General Medical Issues
Dear Pat, my dad told me that my cousin has a brain injury. I am very nervous because my dad said she may get a tumor. What should I do?
Brain tumors make everyone nervous, especially because tumors can appear in otherwise healthy, young individuals. There are many possible causes for a brain tumor, such as cancer, but sometimes the cause cannot be determined. If your cousin is at-risk for a brain tumor, for whatever reason, she should be evaluated by a neurologist regularly to monitor her health. This is the best way to "watch" for tumor growth and initiate prompt treatment if it becomes necessary. Pat’s advice to you is to find out as much as you can about brain tumors, so that you know what your cousin and family are dealing with. Look at the links on this site, investigate information at a medical library, look through medical journals at a university library. The more educated you are about brain tumors, the better able you will be to support your cousin, and the less frightening this will seem.
The more one knows about anything, the more empowered one is (except when it comes to Pat, in which case the less one knows about Pat, the better).
Why would a neuropsychologist recommend Ritalin to a person with a traumatic brain injury? Can a brain injury cause Attention Deficit Disorder (ADD)?
This question presents Pat an interesting opportunity to reveal some very personal information to the audience. Pat is NOT a neuropsychologist. Pat recommends that you consult a neuropsychiatrist for the following reasons:
* A neuropsychiatrist is a Medical Doctor (M.D.) and can prescribe medicines; a neuropsychologist cannot.
* A neuropsychiatrist specializes in neurological dysfunction/brain injury treatment; a psychiatrist does not necessarily have this specialty.
* A neuropsychiatrist can work effectively with a neuropsychologist and other professionals to determine whether the brain injury possibly caused the ADD. There can be a link between brain injury and behavioral, emotional, and psychiatric conditions such as ADD. See the FAQ’s on this site for more information.
Our son suffered a serious TBI 18 months ago. He remains very spastic in both his upper and lower extremities. He cannot walk or use his hands. What state-of-the-art approaches are being used to help patients with this problem regain normal motor function?
Recently the FDA approved a new treatment for spasticity due to brain injury or cerebral palsy called Intrathecal Baclofen Therapy. Clinical studies showed a reduction in spasticity and improvements in functioning (e.g., self-care). Intrathecal Baclofen Therapy involves the implantation of a pump and catheter which dispense a liquid form of baclofen to the spinal cord area. The pump can be refilled through the skin by a medical professional, such as a nurse. This type of therapy is more potent than oral medications, without the undesirable side effects. Results of Intrathecal Baclofen Therapy vary, but in many patients the therapy successfully controlled spasticity, completely replacing other less effective treatments on a long-term basis. For more information on Intrathecal Baclofen Therapy, talk with your doctor.
(Information from "FDA Approves New Treatment for Spasticity in TBI Patients." by Greg Marlin of Medtronic Neurological, Inc. 1996.)
My wife had a postpartum hemorrhage and is in a rehabilitation hospital now. She suffers from lack of oxygen to the brain. Can we classify her as a TBI patient? How can I get more information about her illness and the treatment needed?
Brain injury can include any event which causes bruising, swelling, bleeding, tearing to brain tissue/cells, nerves .... This includes a blow to the head, gunshot, stroke, aneurysm, tumor, and hemorrhage. Lack of oxygen to the brain is called hypoxia (diminished oxygen) or anoxia (complete lack of oxygen). In brain injury, the tissue which is damaged may repair itself (just as a bruised knee eventually gets better). There is debate as to whether nerves can repair themselves. Even if nerve regeneration occurs, the nerves are not the same as pre-injury, so functioning is impaired. In anoxia, brain cells die and do not recover. It sounds like you need to get very clear information on your wife's diagnosis and then consider pursuing information through the Internet and the nearest university library.
Hi Pat, I was in an automobile accident in 1983. I sustained a concussion and was in and out of consciousness for the first 3 to 4 days. The doctors at the time showed no real concern. In 1997, after experiencing severe headaches, I was diagnosed with Chiari I malformation and Hydrocephalus. After having 2 separate surgeries to correct the conditions, I still experience the same symptoms. My question is: Is it possible that the Chiari was triggered by the head injury I sustained over 16 years ago? Since being diagnosed I have done a lot of research, and there does seem to be evidence that any "head injury" may be a contributing factor. Any feedback would be greatly appreciated. God Bless you Pat.
It certainly sounds like a complicated case! The Chiari malformation (Also known as Arnold Chiari Malformation) is an anomaly in which the brainstem and cerebellum protrude into the spinal canal. It is congenital (meaning people are born with it). I am unaware of any cases that resulted from injury. It can also be associated with other anomalies such as syringomyelia, spina bifida, and hydrocephalus. Many people experience symptoms beginning in infancy, but in other cases there may not be symptoms until adolescence or adulthood. Symptoms can include vomiting, muscle weakness, problems with arm and leg movements, or cognitive difficulties.
