Understanding of Severe Brain Injury
The Caregivers Quest for Understanding of Severe Brain Injury
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Chris’s Mom, like almost every parent or spouse of a severely brain injured person, felt an insatiable need to increase her understanding of severe brain injury. The neurosurgeon never takes the time to explain. Perhaps it is because there are more questions than answers. But “we will just have to wait and see” is not enough to fill the void.
While most major trauma centers have medical libraries, those books are not written in a way that a overwhelmed family member can easily understand. From this need came waiting.com, The Coma Waiting Page, in 1997. When we began waiting.com, it was designed not for the internet, but to be viewed on dedicated computers for this particular purpose. Fortunately, the internet provided a much broader platform for it than we ever imagined.
One of Becca’s most lasting contributions in waiting.com are its brain anatomy and pathology charts. She drew these with her own hands, combining things she learned while she waited for coma emergence, with things and resources I accumulated in my career as a brain injury attorney. She was greatly assisted by what we called our “faculty”, professional contributors from the trauma center where she had waited, where other clients of mine had waited.
In the generation that has passed since waiting.com was uploaded, the internet’s bandwidth capacity has increased to the point that we can offer more than what is on waiting.com and in understanding of severe brain injury. Thus, these pages will also include sophisticated graphical illustrations of the basic principles of brain anatomy and neuropathology. But before we start on that, I must put on my brain injury professor’s hat (remembering I am a lawyer not a doctor) and begin with the the basic principles necessary of neuropathology, key to the understanding of severe brain injury. The first step in the understanding of severe brain injury is to understand normal brain anatomy.
I. Explain the nature of brain structures:
- The nature and texture of the brain,
- The role of the skull in protecting the brain
- The cribiform plate,
- The neuron.
II. Understanding Neuropathology:
- The brain in motion,
- Blows to the head,
- Diffuse v. focal injuries,
- Contact phenomenon,
- Primary versus secondary injury,
- Swelling, hematoma, hemorage, edema,
- Diffuse axonal injury.
- Acceleration deceleration
III. Diagnosis of Brain Trauma
The fundamental challenge, is in a live subject, to look through skin, skull and tissue, to see a mixture of pathology involving damage to:
- Blood vessels,
- Microscopically thin axons, with macroscopic length,
- Microscopic damage to nerve cells,
- Changes in brain chemistry,