconscious after the incident.

For simple concussions, it can be a headache and loss of memory surrounding the event. For more severe forms of traumatic brain injury — usually from large clots and heavy bleeding), it can lead to collapse, pupil and breathing changes and the need for urgent medical care. During such emergency, the priority to decrease intracranial pressure and preserve as much brain tissue as possible. Refer to this article for Frequently Asked Questions During the Early Days after Severe Traumatic Brain Injury

Remember that not all symptoms appear right away. Some injuries swell gradually, so symptoms can start days or weeks later. With subdural hematomas, blood can trickle and form clots that cause symptoms only weeks after the incident.

How Long Do These Symptoms Last?

Each injury and each survivor is unique. Mild TBI symptoms usually resolve within weeks, but some are left with persistent deficits. As much as it’s predictable that symptoms should go away after the swelling has disappeared, much of it depends on the individual brain itself. If permanent damage occurred, how well and how fast does this particular individual’s brain rewire and compensate? Recovery doesn’t happen overnight. It can take years. Many people live with some remnant of the injury — be it occasional headaches, strange sensations, movement problems, occasional seizures. For others, they recover completely. For the unfortunate few, they live in a coma or with severe disability.

What Should I do if I sustain Brain Injury?

So you hit your head. Bad luck. Seek medical attention right away when you detect any change in your mental status as explained above. A visit to the clinic or hospital will determine if you need scans, or hospitalization for close monitoring. Don’t wait too long. Remember, brain cells die after 4 – 6 minutes without oxygen!

How are Brain Injuries treated?

Mild brain injuries require no treatment. Others may be given medications to prevent seizures and to control swelling. For severe injuries, immediate surgery may be necessary to evacuate a clot or to control bleeding. After that, depending on the damage, it’s on to physical therapy, speech therapy, occupational therapy, etc…

How Do I Prevent Brain Injuries?

Wear a helmet! Wear your seatbelt. Don’t drink and drive. Avoid rough sports. And no fighting!

Help promote TBI awareness and keep your brain safe.
It is very, very, very PRECIOUS!

These two conditions are somewhat opposites. Many confuse them. In Persistent Vegetative State (PVS), the person may open his eyes, but is not aware of his environment.  In Locked-in Syndrome (LIS), the person is fully aware of his environment, but cannot talk or move.

To fully understand them, you’ll need to remember two brain structures:

(1) The cerebral cortex (upper brain):  responsible for consciousness, awareness, cognition, reasoning, speech

(2) The brain stem (lower brain): the part of the brain that keeps you alive!  It maintains breathing, houses the cranial nerves and contains nerve pathways that connect your upper brain to the spinal cord.

For a thorough review of human brain anatomy, read this article:
Parts of the Brain – Simplified

Persistent Vegetative State
“Awake but not Aware”

Causes: Damage to the upper brain (cerebral cortex).  The upper brain is responsible for consciousness, awareness, cognition, reasoning, speech — thinking abilities in general.  The lower brain (brain stem) is intact.

People in persistent vegetative states CAN:

• breathe on their own
• open and move their eyes (some can even track objects with their eyes)
• have regular sleep-wake cycles
• cry, laugh, smile, moan, scream spontaneously (not related to external stimulus)
• move their limbs slightly (only as a reflex)

People in persistent vegetative state CANNOT:

• speak
• understand his environment
• perform any voluntary action such as follow commands
• move his body beyond reflexive actions, such us raise his arms

Locked-in Syndrome
“Conscious but Cannot Move”

The film "The Diving Bell and the Butterfly" illustrates locked-in syndrome

Locked-in syndrome is a condition in which a person is completely conscious and aware of his environment, but cannot move due to complete paralysis of all voluntary muscles in the body except for the eyes. In fact, there’s a version called total locked-in
syndrome where the eyes are paralyzed as well.  It’s considered the closest experience someone can have to being “buried alive.”

Cause: Damage to the anterior portion of the pons, which is part of the brain stem.  The ventral or anterior portion of the pons contains majority of the motor nerve tracts that control voluntary movement.  Since the brain stem also controls breathing and circulation, some locked-in patients have trouble breathing on their own.
The upper brain (cerebral cortex) is intact.

