Over the course of history there have been many discoveries and breakthroughs related to the brain and how trauma affects it. Modern medicine has allowed the death toll due to brain trauma to decrease dramatically. Although some illnesses that stem from TBI (traumatic brain injury) have no complete cure yet, scientists are continually working to improve treatments. Without the hard work of many doctors and scientists we would not have as much information about trauma to the brain that we do today.
Brain injury has been evident since ancient times, displayed in skulls found in battleground graves and cave drawings. One of the first documents discussing trauma to the brain was the Edwin Smith Papyrus. “The papyrus contains the first description of the brain, pulsations, contusions as the result of TBI, the dura, the cerebrospinal fluid, revealing a more or less sophisticated knowledge of cerebral anatomy.” (Kamp, Tahsim-Oglou, Steiger, & Hänggi 2012)
The Greek physician Hippocrates was one of the most influential pioneers in the treatment of head injuries. His short treatise On Wounds in the Head was revolutionary in describing the brain, information on injuries to the head and treatment regarding it. In this work he discusses topics such as pressure in the skull, and making a hole in it to relieve such pressure. Hippocrates was also one of the first to contemplate whether brain trauma causes psychological damage or not.
Moving in to the Renaissance era, more and more information was discovered regarding TBI. A prime example of TBI in this time period was King Henry VIII. In his later years he suffered from paranoia thought to be caused by trauma to the head, although the sure cause is still debated to this day. “Several hypotheses have been put forward regarding his transformation from a renaissance king to a later medieval tyrant, including endocrinopathies, psychiatric illnesses and traumatic brain injury.” (Ikram, Sajjad, & Salardini 2016) One of the main methods practiced by Medieval and Renaissance surgeons was trepanation. It was around this time that the term concussion was more frequently used.
A prominent figure in the study of concussions , or mild traumatic brain injury, is Berengario da Carpi. “Although concussions were first described in ancient times by Hippocrates, the definition of concussion and what differentiates it from other head trauma has been debated throughout history. Since the 9th century, doctors such as Rhazes, Berengario da Carpi, and Doctor Read have further refined the definition and diagnosis of concussion, coming to the first neuropathologic descriptions of the term in the 17th century. Today, the debate continues over whether a concussion is defined as a physical blow to the head, or the abnormal symptoms following such trauma.” ("Sound Neuroscience: An Undergraduate Neuroscience Journal”)
Further into the 20th century, the CT scan was invented. Short for Computed Tomography, the CT scan is used to make very detailed pictures of the body. It was invented by a man named Godfrey Hounsfield and his team at EMI Central Research Laboratories which is located in Hayes, West London. The first scan was performed in London in the year 1971. Six years later, after much extensive research, the first Magnetic Resonance Imaging scan was performed by Dr. Raymond Damadian. The MRI uses pulses of radio wave energy and a magnetic field to produce pictures of structures inside the body. More recently, we have seen the Diffusion Tensor Imaging scan or DTI. This scan is designed to view the white matter of the brain. “ DTI is a sensitive probe of cellular structure that works by measuring the diffusion of water molecules.” (O’Donnell & Westin 2011) All of these scans have greatly advanced the way that scientists study the brain, therefore causing research on brain trauma to improve.
Another portion of history that had an effect on the study of TBI was World War 1. This is due to the use of bombs. Soldiers in the trenches experienced a number of side effects including memory loss, headache, and changes in behavior, all due to the impact from the explosives. During this time the brains of deceased soldiers were examined by doctors to study more about how the impact of explosives affect the human brain. Since then, a number of diseases and disorders have been uncovered and the study of TBI in this area continues.
Research in the 1970’s dealt with primary and secondary traumatic brain injuries. To give a brief summary, a primary brain injury is an initial trauma to the brain which causes displacement of structures of the brain. Moreover, secondary brain injury is not merely somatic. Secondary TBI occurs over time and could either be dependent or independent of the initial injury.
More recently, the study of traumatic brain injury encountered the Decade of the Brain: the 90’s. President George Bush set the goal that from 1990-1999 the United States would see many breakthroughs regarding mental health and the brain as a whole, and that is exactly what happened. Although this was meant to be an objective for America, the movement soon spread across the globe. This era saw advancements in the areas of neural development, antidepressants and antipsychotics, as well as the fMRI. Scientists also discovered genetic mutations responsible for ALS, Rett Syndrome, Huntington’s disease, as well as uncovering neural plasticity. As a whole, this decade was crucial to our current knowledge of the brain. Not only that, but the research in the Decade of the Brain assisted in uncovering information about TBI.
