It’s estimated that hundreds of thousands of Americans are exposed to potentially serious brain injuries every year; they often don’t know it nor do their doctors. It’s shocking that this state of affairs continues to be possible, given the level of attention that is continually paid in the media to the consequences and causes of head injuries. “Concussion” is even the title and subject of a major motion picture, another flash point for public and clinical discussion and debate on what to do to properly address the problem.

Much of the discourse regarding head injuries in recent years centers on football players and combat troops – and rightly so. Putting U.S. troops in harm’s way in Iraq and Afghanistan has left hundreds of thousands of America’s finest with permanent and debilitating effects of head injuries. Yet, in many of those cases, the shock waves our soldiers have been exposed to have resulted in microscopic damage that’s been hard or often impossible for medical professionals to detect. In 2015, a Johns Hopkins-led research team studying the autopsies of combat veterans who survived IEDs and later died of other causes reveal a distinct pattern of injuries in parts of the brain involved in decision making, memory, reasoning and other decision-making functions. Exactly how many combat veterans are impaired in these areas is hard to measure. Many never seek treatment or are misdiagnosed.

Complicating the problem is the fact that no two brain injuries are exactly the same. Combat injuries are different from the football concussions in which blows to the head damage the brain’s electrical wiring. A pattern that seems common to both is that, even with all the attention being given to head injuries to football players, its unknown exactly how many players end up with permanent debilitating symptoms because of head injuries. Not everyone who hits their head repeatedly develops brain disease. Still, common sense tells us that it is better for athletes to absorb fewer knocks to the head. Health professionals presently have no way of identifying people at a higher risk of developing brain disease from such contact.

The danger of repeated jolts to the head now receiving the most attention is the connection to a degenerative brain disease called chronic traumatic encephalopathy. Now commonly referred to as CTE, it is a degenerative brain disease similar to Alzheimer’s, but unique in its association with those with a history of repetitive hits to the head – such as NFL football stars Junior Seau, Dave Duerson and, most recently, Frank Gifford. All were found to have CTE during autopsy following their death, which is the only way to currently diagnose the disease.

In an effort to find a way to early diagnosis that might lead to treatments, the federal government recently announced that nearly $16 million will be earmarked to diagnose in living patients.

It’s clear that there is much that needs to be learned.

Not to be lost in all of this attention on CTE is the fact that researchers estimate that hundreds of thousands of ordinary people in the U.S. – from adults to infants – get potentially serious brain injuries every year as well.

Research is showing that a simple bump on the head, or the act of starting to fall and then catching yourself (where your head doesn’t strike anything, but it jerks in the air) can be enough force to jostle your brain and cause what is known as a subdural hematoma. The main population at risk for a subdural hematoma is the elderly.

Studies suggest that as you get older, especially in your 60s or 70s, your brain shrinks, which causes the veins to stretch and become more vulnerable to tearing. This could make you more susceptible to a tear caused by a sudden bump or jostle of the head, leading to bleeding into the space between the dura, which covers the brain, and the brain itself. The accumulation of blood can press on the brain and damage it, much like a tumor. This event can often go unnoticed, sometimes for weeks. When they do cause problems, the incident that caused the bleeding is often long forgotten.

Symptoms of subdural hematoma can include increasing daily headaches, fluctuating drowsiness or confusion, and mild weakness on one side of the body. Consult a physician as soon as possible if you have these symptoms and they persist following some event to your head. Also know that most people who get a subdural hematoma never know it. The brain reabsorbs the blood, the victim’s symptoms disappear, and life will go on as normal. Yet, for tens of thousands of others, it can be a serious life-threatening condition.

Subdural hematomas are also found in infants. Head trauma is the leading cause of death in child abuse cases in the United States. It is 100 percent preventable. The National Center on Shaken Baby Syndrome estimates that there are as many as 16 to 33 cases of shaken baby syndrome per 100,000 children a year in the U.S. for children in the first two years of life. Even in milder cases, in which babies look normal immediately after the shaking, there is a possibility of irreversible damage later in life.

Let’s hope that the heat does not let up on the important issue of brain injury and disease, and that it is explored in the broadest extent possible.

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© 2012 Christian King

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