People with Locked-in Syndrome CAN:

• understand his environment
• perceive and process thought like any other person
• feel pain and other regular sensations
• have normal sleep-wake patterns
• (mostly) move their eyes, track objects and blink

People with Locked-in Syndrome CANNOT:

• speak
• move his body
• (occasionally) cannot even move his eyes

A brilliant French movie about Locked-In Syndrome was made in 2007 called The Diving Bell and the Butterfly.  It tells the real life story of Jean-Dominique Bauby – from his stroke, his locked-in diagnosis, and how he was able to write an entire book by just blinking one eye.  Highly, HIGHLY recommended!

Hopefully this entry helps family and friends understand and differentiate Persistent Vegetative State and Locked-in Syndrome.  Both conditions are devastating to family, and in the case of LIS, exponentially more devastating to the patient!  And remember:

1. PVS and LIS are NOT coma.  In coma, the person does not wake up at all
2. PVS and LIS patients are NOT brain dead.  In brain death, there is absence of total brain function, not just part of it.  To learn more about brain death, read this entry: How to Determine Brain Death

Here’s a head to toe walk-through of common devices attached to patients while in the hospital.

HEAD

External Ventricular Drain (EVD)

Intracranial Monitoring Devices (for brain patients)

You may often hear medical devices such as an EVD (external ventricular drain), intraventricular catheter, or head bolt.The y are placed in specified locations in the head mostly to do either or both of 2 things:

(1) Drain excess fluid or blood from the brain
(2) Monitor the pressure or oxygenation in the brain

These devices are usually only seen in ICUs.

Nasogastric Tube (NGT)

A tube through the nose, or sometimes through the mouth (orogastric tube or OGT), will be necessary for feeding when someone is at risk for choking. The tube goes directly through the stomach and can be used for tube feeds and medications. These tubes can typically be used for only a couple of weeks.

If a patient will need a feeding tube for a prolonged period of time, the doctor will recommend placing a gastric tube (GT or PEG). A minor surgical procedure places a gastric tube through the abdomen into the stomach.

Endotrachial tube (ET tube)

Endotrachial Tube (ETT)

The breathing tube. These are for patients who cannot breathe effectively on their own and need the help of a breathing machine (ventilator).  The tube supplies oxygen-rich air to the lungs.  It will be removed when the patient is more awake, can manage his secretions, and has improved lung function.

If they need a ventilator for a prolonged period, a tracheostomy will be placed. A surgical procedure places a hole through the neck. This hole can later be closed if the patient has been proven capable of breathing independently.

NECK & SHOULDERS

A subclavian central line

Central lines

See thin tubes sticking out of strange places? These are called central lines. We are all familiar of IVs that go into veins in hands and arms, but these small IVs can’t handle large amounts of medications and fluids. They also don’t last. This is why sicker patients often need central lines, usually inserted in the neck or the upper chest near the shoulders. Sometimes, they can also go into the groin.

PICC line

For an even more lasting solution, the doctors might insert a peripherally inserted central catheter (PICC) line, which goes in the arm. Patients with long-term needs for IV medications are often sent home with them.

All these lines are called central lines because while they may have different points of entry, the catheter tip ends centrally near the heart.

ARMS & FINGERS

Peripheral Lines

These are the ordinary IVs we see that go into veins. Almost everyone in the hospital needs “access,” a means of delivering medications through a vein. A patient may have one, two or three of these. Unlike central lines, these IVs are smaller and shorter — and therefore also shorter-lasting.

Blood Pressure Cuff

Constant blood pressure monitoring may be necessary for some patients. It’s not unusual to see a blood pressure cuff left around one arm.

Arterial Lines

pulse oximeter

We’ve talked about lines that go into veins above. But what about arteries? There are lines that go into arteries too. Arterial lines are usually placed in the wrist. Or in the groin if the wrist isn’t an option. They measure blood pressure continuously (unlike BP cuffs that measure intermittently). Also, arterial blood can be drawn through these lines – used to measure oxygen levels in the blood.