Hydrocephalus is an accumulation of cerebrospinal fluid (CSF) in the ventricles in the brain. CSF helps to protect your brain and spinal cord against injury, contains nutrients for your brain, and carries waste products away from surrounding tissues. When CSF is not absorbed as fast as it is produced, it can build up causing the ventricles to enlarge and the pressure inside the head to increase. In your case, hydrocephalus may be associated with the Chiari malformation, although some types of brain injury can cause it as well.
As for your symptoms, it is hard to distinguish what extent your injuries may have contributed to your present symptoms. Although most people recover fully from concussion injuries, there are some people who experience permanent problems. I’m not clear from your question if you have experienced symptoms over the 16 years since your injury or if your symptoms began with your 1997 headaches. If you were not having problems prior to 1997, I would suspect that symptoms are likely unrelated to your concussion 16 years ago since constant or severe headaches are common symptoms of both Chiari malformation and hydrocephalus. There is really no way to know for sure if your brain injury contributed or not.
Also, while surgery is often successful in alleviating symptoms of Chiari malformation, surveys of patient outcomes following surgery show that about 66-80% show improvement. However, that means that up to a third of people following surgery may have continuing symptoms or even deterioration. There is still a lot to be understood about Chiari malformation. It is extremely important that you continue to be followed by physicians who can track your progress. Sometimes hydrocephalus recurs. Please talk to your physician, neurologist, or neuropsychologist about your symptoms and concerns.
I have a cousin that just had an accident that resulted in a brain injury. They discovered in doing x-rays that he has calcium deposits, which the doctor said it was not caused by current trauma-is this to be concerned with? What causes calcium deposits in the brain? Can it be reversed? I have been searching for answers on the web for 2 days and have not found anything. Can you help or lead me in the right direction for answers? Thanks.
Pat has a cousin who’s kind of hardheaded. I wonder if… No, actually calcification of the brain can occur from several problems. Most calcium that enters the body is deposited in bones and teeth. Sometimes, calcification can occur through aging. Calcification of the pineal gland for example, sometimes necessitates surgical removal. In other cases, calcification can occur because of brain cancer, vascular problems in the brain, some forms of infection (such as tuberculosis or toxoplasmosis), or a number of other metabolic disorders or problems with the kidneys. As for reversing the disorder, there are some techniques used for removing excess calcium deposits from tissues and joints – some involving diet, others involving medication. Your cousin’s physician should be consulted about treatment issues.
My Cousin was 28 years old when she was thrown from a car in an accident and suffered a brain stem injury. She was not expected to live. Yet, she made an almost complete recovery. We were rather happy about here recovery, when she began to fall down a lot. My aunt went with her to the hospital to do some tests, and they discovered numerous brain tumors. They were cancerous, and she has been undergoing chemotherapy for a while now. My whole family has been wondering whether or not the tumors were caused by the accident that happened almost 18 months prior.
Unless your cousin’s accident involved colliding with a truck carrying radioactive waste these are likely two independent events. Pat knows of absolutely no evidence that injury to the brain can later cause cancer in the brain - anymore than breaking a bone will cause cancer in the bone. Of course, anything is possible. However, as in most cases with cancer, there will likely be no way to trace it to a single "cause". Many things increase one’s chances of getting cancer and there are more likely suspects than brain injury. Genetic vulnerability and exposure to cancer causing agents in the environment are two big ones. Keep in mind that at this point, finding out what "caused" the cancer won’t help your cousin. What is important is giving her love and support so she can fight the cancer and hopefully win the battle.
My nephew sustained a severe brain injury three weeks ago. It seemed as if he was recovering but this has stopped. At the same time, he continually spikes high fevers. Could these fevers be deteriorating his recovery?
Fevers are the body’s way to fight infection. Talk to your nephew’s physicians about the source of the infections or if there is some other reason he has a fever. Infections can occur after a serious injury because the body’s immune system is weakened, or because bacteria enters the body through an open wound. Only three weeks after a severe brain injury is really too early to evaluate recovery. Ups and downs often occur. Keep supporting your nephew and remain optimistic. Don’t be shy about asking his doctors questions. They have the best understanding of his current medical situation and prognosis.
Do you know of any resources available for obtaining a specialized wheelchair for a low-level brain injured patient with no access to financial resources?