Perhaps one of the most commonly discussed cases of severe traumatic brain injury is a man named Phineas Gage. He is named neuroscience’s most famous patient. The man’s injury is one of the reasons why we know that different sections of the brain have specific functions and work independently. Scientists are still obsessed with this man and the affects that the brain injury had on his life.
In the year 1848, twenty-five year old Phineas Gage was working one day at his job on a railroad in Cavendish, VT. His job consisted of drilling a hole, and packing sand into it with a tamping iron (a 13-pound metal bar) only after placing an explosive charge into the hole. Suddenly, the metal bar created a spark that set off the charge. The force was so powerful that it sent the bar through the left side of his face, behind his eye socket, and followed all the way through the top of his head. The speed of the bar, in a way, cauterized the blood vessels which caused very little bleeding to occur and Gage surprisingly survived.
His friends and family were completely in shock at his survival, and expected a semi-normal life for Gage after recovery, considering there wasn't much knowledge of how the brain works at that time. This was an era in which it was thought that one’s personality could be assessed by measuring bumps on the head. Contrary to what was expected, Gage’s behavior after recovering is a prime example that shows how individual parts of our brain work together simultaneously but have different purposes.
To describe what exactly happened to Gage in simple terms, it is easiest to explain the two main parts of the brain that were affected and what they do. First, there is the limbic system, also called the old mammalian brain, located at the center of the brain. This specific part is mainly responsible for primary emotions like anger and sadness. Next, the frontal cortex would basically be described as the place where rational thinking, or problem solving occurs. It is located in the front of the brain.
When the bar shot through his skull, it separated the limbic system from the frontal lobe. Which, as you could guess, would alter his rational thinking and actions based on emotion. To quote the physician that treated Gage (according to William J. Winslade), John Martyn Harlow, “He is fitful, irreverent, indulging at times in the grossest profanity, which was not previously his custom.” (Winslade 1998) For the next three or so years Phineas Gage lived with a deranged, irrational personality. Eventually he became somewhat normal, although still suffering side effects of the injury, and returned to the workforce.
This TBI case is one of the main reasons that scientists became so eager to research the anatomy of the brain and how it works. Phineas Gage is still a topic of study for scientists today. Although he is the most talked about and studied TBI, there are a number of cases of traumatic brain injuries that caused scientists to uncover more and more information about trauma to the brain.
Another example of TBI is a man named Lev Zazetsky. He was a twenty-three year old soldier in the Soviet army. On March 2nd, 1943 at the Battle of Smolensk, he was shot in the head. He went into a coma for a period of time and shortly after developed a form of agnosia.
The injury caused Zazetsky a lot of problems for the rest of his life. According to William J. Winslade, “Before the war he had been a fourth-year student at a technical university; after his injury he couldn't read or perform simple addition.” The injury prevented him from being able to see out of the ride side. In his journal he wrote about times where he would wonder what happened to the right side of his body, as he could feel his fingers moving but not see them. This made it extremely difficult for him to read, as he could only pick up fragments of words and only a few letters at a time.
Furthermore, the trauma to his brain caused him to hallucinate. When he closed his eyes he would see odd shapes or ugly faces. As a result he would keep his eyes open and barely ever sleep. The TBI also affected his speech as well as his memory. He was treated by Neuropsychologist A.R. Luria who said "His only material consisted of fragmentary recollections that came to mind at random. On these he had to impose some order and sense of continuity though every word he recalled, every thought he expressed required the most excruciating effort.”
Perhaps one of the most interesting things about this case is Zazetsky’s ability to write despite his other disabilities. One of his most valuable items was his journal. He could write swiftly and automatically, even though he could not comprehend the letters that were written. This is because there was no damage to the parts of the brain that are responsible for hand writing.
Unlike Phineas Gage, Lev Zazetsky never returned to a “normal” life. Until he died at age 73, he had problems communicating and impaired vision. Sometimes he would get lost because he did not have a sense of direction. However, one thing that helped him to partially recover is his motivation to let his brain injury have control of his life.