Pulse Oximeter

Something sticking to one of the fingers, the pulse oximeter, or O2 saturation sensor, indirectly measures the oxygenation in the blood. They can also count the heart rate.

CHEST

EKG leads are attached to the chest

EKG leads

Sticky pads attached to wires are placed at various points in the chest in order to monitor the heart rate and rhythm. They go into a cardiac monitor and will alert the nurse if the heart rate is too fast, too slow, irregular or just plain nonexistent!  Certain leads can also detect chest movement and count the breathing rate.

Continuous heart monitoring usually consists of 3 or 5 leads. A more thorough test would require 12 leads.

ABDOMEN & PERINEUM

A gastric tube (GT or PEG) can be placed as a long-term solution to feeding needs as explained above.

A foley catheter

Urinary Catheter

Often called a foley catheter, these are small tubes that go into the bladder. Many patients have them temporarily after surgery. For sicker patients, foleys are important to measure urine output every hour. They can also help keep incontinent patients clean and dry.

Rectal Tube or Pouch

For patients having uncontrolled diarrhea or frequent loose stools, a rectal tube or pouch may be placed. They mainly help prevent skin irritation and breakdown from constant contact with stool. They also make the nurses’ life easier!

LEGS

SCDs or leg squeezers

Leg Squeezers

Sequential compression devices (SCDs) or leg squeezers do just that — squeeze the leg or foot. These are prescribed for patients on bed rest and are therefore at higher risk for developing clots in their legs. Some also have TED hoses — really tight stockings for the same purpose - to prevent leg clots. Many patients have them after surgery while leg mobility is limited.

Now that you know what they’re for, perhaps your next hospital visit won’t be as daunting!

What does brain death mean?

Brain death is the irreversible loss of function of the brain, including the area that controls life – the brainstem.  It is the end of all brain activity.

In the US, brain death is a legal indicator of death.  It is regarded the same as someone whose heart has stopped beating.

How do you determine brain death?

The doctors will perform careful tests before they can safely proclaim someone as brain dead.  Before they perform the exams, they will likely explain what they’re considering, and should tell you the results after.

Medical Criteria for Brain Death: the 3 Cardinal Findings:

1.  Coma or Unresponsiveness
2. Absence of Brainstem Reflexes
3. Absence of Breathing (Apnea)

Let us dissect each criterion.

1.  Coma. The person in a coma cannot be awakened by any stimulus.  He does not respond to pain or speech.

2.  Absence of Brainstem Reflexes. Brainstem reflexes include:

• Pupillary reflex: Pupils do not react to light.  They are fixed and dilated
• Corneal reflex: Loss of blink reflex
• Cough & Gag reflexes: No reaction when the back of the throat is stimulated
• Jaw reflex: The face does not move when the jaw is tapped

Tests the doctors will often perform:

• Oculocephalic reflex or Doll’s Eyes reflex.  The doctor will rapidly turn the patient’s head 90 degrees to both sides.  A brain dead patient’s eyes will stay fixed at midline.
• Vestibulo-ocular reflex.  Often called the caloric test, the doctor will instill 50ml of cold water into the patient’s ears.  A brain dead person’s eyes will have no reaction.

3.  Apnea. The doctors will disconnect the patient from the ventilator and check blood gas levels after.  A brain dead person will  NOT breathe on his own, and the carbon dioxide levels on his blood gas will be very high.

Other confirmatory tests that support brain death, but are not necessary to diagnose it:

• EEG (Electroencephalogram): shows no electrical activity
• Cerebral Angiography: shows no blood flow through the Circle of Willis
• Transcranial doppler: shows high vascular resistance associated with greatly increased intracranial pressure
• Cerebral blood flow & MRI: shows no cerebral perfusion

Can someone who’s brain dead still have reflexes?

Yes.  Often loved ones get excited when they see small movements from brain dead patients.  Sadly, they can just be reflexes that don’t necessarily come from the brain.

It’s confirmed.  Your loved one is proclaimed brain dead.  What now?

Then comes the painful decision to withdraw care.

A brain dead person is only kept alive by artificial means – the breathing machine (ventilator), and sometimes medication to keep their blood pressure and heart rate.  Once off, the body will not be able to keep itself alive.

