ANN ARBOR, MI -Inge Ferguson, 46, feels a profound sense of loss. A highly educated computer programmer, she has recurring migraine headaches, loses track of things like her keys and glasses, and sometimes shows up for appointments at the wrong time or the wrong day. Ferguson left her job following a traumatic brain injury four years ago from which she has never fully recovered.

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Percival Pangilinan Jr., M.D., of the University of Michigan Department of Physical Medicine and Rehabilitation, says more than half a million people each year sustain a traumatic brain injury, or TBI. These brain injuries are caused when the brain, which floats in cerebral fluid, smashes against the hard wall of the skull following an impact. They are often caused by motor vehicle or sports traumas, but also can be caused by physical abuse or violence – including shaking a small child or infant – or, surprisingly, by mundane household or workplace accidents.

Ferguson, for example, sustained her TBI when she fell on concrete stairs at work, breaking her wrist and gashing her face. It wasn't until she was recovering from these injuries that she noticed signs of a concussion.

“I was sleeping 14 hours a day minimum. I was just exhausted and had blurred vision. I also had constant head pain,” she says.

When she mentioned these symptoms to her doctor, Ferguson was referred to a specialist for diagnostic testing. She says that, even though the diagnosis showed only a mild injury, the TBI has totally changed her life.

“Most of the time, the symptoms of a concussion, or a mild traumatic brain injury, do go away by themselves. Often they take days to weeks,” Pangilinan says. “However, some of the symptoms can linger on and be poorly amenable to treatment. We call these post-concussive syndromes and it's very common for people with this diagnosis to have symptoms for a long period of time.”

A concussion is synonymous with a mild traumatic brain injury. Common symptoms include:

• Headaches
• Dizziness
• Nausea
• Vomiting
• Confusion
• Problems concentrating
• Becoming more confused
• Forgetfulness

Someone with moderate or severe TBI also may have these symptoms, but to a more extreme degree.

Moderately or severely injured patients receive rehabilitation that can involve physical medicine, speech and language therapy, physical therapy, occupational therapy, psychology, psychiatry and social support.

Humans do not have the capacity to make new brain cells to replace those that are lost through aging or injury. However, we can make new connections between existing cells. Recovery from a TBI involves making or reestablishing connections in the brain over time. The medication Ritalin, while traditionally used for children with attention deficit hyperactivity disorder, is very helpful after a TBI with the patient's thinking speed and concentration.

It is also important to a patient's recovery to seek medical treatment as soon as possible, as bruising inside the skull can cause secondary swelling and pressure, resulting in further neurological injury.

‘Second impact syndrome' dangers

Pangilinan cautions athletes, parents, coaches and trainers to be wary of head injuries. Having a second concussion soon after a first concussion is potentially lethal. It's a phenomenon called second impact syndrome, and it develops when a second concussion occurs before the brain has had a chance to recover from the first.

“It is surprising what a little amount of force it takes to sustain a TBI. Most people probably don't recognize the danger signs of a concussion or a mild TBI. I think if more people were aware of some of these danger signs, they'd be more apt to see their physician for evaluation,” Pangilinan says. “People are also probably surprised at the profound effects that brain injury may have on someone's life and, just as importantly, what those effects might have on the patient's family.”

The National Institutes of Health estimates there are between 2.5. – 6.5 million people in the United States who have had a traumatic brain injury. This includes mild, moderate and severe cases. It accounts for tens of thousands of hospitalizations and visits to doctors.

For more information, visit the following Web sites:

U-M Health Topics A – Z:

Concussion
www.med.umich.edu/1libr/sma/sma_concussi_sma.htm

Head Trauma
www.med.umich.edu/1libr/aha/aha_headtraa_crs.htm

Head Injury – Resource List
www.med.umich.edu/1libr/pa/pa_blheadin_pep.htm

Pediatric Health Advisor: Head Injury www.med.umich.edu/1libr/pa/pa_headtrau_hhg.htm

UM Traumatic Brain Injury

National Institute of Neurological Disorders & Stroke www.ninds.nih.gov/disorders/tbi/tbi_pr.htm

Family Doctor: Head Injuries – What to Watch for Afterward http://familydoctor.org/084.xml?printxml

CDC: Heads Up – Preventing Brain Injuries www.cdc.gov/doc.do/id/0900f3ec800089f7

Neurosurgery Today: Concussion www.neurosurgerytoday.org/what/patient_e/concussion.asp

Written by Mary Beth Reilly

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