Brain damage

Neurotrauma, brain damage or brain injury (BI) is the

destruction or degeneration of brain cells. Brain injuries
Brain damage
occur due to a wide range of internal and external factors.
In general, brain damage refers to significant,
undiscriminating trauma-induced damage, while
neurotoxicity typically refers to selective, chemically
induced neuron damage.

A common category with the greatest number of injuries is

traumatic brain injury (TBI) following physical trauma or
head injury from an outside source, and the term acquired
brain injury (ABI) is used in appropriate circles to
differentiate brain injuries occurring after birth from injury,
from a genetic disorder, or from a congenital disorder.[1]
Primary and secondary brain injuries identify the processes
involved, while focal and diffuse brain injury describe the
severity and localization.

Recent research has demonstrated that neuroplasticity,

which allows the brain to reorganize itself by forming new
neural connections throughout life, provides for
rearrangement of its workings. This allows the brain to
compensate for injury and disease. A CT of the head years after a traumatic brain
injury showing an empty space where the
damage occurred, marked by the arrow.
Contents
Signs and symptoms
Mild brain injuries
Moderate/severe brain injuries
Symptoms in children
Location of brain damage predicts symptoms
Non-localizing features
Long term psychological and physiological
effects
Body's response to brain injury
Causes
Chemotherapy
Wernicke-Korsakoff Syndrome
Iatrogenic
Diffuse axonal
Diagnosis
Management
Acute
 Chronic
Prognosis
History
See also
References
Further reading
External links

Signs and symptoms

Symptoms of brain injuries vary based on the severity of the injury or how much of the brain is affected. The
three categories used for classifying the severity of brain injuries are mild, moderate or severe.[2]

Mild brain injuries

Symptoms of a mild brain injury include headaches, confusions, tinnitus, fatigue, changes in sleep patterns,
mood or behavior. Other symptoms include trouble with memory, concentration, attention or thinking.[3]
Mental fatigue is a common debilitating experience and may not be linked by the patient to the original (minor)
incident. Narcolepsy and sleep disorders are common misdiagnoses.[4]

Moderate/severe brain injuries

Cognitive symptoms include confusion, aggressiveness, abnormal behavior, slurred speech, and coma or other
disorders of consciousness. Physical symptoms include headaches that worsen or do not go away, vomiting or
nausea, convulsions, abnormal dilation of the eyes, inability to awaken from sleep, weakness in extremities
and loss of coordination.[3]

Symptoms in children

Symptoms observed in children include changes in eating habits, persistent irritability or sadness, changes in
attention, disrupted sleeping habits, or loss of interest in toys.[3]

Location of brain damage predicts symptoms

Symptoms of brain injuries can also be influenced by the location of the injury and as a result impairments are
specific to the part of the brain affected. Lesion size is correlated with severity, recovery, and
comprehension.[5] Brain injuries often create impairment or disability that can vary greatly in severity.

In cases of severe brain injuries, the likelihood of areas with permanent disability is great, including
neurocognitive deficits, delusions (often, to be specific, monothematic delusions), speech or movement
problems, and intellectual disability. There may also be personality changes. The most severe cases result in
coma or even persistent vegetative state. Even a mild incident can have long-term effects or cause symptoms to
appear years later.[6]
Studies show there is a correlation between brain lesion and language, speech, and category-specific disorders.
Wernicke's aphasia is associated with anomia, unknowingly making up words (neologisms), and problems
with comprehension. The symptoms of Wernicke’s aphasia are caused by damage to the posterior section of
the superior temporal gyrus.[7][8]

Damage to the Broca’s area typically produces symptoms like omitting functional words (agrammatism),
sound production changes, dyslexia, dysgraphia, and problems with comprehension and production. Broca’s
aphasia is indicative of damage to the posterior inferior frontal gyrus of the brain.[9]