These are painful times.  When agreeable, families are often asked about organ donation.  In most circumstances, the doctor will discuss the path with the family, give them time to say goodbye, and then withdraw care.

Basal Ganglia

Buried deep inside the cerebral cortex, the basal ganglia functions for initiating and integrating movement.  Damage to it causes Parkinson’s – a disorder marked with tremors, rigidity and abnormal gait.

Hypothalamus

The hypothalamus is your inner thermostat, controlling body temperature.  Often, when people have central fever (sustained increased temperature) after brain injury, it’s caused by damage to the hypothalamus. It also has several other important functions, including control of the body’s appetite (thirst, hunger), sleep patterns, sexual drive and response to anxiety.

Thalamus

Think about the thalamus as a collection of highways and byways. It is the brain’s relay center for movement and sensory information, creating a bridge from the cerebral cortex to other parts of the brain. Interruption in one of those connections can result in impairments.

Pituitary Gland

The size of a pea resting at the bottom of the hypothalamus, the pituitary gland is primarily an endocrine gland.  It is sometimes referred to as the “master gland” as it secretes hormones for temperature, thyroid activity, growth during childhood, urine production, water balance, testosterone production in males and ovulation and estrogen production in females. In effect the pituitary gland controls all other glands that are responsible for hormone secretion.

Limbic System

The limbic system is a series of nerve pathways incorporating several structures. Central to its function is the control of emotions. It also houses the hippocampus, which is important in memory and learning.

Reticular Activating System

Part of the reticular formation, the reticular activating system (RAS) influences wakefulness, overall degree of arousal and consciousness.

Ventricles

Within the brain there are four cavities called ventricles. Ventricles are filled with cerebrospinal fluid (CSF), which is produced within the ventricle wall. The term “hydrocephalus” refers to enlarged ventricles, usually due to interruption with CSF flow.

To learn about the cerebral cortex and its lobes, the cerebellum and the all-important brainstem, refer to this article.

Here are the most COMMON NEUROLOGY TERMS you may hear along with their definitions.  Most of them are symptoms or manifestations of any damage or change in the brain — be it from stroke, a brain tumor, or even Alzheimer’s.  Soon enough you’ll be using them, too!

** The most common ones will be in bold**

Common Symptoms:
Remember these Prefixes:
a~ = absence or inability
dys~ = difficulty

• Agnosia = inability to recognize objects & people
• Agraphia = inability to write or spell
• Akathisia = inability to sit still; motor restlessness
• Anopia = inability to see
• Aphasia = inability to speak or comprehend spoken word
• Apraxia = inability to carry out purposeful movement
• Anisocoria = absence of pupil size equality; unequal pupil sizes. Bad sign!
• Ataxia = inability to coordinate movement. Usually a problem in the cerebellum
• Coma = state of unconsciousness; cannot be awaken by stimuli
• Diplopia = double vision
• Dysarthia = difficulty articulating words
• Dyslexia = difficulty reading
• Dysphagia = difficulty swallowing.  They may temporarily need a feeding tube
• Extinction or Neglect = not recognizing the presence of one side of the body.  Usually a right parietal lobe problem
• Nystagmus = involuntary eye movement
• Ptosis = drooping of the eyelid
• Vertigo = dizziness

Movement problems
Remember:
~ paresis = weakness
~ plegia = paralysis
hemi~ = one side of the body, either left or right

• Hemiplegia = paralysis of either left or right side of the body
• Hemiparesis = weakness of either left or right side of the body
• Paraplegia = paralysis of the lower half of the body
• Quadriplegia = paralysis of all four extremities; paralysis from the neck down

• Contralateral = opposite side of the body when divided into left/right
• Ipsilateral = same side of the body

Putting it all together:

• A cerebral infarct will cause contralateral hemiplegia. In short, damage in the right brain will cause paralysis in the left side of the body.
• A person with right hemianopia will not be able to see in his right visual field

Suffixes:

~ itis = inflammation, usually caused by infection

• Encephalitis = inflammation/infection of the brain
• Meningitis = inflammation/infection of the meninges (covering of the brain)

