Traumatic Brain Injury: A 300-Year History of Treatment - Research Paper

Introduction

Many people around the globe suffer from Traumatic brain injury, something that makes the condition a public health concern. However, traumatic brain injury has been in existence for three centuries now. For instance, during the ancient period, skulls suggest that there was the treatment of traumatic brain injury. Physicians in Greece and Mesopotamia understood that the brain is the center of thought; this is because they had treated people with head trauma. With time, technology has taken over in that evaluation of patients is done using x-ray and other computed equipment. Scientist defines traumatic brain injury like brain damage that interferes with the normal functions of a person. According to research, the brain damage is caused by a blow, bump, jolt to the head, or explosive blasts. The paper will discuss in detail and demonstrate the history of traumatic brain injury, when they were first diagnosed, how they are diagnosed, and how they affect today's athletes and military.

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History of Traumatic Brain Injury (TBI)

Traumatic brain injury was first discovered in the 16th century although it was renamed neurological condition (Omar Al Awar 1). Patients had lines of fracture on their skulls, something that forced physicians to develop treatment methods. The effects of the fractures on the patients were worse, including problems with hearing and speech, loss of sight, paralysis to mention but a few. Physicians discovered that trepanation can be used as a treatment method to reduce the symptoms. As with time, medieval surgeons continued with trepanation until when the brain injuries became widespread. In the 18th century, the effects worsened and it was again renamed as intracranial pressure (Omar Al Awar 1). Around the 19th century, the hypothesis was confirmed to be serious and another treatment method was proposed; the opening of the skull, which helped to relieve pressure (Omar Al Awar 11).

In the 1970s traumatic brain injury became a public concern due to augment deaths recorded (Omar Al Awar 1). Research about the discoveries of the problem progressed to a level where the damage was classified into primary and secondary levels. In the 1990s, protocols were introduced which could help reduce the brain pressure and reduce the effects. Moreover, drugs were also proposed to manage the condition. Since then, there was an improvement in terms of survival and reduction of the effects. However, advances continued to be made on brain damage research. The 20th century saw the emergence of science and technology something that improved treatment (Omar Al Awar 1). Surgeons could use x-rays and other imaging tools such as MRI, CT scans, and diffusion tensor imaging to observe and monitor what happens in the brain (Gray, Bruce G., et al. 52). During the 1950s, the mortality rate of traumatic brain injury high until the 20th century when new technology emerged (Omar Al Awar 1). The modern era saw improvement in care, made rehabilitation possible, and reduced the death rates. Facilities that were used to treat traumatic brain injury during ancient times were upgraded and this allowed researchers to begin learning about localization and functions of the brain parts.

Scientists can now better understand traumatic brain injury in that technology has enabled them to understand the impairment in children, adolescents, and even adults. Omar Al Awar reports that the mechanisms of traumatic brain injury are diverse in that there are injuries, which are classified as closed, open, and penetrating (4). At the same time, there are focal and diffuse brain injuries; most hospitals have patients with diffuse traumatic brain injuries. Though, there are cases of focal injuries in which patients have localized damage, particularly in the grey matter. Focal injuries are easier to detect with advanced technology due to their macroscopic nature. On the other hand, penetrating injuries occur when a foreign object such as a bullet enters the brain. It can cause damage to the localized or focal part of the brain. Closed injuries are also caused by blows or blast on the head; this at many times occurs when there are accidents or head strikes. Individuals with traumatic brain injuries have varied problems depending on the location of the injury.

History of TBI Diagnosis

Omar Al Awar asserted that traumatic brain injuries were first diagnosed during ancient times (1). The conditions were present in the ancient myths before it was even recorded in history. For instance, Edwin Smith at around 1650-1550 BC came up with writings, which described various head injuries that people experienced and how they were diagnosed (Omar Al Awar 1). The main treatment was called trepanation and it helped reduce the effects that patients experienced. Nonetheless, the presentation was classified according to the area of brain injury and tractability. A prehistoric surgery was then done although it lacked several important essentials (Omar Al Awar 2). The physicians had an understanding of anatomy, comprehension, and recognition of a brain. Many arguments have been made on trepanation because by then it effectively helped to treat headaches, correct head injuries among other things. The skills of the earlier surgeons were remarkable since many patients who were subjected to traumatic brain injuries survived after being diagnosed.

How Traumatic Brain Injuries are DiagnosedAs indicated in the previous paragraphs, traumatic brain injury can be described as a hard impact to the cerebrum by an external object that contributes to temporary or permanent damage of mental, physical, psychosocial function (National Academies of Sciences, Engineering, and Medicine n.p). TBI can be grouped as mild, moderate, or severe, depending on clinical results. A TBI diagnosis is best presented at the time of injury, or within the first 24 hours. TBI has been likened with such behavioral results as depression, anxiety, aggression, and impulse control, thus, a TBI assessment might not be deemed complete unless the clinician becomes familiar with the symptoms of Post Traumatic Stress Disorder (PTSD). Given the difficulties in clinically diagnosing TBI, a clinician needs to have broad experience with TBI, and be trained, and familiar with the state of science in order to correctly make a determination of brain injury and its extent.