Finding money for specialized equipment is often very difficult. Wheelchairs often range from around $1000 for a basic model to more than $10,000 for more specialized power models. There are a few options for financial assistance that you might explore. First, carefully check the patient’s insurance policy. Some policies pay for necessary medical equipment such as wheelchairs or other specialized healthcare equipment. Contact your state’s Department of Rehabilitation Services to find out if your state offers financial assistance for such situations. If that is not an option - churches, community groups (Rotary or Kiwanis clubs) or other charities may be willing to help you raise money. Often, people are willing to help if you just ask! If other people have suggestions that Pat hasn’t thought of, send your ideas!
It seems like most of your questions are related to severe head injuries. What about the minor ones? I’ve had a headache daily now for over 4 months since being injured. Any advice?
If I had a daily headache for four months, I wouldn’t call that minor! First, you need to talk to your physicians about your headache. They may be able to recommend some medications to cope with the headache. You may also want to consider behavioral techniques such as relaxation training or biofeedback to help you cope with pain. Other things I would advise include avoidance of high stress situations and getting plenty of sleep each night. Stress and insufficient sleep can both limit recovery after a brain injury. Consult with a physiatrist, neuropsychologist or pain management specialist (or all three) to get a better sense for your specific prognosis!
I am a 29-year-old who has suffered several concussions.
1. Bicycle accident at age 6
2. Fall and blow at age 8
3. Fall and blow at age 10
4. Car accident at age 19
5. Car accident at age 28
6. Hockey accident at age 29
The first one resulted in stitches and the 6th one with a loss of memory of the day it happened. I have had headaches for several years and then they went away. The last car accident restarted them. I am now seeing a psychiatrist that is helping me deal with my emotional difficulties such as memory, anger and social skills. I am on a diet that includes fatty acids to help heal my brain. Am I going about things correctly or should I be doing more? After the last accident my wife left me due to my behavior. Thanks for the information as it is helping me understand me.
Are you Evel Knievel's long lost son? Seriously, I don’t know if you’re just unlucky or if you have tended to be someone who is impulsive or likes risks. The fact that you were injured playing hockey, after all of your other injuries, suggests that you probably like excitement and physical activity. However, in choosing your activities, it is important to understand that having multiple brain injuries is a serious problem. If you pay attention to sports, you know this has become a major issue among professional football players. Many ex-players now talk about the serious problems they have experienced after their football careers because of multiple concussions. Certainly, you should remain as physically active as possible, but you might want to choose sports and activities with less chance of head injury. Also, be sure to drive carefully and defensively. Otherwise, it sounds like you are working hard to understand the effects the injuries have had on your behavior, and to move forward with your life. I’m certainly sorry to hear about your marriage and hope you will find happiness with someone in the future. Please continue working with your psychiatrist as it sounds like it is really helping you. Consider contacting the Brain Injury Association and locating a brain injury support group. Talking to other survivors is often very helpful. You’re to be commended for working very hard at recovery, and I suspect things will continue to improve with time.
My mother had a seizure, and was found to have a large mass last month. An MRI was not helpful because the swelling was so great, they cannot see what is inside. She doesn't have insurance, so she was sent home from the hospital and ordered another MRI three weeks later. The swelling had remained the same, but with a new pocket in a new location. She has an appointment to see a neurosurgeon next month. No angiogram was done, and besides the MRIs she has not seen a doctor since being released from the hospital. Worse, her doctor does not return our calls when we have concerns. I am concerned that she is not getting proper care because of her lack of insurance. She was in a car accident in October, and it is possible that this is a related injury from that incident. What will happen to my mom if this swelling continues to increase? Are there other diagnostic tests to see what it could be? I am afraid for her, and I don't think this case is being treated with the appropriate urgency. Am I overreacting, or is this normal for brain injuries?
The person with the most information about your mother is her doctor. Pat certainly can't comment on the specifics of your case. If your mother has a "mass" (often a tumor or growth), a few weeks may not make much difference to her physical health. In fact, sometimes "growths" are evaluated over a period of months to see if they are growing or not. Also, if it is a growth, it is unlikely to be associated with her accident. My advice is to wait and see what the neurosurgeon says. Carefully monitor your mother, and if you see any further seizures or witness changes in her behavior (such as disorientation or confusion), take her to the Emergency Room.
As for returning your phone calls, doctors should always communicate with patients and family members. However, remember that medical information is confidential and is not to be released to anyone but the patient. Some doctors follow this more strictly than others, and laws may vary from state-to-state. However, if the doctor is not returning calls or providing adequate explanation of your mother's condition to her - then change doctors. It is essential that patients feel comfortable with their physicians and physicians have a clear responsibility to keep patients fully informed of their medical condition.