Tonsilitis (tonsils), Hepatitis (liver), Arthritis (joints), Gastritis (stomach)…. you get the picture…

~ oma = tumor

• Glioma = tumor from the glial cells
• Meningioma = tumor in the meninges

Posturing Terms:

• Decorticate = abnormal posturing where arms are flexed and legs rotate inward as a response to stimuli. It usually indicates damage to the cerebral cortex (Bad)
• Decerebrate = abnormal posturing where arms and legs extended as a response to stimuli. It usually indicates damage to the brain stem. (Worse)

Oxygenation Terms:

• Ischemia = lack of oxygen (can be temporary)
• Infarction = cell death (due to prolonged ischemia)

Therefore, a Transient Ischemic Attack (TIA) is a temporary period of decreased oxygenation in the brain. Does it cause permanent damage? No.

Common Procedures:

• Anticoagulation = giving medications to prevent blood clots from forming
• Thrombolysis = giving medications to bust the clot!
• Embolization = procedurally occluding part of an abnormal blood vessel.  Treats aneurysms.

There you go!  Simple terms to remember.  That wasn’t so complicated, was it?

We have been asked and have answered these questions many times.  The cause for concern is very real after traumatic brain injury.  After all, the brain is NOT like a bone that heals readily.  Once brain tissue dies, it is gone forever. That’s why an injured patient’s loved ones deserve utmost sympathy, patience and understanding.

Lucky are those who suffer mild concussions, are fully awake after a brief period, and are sent home after some observation.  Lucky are those who wake up after surgery and start recognizing people instantly.  But for many severely injured brains, the road to recovery is long and uncertain.  No, it is not like the movies, where actors wake up from a coma and resume life like nothing happened.  It takes weeks, months, even years for “recovery” to happen.  This entry focuses on the first few days after severe brain injury — the critical phase.

What to Expect

After determining the extent of brain injury, many patients need immediate surgery to evacuate blood, clots, dead tissue and unwanted debris that may harm the brain.  To save as much brain tissue as possible, any surgery needs to happen as soon as possible.  Remember, brain tissue starts to die 4 – 6 minutes without oxygen.

After brain surgery, patients usually stay in an Intensive Care Unit (ICU), with a highly trained team, for critical monitoring.  How long they stay there depends on their progress.

Families should be aware that many complications can happen after brain surgery.  For severe injuries, it’s rarely a smooth road. So it’s best to take it one day at a time.

The Irony of  “wait and see”

What will he be like?  Will there be permanent damage? These questions are dependent on the extent of brain tissue damage.  Learn the basics here.  But most likely, immediately after the injury, doctors reply with “we’ll have to wait and see”…

Frustrating.  But unfortunately, it’s true.  We do not yet know exactly how much of the brain tissue had died, how much of it only got cut off of oxygen and can still heal, and how much of it is temporarily compromised because of swelling.

After any injury (like a broken arm or cut skin), there’s bound to be swelling.  Brain swelling is called cerebral edema, and can be fatal if not treated promptly.  Brain swelling can increase the pressure inside an enclosed skull (intracranial pressure) and compress on other brain structures, causing more tissue death.  It is only after the swelling has gone down that we can start to appreciate the “extent of damage.”

Early Goals after Traumatic Brain Injury

• keep intracranial pressure (ICP) down
• reduce brain swelling (cerebral edema)
• give the brain as much oxygen it needs to heal

And if you think about it, they all go hand in hand.  By reducing swelling, we keep the brain pressure down, which in turn allows space for the blood vessels to supply oxygen-rich blood to the brain.

The doctors will try their best to make this happen.  Complications after traumatic brain injury almost always involve any of these three issues. The docs will give medications to keep the swelling down.  They may install devices to measure intracranial pressure and brain tissue oxygenation.  These may look scary at first.  Patients may get repeated scans to make sure the brain is in good shape.  And if necessary,  the docs will bring the patient back to surgery to achieve these goals.

When will he wake up?  And how can he wake up when they’re sedating him?

