|
Further Medical Problems After a Brain Injury - Fact Sheet
 In addition to the commonly encountered medical problems following a brain injury,
there are other less customary ones which vigilant families may be able to
detect.
Few in this era of cost containment will
receive long-term rehabilitation services. Families often become the primary
caregivers and need to be alert to various problems and changes that may
indicate the need for re-evaluation or follow-up treatment. When the brain is
damaged some conditions are readily apparent, such as  Coma, loss of speech or
motor function. Many other areas - less visibly obvious - are adversely
affected and may cause difficulty. Often the individual lacks sufficient
communication skills to adequately describe problems and alert the treatment
team or family. Additionally, impaired self-awareness may prevent the
individual from realising there is a problem. Problems developing after the
individual is home and no longer involved in medical or rehabilitation settings
may not be as readily recognised as a result of brain injury, and valuable
treatment time can be lost if caregivers are unaware of some possible medical
consequences of brain injury.
HO is abnormal bone growth within soft
tissue at selected joints, most commonly in the hips, shoulders, knees and
elbows. It occurs when stem cells within the soft tissue are incorrectly
triggered to start producing bone. It usually occurs within the first nine
months after injury and is most often discovered by the physical therapist when
limited or painful range of motion is seen. However, HO is frequently spotted
first by family members who notice swollen or reddish joints or expressions of
pain upon being moved.
In general, once HO is confirmed through
clinical observation and lab tests, medication is started to retard or slow the
growth of the excess bone. There is some recent evidence suggesting that HO can
occur as the individual with brain injury ages. This, along with changes in
musculoskeletal system problems, such as various forms of arthritis,
osteoporosis, and worsening Spasticity (involuntary muscle stiffness) and
dystonias (muscle problems causing movement disorders) warns of future problems
that must be addressed.
Hearing Loss
Hearing problems can occur for a number of
reasons, particularly when the inner ear and/or Temporal Lobes have been
damaged. In a traumatic injury the mechanisms of the inner ear may be damaged,
or any injury to the brain may include the nerve pathways from the ear, or the
regions of the brain responsible for processing sound.
All patients should have an otoscopic
examination and hearing screening followed by behavioural testing. External
bleeding in the ear canal, middle ear damage, cochlear injury, and/or temporal
lobe lesions can cause auditory dysfunction.
Owing to the role of the ear in balance,
balance and movement disorders may also occur in people who have impaired
hearing following a brain injury.
Visual System Changes
Vision and visual functioning is often
impaired following a brain injury. Violent blows to the head can tear the optic
nerves running from the eyes to the brain or damage the eyes themselves, and
the position of the occipital lobe at the very rear of the brain makes it
particularly vulnerable to damage in motor vehicle accidents or assaults. In
addition to this, the hospital environment and certain surgical procedures mean
that an infection in the eyes is more likely to develop.
The results of an untreated infection of
this nature may cause corneal ulcers and other undesirable problems related to
the eye. Families who remain vigilant at the bedside are often the first to
notice changes in the eyes, such as redness, watering and other signs of a
problem. A consultation is usually arranged with an ophthalmologist and with
treatment the infection can be brought under control.
Occupational therapists evaluate visual perceptual
functioning and teach methods for compensating for any perceptual deficits. In
addition, it is important that visual processing and visuomotor ability be
evaluated. Some of the more common visual systems problems include double
vision, field cuts, sector losses, rapid eye movement and near-sightedness. More
complicated problems such as being unable to recognise objects (Agnosia) or
even specific classes of objects (such as prosopagnosia: The inability to
recognise faces) may also occur.
Due to the eye’s role in informing the
brain about the world, clumsiness and other physical problems, including
balance disorders and dizziness, can also occur as a result of visual systems
changes.
Neuroendocrine Disorders
The Endocrine system refers to
communication within the body using hormones made by endocrine glands such as
the Hypothalamus, pituitary gland, pineal gland, thyroid, parathyroids, and
adrenal glands
The Nervous system refers to the neural
collecting, transferring and processing of information between the brain, spinal
cord, peripheral nerves, and nerves
The neuroendocrine system refers to the
combined workings of these two systems. In other words, “neuroendocrine” covers
communication within the body and, therefore, regulation of internal body
systems.
At this time, there is very little
substantive research information about your risk of developing other medical
problems as you age with a brain injury. However research suggests that chronic
neuroendocrine difficulties are occurring in women some years post injury.