An impairment following damage to a region of the brain does not necessarily imply that the damaged area is
wholly responsible for the cognitive process which is impaired, however. For example, in pure alexia, the
ability to read is destroyed by a lesion damaging both the left visual field and the connection between the right
visual field and the language areas (Broca's area and Wernicke's area). However, this does not mean one
suffering from pure alexia is incapable of comprehending speech—merely that there is no connection between
their working visual cortex and language areas—as is demonstrated by the fact that pure alexics can still write,
speak, and even transcribe letters without understanding their meaning.[10]

Lesions to the fusiform gyrus often result in prosopagnosia, the inability to distinguish faces and other complex
objects from each other.[11] Lesions in the amygdala would eliminate the enhanced activation seen in occipital
and fusiform visual areas in response to fear with the area intact. Amygdala lesions change the functional
pattern of activation to emotional stimuli in regions that are distant from the amygdala.[12]

Other lesions to the visual cortex have different effects depending on the location of the damage. Lesions to
V1, for example, can cause blindsight in different areas of the brain depending on the size of the lesion and
location relative to the calcarine fissure.[13] Lesions to V4 can cause color-blindness,[14] and bilateral lesions
to MT/V5 can cause the loss of the ability to perceive motion. Lesions to the parietal lobes may result in
agnosia, an inability to recognize complex objects, smells, or shapes, or amorphosynthesis, a loss of perception
on the opposite side of the body.[15]

Non-localizing features

Brain injuries have far-reaching and varied consequences due to the nature of the brain as the main source of
bodily control. Brain-injured people commonly experience issues with memory.[16] This can be issues with
either long or short-term memories depending on the location and severity of the injury. Sometimes memory
can be improved through rehabilitation, although it can be permanent. Behavioral and personality changes are
also commonly observed due to changes of the brain structure in areas controlling hormones or major
emotions. Headaches and pain can also occur as a result of a brain injury either directly from the damage or
due to neurological conditions stemming from the injury. Due to the changes in the brain as well as the issues
associated with the change in physical and mental capacity, depression and low self-esteem are common side
effects that can be treated with psychological help. Antidepressants must be used with caution in brain injury
people due to the potential for undesired effects because of the already altered brain chemistry.

Long term psychological and physiological effects

There are multiple responses of the body to brain injury, occurring at different times after the initial occurrence
of damage, as the functions of the neurons, nerve tracts, or sections of the brain can be affected by damage.
The immediate response can take many forms. Initially, there may be symptoms such as swelling, pain,
bruising, or loss of consciousness.[17] Post-traumatic amnesia is also common with brain damage, as is
temporary aphasia, or impairment of language.[18]
As time progresses, and the severity of injury becomes clear, there are further responses that may become
apparent. Due to loss of blood flow or damaged tissue, sustained during the injury, amnesia and aphasia may
become permanent, and apraxia has been documented in patients. Amnesia is a condition in which a person is
unable to remember things.[19] Aphasia is the loss or impairment of word comprehension or use. Apraxia is a
motor disorder caused by damage to the brain, and may be more common in those who have been left brain
damaged, with loss of mechanical knowledge critical.[20] Headaches, occasional dizziness, and fatigue—all
temporary symptoms of brain trauma—may become permanent, or may not disappear for a long time.

There are documented cases of lasting psychological effects as well, such as emotional swings often caused by
damage to the various parts of the brain that control human emotions and behavior.[21] Some who have
experienced emotional changes related to brain damage may have emotions that come very quickly and are
very intense, but have very little lasting effect.[21] Emotional changes may not be triggered by a specific event,
and can be a cause of stress to the injured party and their family or friends.[22] Often, counseling is suggested
for those who experience this effect after their injury, and may be available as an individual or group session.

It is important to note that the long term psychological and physiological effects will vary by person and injury.
For example, perinatal brain damage has been implicated in cases of neurodevelopmental impairments and
psychiatric illnesses. If any concerning symptoms, signs, or changes to behaviors are occurring, a healthcare
provider should be consulted.

