“Road traffic crashes account for around 70 per cent of the head injury cases in India,” says Dr Dhaval Shukla, professor of neurosurgery at the National Institute of Mental Health and Neurosciences (NIMHANS).
He recalls the case of a 20-year-old student who met with an accident while riding a two-wheeler without a helmet. “Despite [apparently] experiencing only heavy bruising, a subsequent CT scan revealed a large blood clot in his brain,” says Dr Shukla.
The medical team quickly performed a surgery on him, which saved his life. The young man then underwent extensive neuropsychological and neurological rehabilitation to improve his cognitive, emotional and behavioural symptoms.
Untangling the knot
“Whether it is a minor bump on the scalp or a major blow to the brain, the consequences of head injury can be life-changing,” says Dr N K Venkatramana, founder, chairman and managing director of BrainS Super Speciality Hospital, Bengaluru.
He says that head injury is a broad term that describes a wide range of complications. It can affect not only the scalp and skull but also the underlying tissue, the brain and its blood vessels.
When external forces like falls, assaults, violent jolts and accidents cause internal injury, it is specifically traumatic brain injury (TBI), explains Dr Venkatramana.
The severity of TBI can range from mild concussions to severe injuries, the latter often resulting in long-term complications. The neurological complications stemming from TBI can be wide-ranging.
On the surface – physical complications
According to the National Institute of Health, the damage from TBI can limit to one part or a large part of the brain. However, the type of injury determines how the damage is caused to the brain.
The physical symptoms can be headaches or loss of consciousness, slurred speech, nausea, and vomiting. These can worsen to seizures, persistent headaches, loss of coordination and the inability to wake up. “In severe cases, the brain can swell, which is often life-threatening,” says Dr Venkatramana.
Silent agony – the sensory fallout
Depending on the part of brain injury and the intensity of the impact, individuals can lose their senses. “It [TBI] can even leave an individual with a loss of memory, paralysis, impaired vision, and prolonged unconsciousness,” says Dr Venkatramana.
Dr Shukla points out that even mild traumatic brain injuries can have lasting effects, with up to 15 per cent of the injured experiencing behavioural and cognitive challenges. “Memory loss, speech difficulties, personality changes, or lack of concentration are often seen in them. These issues can be severe enough to prevent them from returning to work,” he says.
According to a 2019 study, people with mild TBI may experience acute challenges with cognition, which is seen within the first 24 hours of the injury. However, this, in turn, may lead to long-term and persistent symptoms, decreasing their quality of life.
Finding the way back
Overall, the topic of head injury requires attention, say experts. Understanding the risks and taking appropriate precautions, like wearing a helmet or seat belt, help prevent these injuries or minimise their effect when they do occur.
Timely treatment and rehabilitation are crucial for TBI recovery, opine the experts, as seen in the recovery of the 20-year-old.
“The young man regained his strength, motor skills, and cognitive abilities, ultimately leading to his successful recovery”, says Dr Shukla. The rehabilitation also helped him improve his motor coordination for daily activities such as eating, dressing, bathing, and basic housekeeping.
“I am happy my child survived this grievous injury. He is performing fairly well,” adds the boy’s mother.
Editor’s note: 20 March is World Head Injury Awareness Day. This article is the first in a two-part commemorative series.