When conducting the diagnostic process, a physician mainly examines the severity of TBI. Though, the preliminary evaluation of TBI extent of damage does not primarily envisage the extent of impairment emanating from Traumatic Brain Injuries (National Academies of Sciences, Engineering, and Medicine n.p). Normal methods used that clinicians can use to determine the severity of TBI early include; neuroimaging, evaluating the presence of changed perception, or loss of consciousness, examining the presence of posttraumatic amnesia, and applying the Glasgow Coma Scale score (National Academies of Sciences, Engineering, and Medicine n.p). This particular score has worked effectively in assessing trauma patients, since its inception by Teasdale, and Jennet in 1974 (National Academies of Sciences, Engineering, and Medicine n.p). The Glasgow Coma Scale is a clinical apparatus meant to examine coma, and damaged consciousness, and is one of the most often used TBI severity scoring systems (National Academies of Sciences, Engineering, and Medicine n.p). The extent of TBI might range from mild to severe. There are several structures that have been established by numerous organizations to help in defining TBI severity.

Neuroimaging of Traumatic Brain Injuries

Neuroimaging is widely used to diagnose mild, and severe TBI and the most common initial neuroimaging test used by clinicians is known as Noncontrast Computed Tomography (CT) scans of the head (Douglas et al. 2). A CT scans can reveal severe injuries, like a broadening epidural hematoma with future herniation, which needs emergency neurosurgical evacuation. Noncontrast CT scans can also examine may other types of injuries that might include; cerebral fractures, intracranial hemorrhage, contusion, and associated mass impact (Douglas et al. 2).

Traumatic brain injury can be tremendously heterogeneous, spanning in the mechanism, the extent of the injury, and location with primary, and secondary TBI patients (Douglas et al. 2). Convention imaging methods have also been used by clinicians to group the structural injury sequence in the brain. TBI can also be hemorrhagic, or non-hemorrhagic. The locations of intracranial hemorrhage can entail the epidural space, subdural space, subarachnoid space, and intraventricular space (Douglas et al. 2). In an epidural hematoma, the hematoma is found between the dura mater and the calvarium. Clinically, epidural hematomas can be linked with an articulate interval followed by clinical worsening once a critical level of intracranial pressure (ICP) is attained (Douglas et al. 2). Epidural hematomas are normally biconvex shaped often associated with skull fractures and normally arise from arterial bleeding, such as the middle meningeal artery in infants.

Neuroimaging methods can also be used to detect subdural hematoma ( a form of TBI). This kind of hematoma is found among the dura mater and the arachnoid membrane; thus, subdural hematomas can shift across calvarial sutures, and along the falx cerebri, and tentorium cerebelli (Douglas et al. 2). They are often caused by the shearing of interlocking veins and are generally a more common form of TBI than epidural hematomas (Douglas et al. 2).

The subarachnoid hemorrhages are located within the subarachnoid space and can be detected through neuroimaging in the sulci between the cortical gyri, the fissures between the cerebellar folia, and the cisterns (Douglas et al. 2). The Intraventricular hematoma can be detected within the brain tissue itself, and generally occur due to contusions, and axonal injuries (Douglas et al. 2). The extents of injury in diffuse axonal injury (DAI) are likely more intricate than only primary mechanical axotonomy in the setting of trauma (Douglas et al. 2).

Perfusion imaging is a complex neuroimaging method used by clinicians to get more information, such as cerebral blood flow, blood volume, and blood transit period (Douglas et al. 2). Although perfusion imaging has generally been used in diagnosing the cause of a stroke, it is also currently being researched on how it can diagnose the deeper cause of TBI (Douglas et al. 2). Cerebral autoregulation can be defined as the procedure whereby the cerebral vasculature either vasodilates or vasoconstrictors to regulate appropriate levels of cerebral blood flow over a scope of blood pressures (Douglas et al. 2). A healthy patient normally has blood pressure ranging from 50 mmHg to 150mmHg (Douglas et al. 2). In the context of TBI, the ability of clinicians to use cerebral vasculature to perform autoregulation is hindered, therefore, diagnosticians are forced to seek optimal management strategies like maintaining normal blood pressure, avoiding systemic hypotension, and avoiding arterial oxygen saturation (Douglas et al. 2).

How Traumatic Brain Injuries Are Impacting Athletes

Traumatic brain injury has gotten augmented attention, mainly in the field of sports. There is an increasing risk for many athletes to get repeated head injuries, and it is the responsibility of the physician to safeguard their wellbeing. The examination and clinical administration of a player with TBI encompasses; examining the symptoms, medical evaluation, and neurocognitive testing with serial assessments over the ensuing days, weeks, and months before an athlete fully recovers. Sahler and Greenwald (2-3) suggest that the majority of Traumatic Brain Injuries are recreational-related with 70.9 percent of male athletes aged between 10-20 years is the most af...