Five or more years post the injury, women
with a brain injury have reported experiencing problems such as weight gain,
thyroid disorders, and changes in hair and skin texture and perceived body
temperature changes. Other symptoms included chronic sleep disturbances,
difficulty controlling blood pressure, a reduction in levels of immunity to
infections and arthritic complaints. Damage in the hypothalamus, limbic system
and pituitary may play a role in these disturbances.
Treatment for these disorders is usually
topical, involving hormone replacement therapy to balance the hormones that the
body is no longer producing in the appropriate quantities.
Diabetes Insipidus
Diabetes insipidus is not to be confused
with diabetes mellitus, which is the proper name for the condition widely referred
to as simply “diabetes”. Diabetes mellitus is characterised by inappropriate
blood sugar levels, which are regulated by the hormone insulin which is
produced by the pancreas.
Diabetes insipidus is characterised by excessive
urination and extreme thirst and involves the action of antidiuretic hormones
on the kidneys. Diabetes Insipidus caused by a lack of ADH (antidiuretic
hormone, also known as vasopressin) is called central diabetes insipidus. When diabetes
insipidus is caused by failure of the kidneys to respond to ADH, the condition
is called nephrogenic diabetes insipidus.
Central diabetes insipidus is caused by
damage to the hypothalamus or pituitary gland as a result of surgery, infection,
tumour, or head injury – potentially, any cause of a brain injury.
Because the cause of this form of diabetes
insipidus is a lack of antidiuretic hormone (ADH), treatment is usually with a
synthetic hormone called desmopressin.
If treated, diabetes insipidus does not
cause severe problems or reduce life expectancy. If not treated, the symptoms
are the same as for other forms of diabetes and can include blindness, heart
disease and peripheral neuropathy. If diabetes insipidus is severe, the
constant flushing of water through the body flushes out sodium, which is
required for nerves to function, and in extreme cases can result in a heart
attack.
Swelling
of the brain or Cerebral Oedema is a common result of trauma or injury to the
brain. Most tissues in the body swell when traumatized.
They also require more oxygen to heal. There are some special things about the
brain:
- It rests inside a bone case, so when it swells, it experiences more
trauma;
- The more damage the brain receives the more oxygen it needs and the
more it swells.
This swelling
within the skull results in raised intracranial pressure which can, in addition
to causing even more brain damage, result in Hydrocephalus.
Hydrocephalus
Hydrocephalus is a term derived from the
Greek words "hydro" meaning water, and "cephalus" meaning
head.
Hydrocephalus is commonly known as
"water on the brain", although this is not accurate. A watery fluid,
known as cerebrospinal fluid or CSF for short, is produced constantly inside
each of the four cavities or Ventricles inside the brain. The CSF normally
flows through narrow pathways from one ventricle to the next, then out over the
outside of the brain and down the spinal cord. The CSF is absorbed into the
bloodstream and the amount and pressure are normally kept within a fairly
narrow range. If the drainage pathways are obstructed at any point, the fluid
accumulates in the ventricles inside the brain, causing them to swell -
resulting in compression of surrounding tissue. In babies and infants, the head
will enlarge. In older children and adults, the head size cannot increase as
the bones, that form the skull, are completely joined together.
The most common way of treating
hydrocephalus is by way of shunting. A Shunt is a small pump connected to the
ventricular system of the brain and then via a flexible tube diverts the
Cerebrospinal fluid into another part of the body, usually the abdominal cavity
or a chamber of the heart, where it can be absorbed. A pump (or valve)
maintains the CSF at normal pressure within the ventricles.
These shunts are, unfortunately prone to
blockages and infections. The shunt failure rate is relatively high and it is
not uncommon for patients to have multiple shunt revisions within their
lifetime. By 2-3 years of age, approximately half of shunts that have been
inserted have failed and been replaced.
A Seizure is a temporary abnormal
electro-physiologic phenomenon of the brain, resulting in abnormal synchronization
of electrical neuronal activity. It can manifest as an alteration in mental
state, tonic or clonic movements, convulsions, and various other psychic
symptoms (such as déjà vu – the feeling than an unfamiliar experience has
occurred before – or jamais vu – the feeling that a familiar experience has
never occurred before) It is caused by a temporary abnormal electrical activity
of a group of brain cells. The medical syndrome of recurrent, unprovoked
seizures is termed epilepsy, but some seizures may occur in people who do not
have epilepsy.
According to American studies, a quarter of
all people with moderate to severe brain injury will develop epilepsy.
The following fact sheets at www.braininjury.org.au discuss
epilepsy in more depth
|
Further medical problems 