Body's response to brain injury

Unlike some of the more obvious responses to brain damage, the body also has invisible physical responses
which can be difficult to notice. These will generally be identified by a healthcare provider, especially as they
are normal physical responses to brain damage. Cytokines are known to be induced in response to brain
injury.[23] These have diverse actions that can cause, exacerbate, mediate and/or inhibit cellular injury and
repair. TGFβ seems to exert primarily neuroprotective actions, whereas TNFα might contribute to neuronal
injury and exert protective effects. IL-1 mediates ischaemic, excitotoxic, and traumatic brain injury, probably
through multiple actions on glia, neurons, and the vasculature. Cytokines may be useful in order to discover
novel therapeutic strategies. At the current time, they are already in clinical trials.[24]

Causes
Brain injuries can result from a number of conditions including:[25]

trauma; multiple traumatic injuries can lead to chronic

traumatic encephalopathy. A coup-contrecoup injury
occurs when the force impacting the head is not only
strong enough to cause a contusion at the site of
impact, but also able to move the brain and cause it to
displace rapidly into the opposite side of the skull,
causing an additional contusion.
open head injury
A Coup injury occurs under the site of
closed head injury
impact with an object, and a contrecoup
penetrating: when a sharp object enters the brain, injury occurs on the side opposite the
causing a large damage area. Penetrating injuries area that was hit.
caused by bullets have a 91 percent mortality rate
deceleration injuries
poisoning; for example, from heavy metals including mercury and compounds of lead
hypoxia, including birth hypoxia,[26]
 tumors
infections
stroke leading to infarct, which may follow thrombosis, embolisms, angiomas, aneurysms, and
cerebral arteriosclerosis.[27]
neurological illness or disorders
surgery
drug abuse
neurotoxins- pollution exposure or biological exposure (Annonaceae, rotenone,[28] Aspergillus
spores, West Nile Disease, Viral meningitis).

Chemotherapy

Chemotherapy can cause brain damage to the neural stem cells and oligodendrocyte cells that produce myelin.
Radiation and chemotherapy can lead to brain tissue damage by disrupting or stopping blood flow to the
affected areas of the brain. This damage can cause long term effects such as but not limited to; memory loss,
confusion, and loss of cognitive function. The brain damage caused by radiation depends on where the brain
tumor is located, the amount of radiation used, and the duration of the treatment. Radiosurgery can also lead to
tissue damage that results in about 1 in 20 patients requiring a second operation to remove the damaged
tissue.[29][30]

Wernicke-Korsakoff Syndrome

Wernicke-Korsakoff Syndrome can cause brain damage and results from a Vitamin B deficiency. This
syndrome presents with two conditions, Wernicke’s encephalopathy and Korsakoff psychosis. Typically
Wernicke’s encephalopathy precedes symptoms of Korsakoff psychosis. Wernicke’s encephalopathy causes
bleeding in the thalamus or hypothalamus, which controls the nervous and endocrine system. Due to the
bleeding, brain damage occurs causing problems with vision, coordination and balance. Korsakoff psychosis
typically follow after the symptoms of Wernicke’s decrease and result from chronic brain damage.[31]
Korsakoff psychosis affect memory. Wernicke-Korsakoff Syndrome is typically caused by chronic alcohol
abuse or by conditions that affect nutritional absorption, including colon cancer, eating disorders and gastric
bypass.[32]

Iatrogenic

Brain lesions are sometimes intentionally inflicted during neurosurgery, such as the carefully placed brain
lesion used to treat epilepsy and other brain disorders. These lesions are induced by excision or by electric
shocks (electrolytic lesions) to the exposed brain or commonly by infusion of excitotoxins to specific areas.[33]

Diffuse axonal

Diffuse axonal injury is caused by shearing forces on the brain leading to lesions in the white matter tracts of
the brain.[34] These shearing forces are seen in cases where the brain had a sharp rotational acceleration, and is
caused by the difference in density between white matter and grey matter.[35]