As for causes of traumatic brain injury, there are a plethora. Most frequently seen reasons in the U.S. are construction, sports/physical activity, violence, and transportation accidents. The symptoms of TBI are dependent to the case and the section of the brain that is affected, and the severity of the injury. In mild cases, symptoms include dizziness, headache, vomiting, fatigue/lethargy, ringing in ears, lack of motor coordination and many more. On the other hand, more severe cases of TBI could result in behavioral/mood changes, trouble thinking and concentrating, problems with memory, and confusion.
Traumatic brain injury, by statistics, is more common in men than women. A large percentage of employees in construction in America are men. Things such as equipment accidents, falling from high levels, and dangerous jobs cause traumatic brain injury in construction. To prevent this, OSHA has implemented a number of rules and regulations for construction workers.
Another cause of TBI is vehicle accidents. With 20-50 million people a year being injured in car crashes alone, trauma to the brain occurs in a large percentage of them, ranging from mild concussions to cases of extremely severe TBI. Although cars have seatbelts and airbags, in some cases they are not enough to protect from injury to the brain in the event of a car wreck.
An estimated 1.6-3.8 million cases of TBI are caused by sports. Football is very popular in the United States, and it has seen brutal ends to the careers of many professional athletes due to traumatic brain injury. A concussion here and there is common in most football players, but there have been cases in which a TBI is so severe that it could not only end the athletic career of an individual, but impair other aspects of their everyday life. One clinical study found that 87% of former football players have a degenerative brain disease caused by TBI.
Lastly, a more sorrowful cause of traumatic brain injury is violence. “Approximately 1,300 U.S. children experience severe or fatal brain trauma from child abuse every year.” ("Brain Injury in Children")
Other victims of abuse that suffer from TBI are adult women ranging from 25-45, although most studies would factor in that a majority of TBI from abuse and abuse in general go unreported.
Other causes of TBI related to violence are blast injuries from explosions and firearms, which is the primary cause of death among war zones. “Explosions during military combat can initially cause mild traumatic brain injury (TBI), which may lead to later development of neurodegenerative disorders like chronic traumatic encephalopathy and Alzheimer’s disease.”(Brain, 2017)
Over time there have been numerous treatments developed for traumatic brain injury. Some treatments aren’t physical and consist of cognitive behavioral therapy, anger management, and other rehabilitation. TBI patients may might see speech therapists or a neuropsychologist. For physical things like motor skills they may be treated by a physical therapist or occupational therapist to regain strength and relearn everyday tasks if needed. “How much and what rehabilitation therapy the person with brain injury receives depends on factors such as level of awareness, other injuries such as fractures, the need for rest, and the ability to participate in therapy.”(Acorn & Offer 1998)
Medicine given to a patient with trauma to the brain is dependent on the severity of the injury and specific to each case. Some of the medicines usually given to more severe cases are coma-inducing drugs, anti-seizure drugs, or diuretics. In some cases a coma- inducing drug is necessary. According to mayoclinic.org, “…a comatose brain needs less oxygen to function. This is especially helpful if blood vessels, compressed by increased pressure in the brain, are unable to deliver the usual amount of nutrients and oxygen to brain cells.”("Traumatic brain injury" 2014) Anti-seizure medications are given due to the fact that seizures are more common during the first week after a traumatic brain injury, and may cause more trauma to the brain than initially. Diuretics are given to reduce pressure inside the brain and the amount of fluid in tissues.
Numerous surgeries have been developed for people with a TBI. One option is to open a window in the skull, perhaps the most common procedure. This is to reduce swelling and pressure in the brain by draining accumulated cerebral spinal fluid. If a patient has a severe skull fracture it may be necessary to repair it or remove a piece of the skull. Another surgery involves removing hematomas, or blood clots. This surgery is necessary in a lot of cases because of bleeding inside or outside of the brain.
Scientists are still working to uncover more treatments for severe TBI. However, modern medicine has enabled many patients with severe brain injury to make long strides in the recovery process. Some cases have seen full recovery and some severe cases never fully recover. With developments in science and the medical field growing rapidly, one day in the future it is expected to have a cure for every traumatic brain injury, even the most severe. Bibliography
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