The following information has been adapted and translated by one of our French contributors, so apologies in advance if there are some errors in the translation – you should understand the general approach though.
Head injury is a traumatic brain injury. There are also associated other acquired brain injury (brain vacsulaires accidents, ruptured aneurysms, cerebral anoxia, tumleurs …).
The main cause of head injuries is represented by the accidents of public roads, but there are also many other causes, especially sports accidents, acts of violence, assault, domestic accidents, suicides.
Although we do not have official figures for France, the incidence of head injury is about 200 cases per 100 000 inhabitants per year, just under 10% are severe. The number of people affected is estimated at about 120,000 per year in France (about 10 000 severe).
What are the related injuries head injuries:
The main lesions are caused by acceleration, deceleration or violent rotation of the brain, which cause stretching or shearing of the axons (“wires”) within the brain. These lesions may be more or less severe and / or extended. They may cause a brief loss of consciousness or prolonged coma.
There are also other types of lesions, called contusions, i.e. focal lesions, often hemorrhagic nature related to the impact of the brain against hard obstacles most often bone reliefs within the skull.
The different degrees of severity:
Usually there are three levels of severity:
- The mild head injury is a brief unconsciousness of few minutes (less than an hour) and amnesia of trauma and moments that follow (post-traumatic amnesia, lasting less than 24 hours). The evolution is usually favorable: 90% of people recover without sequelae, within 3 to 6 months, but 10% keep more or less important consequences.
- Severe head injury is characterized by coma (score less than or equal to 8 on the most used coma scale, the scale of Glasgow), which can last several hours or days. The risk of sequelae is much higher.
- The head injury moderate intermediate between the two previous levels, there are brain traumtismes said moderates, whose severity is measured by the duration of loss of consciousness, coma depth and duration of post-traumatic amnesia.
The main consequences:
For mild head injuries, the most common sequelae are post-concussion syndrome associating headache, dizziness, fatigue, and cognitive and emotional difficulties. These disorders cure in 90% of cases within 3 to 6 months, 10% keep more or less significant sequelae. But these injuries can also be complicated by the psychological impact of the accident (especially post-traumatic stress disorder characterized by intrusive memories and repeated the accidentou its aftermath).
For moderate to severe head injury, the effects may be more important:
- Sensory sequelae: visual disturbances (diplopia or double vision, achieving an optical nerve or visual field), loss of taste, smell, touch.
- Physical sequelae: it can exist in varying degrees of movement disorders (hemiplegia or quadriplegia in the most severe cases), coordination and balance (cerebellar syndrome), or orthopedic disorders in cases the most severe of vesicoureteral may persist sphintériens or swallowing disorders (risk of aspiration). Epileptic seizures may occur waning, sometimes relatively late.
- Endocrine deficiency, by pituitary lesion, can increase certain disorders, particularly fatigue or sexual dysfunction.
- Cognitive sequelae: they constitute the main difficulty in the recognition of a disability, they are the source of what is commonly called the “invisible disability”: it is a combination of different disorders involving mental slowness , attention disorders, concentration, difficulty doing several things at once, especially in the anterograde memory disorders, ie altering the learning capabilities of new information, and finally disorders executive functions (new or unusual tasks management difficulties, planning, organization, inhibition, reasoning, judgment).
Finally there may be changes in the character and behavior as either a loss of initiative and apathy, on the contrary of disinhibition, and behavioral control problems that could lead to socially maladjusted acts ( violence, aggressiveness, addictive behavior, ….).
There it often combines anosognosia, which means that people are not well aware of their problems. All these problems are never isolated and interact to disabling sequelae as they relate to higher functions (cognitive function).
The most serious cases realize a state of arousal not responding (formerly EVC persistent vegetative state) or pauci-relational state: these states are characterized by persistent impairment of consciousness, totally limiting (not responding awakening) or partially (state pauci-relational) communication skills and interaction with the environment.
Consecutive losses to these effects have an impact on daily life and greatly undermine social reintegration, family, school and professional people. They sound profonément on family and relatives, who must be accompanied and supported.
Their assumption is based on teams specializing in rehabilitation and rehabilitation initially tempqs (Medical Services Physical and Rehabilitation). A distance of the accident, the support in the long term will have to be with relatives and medico-social and social teams with a real knowledge of the problem, in services and / or suitable facilities.
- Each lesion is unique
- each one is injured
- Each family is unique
- every life is unique path
For each brain-injured person can make a life-course consistent with its project and its needs, we must support the creation of the national territory devices characterized by flexibility, proximity, sharing, efficiency.
Namely genuine local platforms coordinates services to brain injured people and their families.
These devices allow:
Integrating existentes structures: partnership, pooling, barriers between the health sector and medico-social
the development of missing responses to deal with situations with behavioral disorders, act in areas where there is no offer, meet the respite needs close
They must rely on specialized institutions and services in the accompaniment of brain injured individuals when they exist and have a strong connection with associations of families of TBI and brain-damaged.
We thank Professor Philippe Azouvi which largely contributed to the development of this document.