Diagnosis
Glasgow Coma Scale (GCS) is the most widely used scoring system used to assess the level of severity of a
brain injury. This method is based on the objective observations of specific traits to determine the severity of a
brain injury. It is based on three traits eye opening, verbal response, and motor response, gauged as described
below.[36] Based on the Glasgow Coma Scale severity is classified as follows, severe brain injuries score 3–8,
moderate brain injuries score 9–12 and mild score 13–15.[36]

There are several imaging techniques that can aid in diagnosing and assessing the extent of brain damage, such
as computed tomography (CT) scan, magnetic resonance imaging (MRI), diffusion tensor imaging (DTI)
magnetic resonance spectroscopy (MRS), positron emission tomography (PET), and single-photon emission
tomography (SPECT). CT scans and MRI are the two techniques widely used and are most effective. CT
scans can show brain bleeds, fractures of the skull, fluid build up in the brain that will lead to increased cranial
pressure. MRI is able to better to detect smaller injuries, detect damage within the brain, diffuse axonal injury,
injuries to the brainstem, posterior fossa, and subtemporal and subfrontal regions. However patients with
pacemakers, metallic implants, or other metal within their bodies are unable to have an MRI done. Typically
the other imaging techniques are not used in a clinical setting because of the cost, lack of availability.[37]

Management

Acute

The treatment for emergency traumatic brain injuries focuses on assuring the person has enough oxygen from
the brain blood supply, and on maintaining normal blood pressure to avoid further injuries of the head or neck.
The person may need surgery to remove clotted blood or repair skull fractures, for which cutting a hole in the
skull may be necessary. Medicines used for traumatic injuries are diuretics, anti-seizure or coma-inducing
drugs. Diuretics reduce the fluid in tissues lowering the pressure on the brain. In the first week after a traumatic
brain injury, a person may have a risk of seizures, which anti-seizure drugs help prevent. Coma-inducing drugs
may be used during surgery to reduce impairments and restore blood flow.

In the case of brain damage from traumatic brain injury, dexamethasone and/or Mannitol may be used. [38]

Chronic

Various professions may be involved in the medical care and rehabilitation of someone suffering impairment
after a brain injury. Neurologists, neurosurgeons, and physiatrists are physicians specialising in treating brain
injury. Neuropsychologists (especially clinical neuropsychologists) are psychologists specialising in
understanding the effects of brain injury and may be involved in assessing the severity or creating
rehabilitation strategies. Occupational therapists may be involved in running rehabilitation programs to help
restore lost function or help re-learn essential skills. Registered nurses, such as those working in hospital
intensive care units, are able to maintain the health of the severely brain-injured with constant administration of
medication and neurological monitoring, including the use of the Glasgow Coma Scale used by other health
professionals to quantify extent of orientation.[39]

Physiotherapists also play a significant role in rehabilitation after a brain injury. In the case of a traumatic brain
injury (TBIs), physiotherapy treatment during the post-acute phase may include: sensory stimulation, serial
casting and splinting, fitness and aerobic training, and functional training.[40] Sensory stimulation refers to
regaining sensory perception through the use of modalities. There is no evidence to support the efficacy of this
intervention.[41] Serial casting and splinting are often used to reduce soft tissue contractures and muscle tone.
Evidence based research reveals that serial casting can be used to increase passive range of motion (PROM)
and decrease spasticity.[41] Studies also report that fitness and aerobic training will increase cardiovascular
fitness; however the benefits will not be transferred to the functional level.[42] Functional training may also be
used to treat patients with TBIs. To date, no studies supports the efficacy of sit to stand training, arm ability
training and body weight support systems (BWS).[43][44] Overall, studies suggest that patients with TBIs who
participate in more intense rehabilitation programs will see greater benefits in functional skills.[42] More
research is required to better understand the efficacy of the treatments mentioned above.[45]

Other treatments for brain injury include medication, psychotherapy, neuropsychological rehabilitation,
snoezelen, surgery, or physical implants such as deep brain stimulation.

Prognosis
Prognosis, or the likely progress of a disorder, depends on the nature, location, and cause of the brain damage
(see Traumatic brain injury, Focal and diffuse brain injury, Primary and secondary brain injury).