Aha!  “Waking up” from the coma.  Another common question. Some patients wake up immediately.  Others take longer.  Some don’t wake up at all.  It all depends on the location/extent of the injury and the amount of swelling involved.  It’s generally thought that those who wake up sooner tend to have better recovery.

So why are you sedating him?

Remember the 3 goals?  Often, after surgery, patients are agitated.  Sometimes they have seizures.  Their intracranial pressures are too high.  Their brain, now in a state of imbalance, has become hyperactive.  All these can cause increased oxygen demand in the brain.  And since our goal is to give it more than adequate oxygen to prevent death and promote healing, we need to rest the brain.  We need to make the patient sleep.  And give them pain medication.  Hence, sedation.

Every so often, the doctors and nurses will turn off the sedation to examine a patient as see what he can do.  Does he open his eyes?  Does he follow commands?  Does he move his arms and legs?

Ultimately, when the brain is ready (controlled edema, normal pressures, enough oxygen), the sedation can be weaned off.  Then we’ll be able to better see what he can be like.  But until then, until he’s stabilized, patience…

What will he be like after all this is over?

Rehabilitation is long.  Common practice say it takes a year to see what a patient will be like in terms of disability.  But some patients take longer, and continue to improve in functionality over the years.  While some parts of the brain die permanently, studies show remaining parts may learn to take over some of their function.  The doctors will be able to give more information over time, after the critical phase is over.

Let’s reserve that discussion for another post.

CEREBRUM

The cerebrum comprises what most people think of as the “brain,” or at least the bulk of it.  It lies in front and on top, and is divided into the the right and left hemispheres.  To understand and explain its functions further, the cerebral cortex is divided into LOBES.  There are 4 sets (as each would have a right and left portion):

Lobes of the Cerebral Cortex:
Please be guided by the image colors to their corresponding lobes

Lobes of the brain

Frontal Lobes
Location: Front part of the brain
Function: MOVEMENT, SPEECH & HIGHER COGNITIVE FUNCTIONS
– Involved in planning, organizing, problem solving, selective attention, personality,behavior and emotions.

• The front portion of the frontal lobe is called the prefrontal cortex. It is very important for the “higher cognitive functions” and the determination of the personality.
• The back portion of the frontal lobe are the motor areas. Nerve cells that produce and modify movement are located in these areas.
• The left hemisphere contains Broca’s area, responsible for the motor aspect of speech

Occipital Lobes
Location: the back of the brain
Function: VISION

• The occipital lobes are responsible for you sight — visual reception and association, including recognition of shapes and colors.

Parietal Lobes
Location: behind the frontal lobe at the top of the brain,
Function: SENSATION, SENSORY INTEGRATION & PERCEPTION

• The parietal lobes contain the primary sensory cortex which controls sensation (touch, pressure)
• Behind the primary sensory cortex is a large association area that controls fine sensation (judgment of texture, weight, size, shape)
• The left parietal lobe is responsible for one’s ability to read and write
• Damage to the right parietal lobe can cause visual-spatial deficits, making them neglect one part of the body or space

Temporal Lobes
Location: one on each side, at the level of the ears
Function: HEARING, SMELL, SHORT TERM MEMORY & SPEECH COMPREHENSION

• The left lobe is mainly involved in verbal memory (memory of words and names).  It contains Wernicke’s area, responsible for the comprehension of speech.
• The right Lobe is mainly involved in visual memory (memory for pictures and faces).

CEREBELLUM

Located at the lower back, the cerebellum helps with muscle COORDINATION and BALANCE. Damage may result in ataxia which is a problem of muscle coordination. This can interfere with a person’s ability to walk, talk, eat, and to perform other self care tasks.

BRAINSTEM

Aha!  The most delicate of them all!  While the upper brain gives your life quality (movement, reasoning, speech), the brainstem KEEPS YOU ALIVE!
Location: The lower extension of the brain where it connects to the spinal cord.
Everything necessary for SURVIVAL (breathing, heart rate, blood pressure) and for arousal (being awake).

Most of the cranial nerves come from the brainstem. The brainstem is the pathway for all fiber tracts passing up and down from peripheral nerves and spinal cord to the highest parts of the brain.