As a growing concern in today’s world, Traumatic Brain Injury (TBI) is known to occur at a rate of 500 out of 100,000 individuals every year, in Canada alone, according to the Northern Brain Injury Association. From a population of 38,000,000 (2021), this construes to about 190,000 serious cases of brain injuries per year. As this life-altering phenomenon composes such a large number of critical injuries treated by the healthcare system each year, it is important to be aware of the extremely prevalent effects TBI can have on one’s mental and physical health, as well as one’s overall quality of life. In fact, it remains to this day one of the leading causes of death in our country. However, technology has proven time and time again to aid in the understanding, prevention, treatment of these brain injuries.
Image is courtesy of The National Institute of Neurological Disorders and Stroke.
What Is Traumatic Brain Injury (TBI)?
As Sage Journals explains, the brain is excessively vulnerable to both external acceleration and compressive forces, and internal disruption by blood or foreign material forcing its way through the delicate tissue. Having very little structural strength, the nerve cells of the central nervous system (CNS) are densely packed, with little intervening space, meaning that the brain can easily be damaged by a rise in pressure inside the skull.
Traumatic Brain Injury (TBI) usually occurs from a blow to the head or body that is proven to be harsh to the nervous system (this can be judged by the effects of this blow) and can be present in many different forms, as stated by the Mayo Clinic. These can range from minor variations in consciousness to comatose and vegetative states of being and brain death. Most notably, this occurs when a sudden change in the velocity of the body occurs, throwing the brain forward against the frontal bone, for example. The CDC explains that as a result, the brain then rebounds from the initial blow to strike the interior of the skull (i.e., a contrecoup injury), producing paired bruising of the frontal and occipital lobes of the brain. Rotational movements, twisting the brain on the midbrain, may also occur. Additionally, the sharp border between the front and middle cavities of the skull base can bruise and tear the tissue at the front of the temporal lobe.
The Mayo Clinic also mentions that while these forces are damaging to the brain surface, flexing and deformation of the interior of the brain tears the axons that connect brain regions. Compressive forces where the brain surface contacts the skull also squeeze these delicate axons, disrupting the neurotubules that transport essential chemicals between the cell body and axon terminal and stopping nerve impulse conduction.
Image is courtesy of Stanford Children’s Health.
It is important to note that the most common causes of these consequential injuries are falls, vehicle-related collisions, violence, sports, explosive blasts, and other combative injuries. While the symptoms of mild Traumatic Brain Injuries may present themselves in a less impactful, temporary way, serious Traumatic Brain Injuries can result in a number of life-threatening consequences, such as brain bleeding, bruising, or torn brain tissues. According to the CDC, these issues may result in long-term implications (i.e. trouble organizing thoughts, difficulty concentrating, headaches, fatigue, memory loss, personality change, paralysis, psychological disorders, etc.) and even death. Needless to say, TBI-related issues may have lasting impacts on the patient, their family, and their community.
What Impacts Has Technology Had on TBI Diagnosis?
Due to the powerful and urgent nature of any form of Traumatic Brain Injury, they require prompt attention from a qualified medical professional in order to be diagnosed adequately. The Mayo Clinic says that a neurological exam is usually conducted to determine if the basic functions of motor, sensory, hearing, coordination, and balance skills are still able to be performed by the patient at a satisfactory level. Moreover, changes in mood or behaviour and mental state are also evaluated to determine the correct treatment plan for the patient.
Primarily, diagnostic imaging is used by medical professionals to create scans of the brain in order to assess the extent and location of the traumatic brain injury and deduce the effects it may have on a patient’s health. This, in turn, will enable medical professionals to then determine the appropriate route of treatment for the patient’s injury, whether it be surgery, the use of pharmaceutical drugs, physical therapy, or other courses of treatment.
For patients with the symptoms of moderate to severe Traumatic Brain Injury, computed tomography (CT) is used by manipulating a sequence of X-rays in such a way that they create two-dimensional images of tissues, organs, and bones. According to the National Institute of Neurological Disorders and Stroke (NINDS), these images depict the location of the swelling, bruising, bleeding, or fracture of the organ or bone.
The NINDS explains that Magnetic Resonance Imaging (MRI), typically used after the initial assessment, is used to create comprehensive images of body tissue through electrically-generated radio waves. It is widely recognized to provide a more thorough and exhaustive image rather than that of a computed tomography scan and hence is more preferred.
It is important to note that in the previous decade, crucial progress has been made in terms of improving the quality of the image produced by Magnetic Resonance Imaging, allowing medical professionals to more easily become aware of the mild, cellular changes that occur during a particular form of TBI. This allows for an increased level of patient care available, lowering the death rate of these serious injuries. The most notable examples of these include the possible creation of an image of white matter in the brain due to diffusion tensor imaging (i.e., MRI technique enabling the measurement of the diffusion of water in brain tissue) and how minuscule areas of damage are located through fluid-attenuated inversion recovery (i.e., MRI technique that can suppress fluid occurrences in the image, bringing to attention important bodily phenomena that may be useful to make a diagnosis), which is a more subtle test than that of an MRI. Moreover, minor yet dangerous areas of bleeding can now be identified by susceptibility-weighted imaging, which is a neuroimaging technique that highlights certain body tissues more than others.
A CT scan (a), and an MRI scan (b) of the same human brain specimen (ScienceDirect).
Article Author: Aneri Buch
Article Editors: Valerie Shirobokov, Victoria Huang