In general, neuroregeneration can occur in the peripheral nervous system but is much rarer and more difficult
to assist in the central nervous system (brain or spinal cord). However, in neural development in humans, areas
of the brain can learn to compensate for other damaged areas, and may increase in size and complexity and
even change function, just as someone who loses a sense may gain increased acuity in another sense – a
process termed neuroplasticity.[46]

There are many misconceptions that revolve around brain injuries and brain damage. One misconception is
that if someone has brain damage then they cannot fully recover. Recovery depends a variety of factors; such
as severity and location. Testing is done to note severity and location. Not everyone fully heals from brain
damage, but it is possible to have a full recovery. Brain injuries are very hard to predict in outcome. Many tests
and specialists are needed to determine the likelihood of the prognosis. People with minor brain damage can
have debilitating side effects; not just severe brain damage has debilitating effects.[47] The side- effects of a
brain injury depend on location and the body’s response to injury.[47] Even a mild concussion can have long
term effects that may not resolve.[48] Another misconception is that children heal better from brain damage.
Children are at greater risk for injury due to lack of maturity. It makes future development hard to predict.[48]
This is because different cortical areas mature at different stages, with some major cell populations and their
corresponding cognitive faculties remaining unrefined until early adulthood. In the case of a child with frontal
brain injury, for example, the impact of the damage may be undetectable until that child fails to develop normal
executive functions in his or her late teens and early twenties.[49]

History
The foundation for understanding human behavior and brain injury can be attributed to the case of Phineas
Gage and the famous case studies by Paul Broca. The first case study on Phineas Gage’s head injury is one of
the most astonishing brain injuries in history. In 1848, Phineas Gage was paving way for a new railroad line
when he encountered an accidental explosion of a tamping iron straight through his frontal lobe. Gage
observed to be intellectually unaffected but exemplified post injury behavioral deficits. These deficits include:
becoming sporadic, disrespectful, extremely profane, and gave no regard for other workers. Gage started
having seizures in February, dying only four months later on May 21, 1860.[50]

Ten years later, Paul Broca examined two patients exhibiting impaired speech due to frontal lobe injuries.
Broca’s first patient lacked productive speech. He saw this as an opportunity to address language localization.
It wasn't until Leborgne, formally known as "tan", died when Broca confirmed the frontal lobe lesion from an
autopsy. The second patient had similar speech impairments, supporting his findings on language localization.
The results of both cases became a vital verification of the relationship between speech and the left cerebral
hemisphere. The affected areas are known today as Broca’s area and Broca’s Aphasia.[51]
A few years later, a German neuroscientist, Carl Wernicke, consulted on a stroke patient. The patient
experienced neither speech nor hearing impairments, but suffered from a few brain deficits. These deficits
included: lacking the ability to comprehend what was spoken to him and the words written down. After his
death, Wernicke examined his autopsy that found a lesion located in the left temporal region. This area became
known as Wernicke's area. Wernicke later hypothesized the relationship between Wernicke's area and Broca's
area, which was proven fact.[52]

See also
Cerebral palsy Neurocognitive deficit
Encephalopathy Neurology
Epilepsy Myogenesis
Fetal alcohol spectrum disorder Primary and secondary brain injury
Frontal lobe injury Rehabilitation (neuropsychology)
Head injury Synaptogenesis
Lobotomy Traumatic brain injury
Nerve injury

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Further reading
Sam Kean (2015). The Tale of the Dueling Neurosurgeons: The History of the Human Brain as
Revealed by True Stories of Trauma, Madness, and Recovery. Back Bay Books. ISBN 978-
0316182355.

External links
Brain damage (https://curlie.org/Health/Conditions_and_Dise Classification D
ases/Neurological_Disorders/Trauma_and_Injuries/Brain_Inj
ury/) at Curlie

Brain injury (https://curlie.org//Health/Conditions_and_Diseases/Neurological_Disorders/Trau

ma_and_Injuries/Brain_Injury/) at Curlie

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