“The Fields twins (Kirtsie & Catherine)started having problems when they were four years old. By the time they had reached the age of nine, they were having difficulty walking and needed frames to assist them with walking. Their muscles have been gradually deteriorating over time. The disease affects the twins’ nerves, causing them to make involuntary muscle movements such as trembling in the hands. The girls have more than 100 muscle spasms a day which are uncontrollable & leave them in great pain.”
Anthony Rodriquez Author on Prezi (prezi.com)
Today’s topic is on “One of the top 5 rare diseases “Fields Condition”. Look at what we are up against in this major health crisis but we can get through this just like these 2 girls have been doing everyday since childhood!
You can be a positive force in resolving this coronavirus. Key element is help yourselves, family, and also your community! Be constructive in opening the doors by connecting with your community and help each other. Volunteer, get a job at opening positions to fight this! History has been through health devastation before and has beat it. Let’s fight it, take preventable precautions, stay home and know there is always hope! Apply these 2 unique girls positive thinking now being up against a complete change in normal daily living. PLEASE FOLLOW THE SOCIAL DISTANCING & BY NOW YOU KNOW WHY!
Dedicated to Kious Kelly Nurse Assistant Manager of 10B at Mount Sinai Hospital who did join the front lines with me in NYC! Kious your spirit lives on!
Fields’ disease is considered to be one of the rarest known diseases in the world, with only two diagnosed cases. The frequency of this disease is therefore 1 in approximately 3.75 billion (although since the disease manifested in identical twins, the actual frequency is 1 in approximately 7.5 billion). It is named after Welsh twins Catherine and Kirstie Fields, of Llanelli. Fields’ disease is a neuromuscular disease, causing muscular degeneration.
The disease was first noticed when the twins were four. Doctors have been unable to identify it and have not been able to match it to any known diseases. As a result, the Fields sisters have undergone numerous tests, but no treatment has yet been found. No definitive cause has been determined, and doctors have generally concluded that they were born with it.
We’re definitely getting into the nitty-gritty of the world’s rarest diseases when we’re talking about Fields Condition, a progressive muscle disorder that affects two sisters (Kirstie & Catherine Fields) and can cause painful muscle spasms up to 100 times each day. The disease is still predominantly a mystery to doctors, but in its wake it’s paralyzed both sisters and cut off their ability to speak, with the two now relying on electronic speech machines to communicate.
The extent of this disease is still not very well known. This very disease has had not shown any effect on their brains or personalities up to now. There is still the uncertainty of not knowing that whether the disease is fatal or not or what is the life expectancy with this kind of disease. If the cause of this disease is considered to be somewhat genetic, then there are possibilities of the twins passing this disease to their offspring’s.
However, it is made clear that this disease is definitely not communicable. However, due to the rarity of this disease, there is still uncertainty and lack of any form or equipment for the cure of this disease.
Regarding the twins alive, the twins require the use of wheelchairs for mobility and are unable to speak without the assistance of electronic speaking aids. They experience persistent and painful muscle spasms which are worsened by emotional distress. They are currently living with their parents, with the assistance of hospice workers. Doctors continue to administer tests to the twins in search of a treatment.
At this point this is all we know about the fields’ disease as the doctors are still researching on it and have not been able to find much on it.
“Diabetic kidney disease is a type of kidney disease caused by diabetes. Diabetes is the leading cause of kidney disease. About 1 out of 4 adults with diabetes has kidney disease.The main job of the kidneys is to filter wastes and extra water out of your blood to make urine. Your kidneys also help control blood pressure and make hormones that your body needs to stay healthy.”
National Institute of Diabetes, Digestive and Kidney Disease (NIH)
Diabetes is becoming more common in the United States. From 1980 through 2011, the number of Americans with diagnosed diabetes has more than tripled as of 2011 (from 5.6 million to 20.9 million). Do you know how much it is costing in our country? Its a combination of factors that has caused such and increase in the disease of Diabetes in the U.S. Factors:
-Look how much our population has increased with fast food companies pushing the unhealthy foods the sell in restaurants or food stores.
-Also people from other countries who permanently came into America becoming a citizen from 1980 to now and came in to the U.S. already eating poor OR picked up the bad habits of eating poor foods that the U.S. media pushes that is acceptable to enough by U.S. society (that is continues) and is adding to the diabetic population whether they came in the U.S. with it or got it when coming to live in America.
-Than people born in U.S. with family having a history of diabetes or worse parents who did not watch good eating habits when raising their children who got obese putting them at high risk for diabetes.
-Ending line, these factors massively increased making the number of Diabetic Americans 3x higher since 1980.
-Than another factor is the illegals with diabetes also adds to the number of diabetic people in America; for they are not left out and are treated in hospitals with citizens. If the come to an ER in the U.S. we treat them.
These factors all IMPACT an increase in the number of Diabetics in America!
Wake up America! We need to get this disease under better control! See how Diabetes keeps increasing in the U.S.?
That’s right. The metabolic condition is about as American as you can get, according to a national report card on diabetes by the Centers for Disease Control and Prevention 2011.
The report shows that nearly half of Americans have diabetes or prediabetes, which puts them at high risk for the condition. A good number of these folks haven’t been diagnosed and don’t even realize their predicament.
People with diabetes have too much sugar in their blood. If the disease isn’t controlled, they can wind up with heart disease, nerve damage, kidney problems, eye damage and other serious health problems.
The new report combines data from the CDC, the Agency for Healthcare Research and Quality, the Indian Health Service and the Census Bureau. Here’s a numerical look at what they reveal about diabetes in America.
30.3 million – The number of people in the U.S. who had diabetes in 2015.
That’s right. The metabolic condition is about as American as you can get, according to a new national report card on diabetes released Tuesday by the Centers for Disease Control and Prevention.
There are 2 types of Diabetes:
Type 1 diabetes was previously called insulin-dependent mellitus (IDDM) or juvenile-onset diabetes. This type of diabetes happens when the immune system ends up destroying beta cells in the body that come from our pancreas and they are the only cells in the human body that make the hormone INSULIN the regulates your glucose. Insulin allows glucose to transfer into the cells and tissues of our body to give them their energy to do their job in the body and nutrition to work properly=sugar-glucose. To live with this diabetes the person must have their insulin delivered by injection or a pump. This form of diabetes usually occurs in children or young adults but can occur at any age.
Type 2 diabetes was called non-insulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes. In adults, type 2 diabetes accounts for about 90-95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disease in which the cells do not use insulin properly due to the pancreas not making enough or the pancreas not secreting the correct form o of insulin to do its function. Ending line the insulin isn’t working properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it.
Type 2 diabetes is associated with older age, OBESITY, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity and race/ethnicity.
Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes. During pregnancy, gestational diabetes requires treatment to optimize maternal blood glucose levels to lessen the risk of complications in the infant.
Diabetes and Kidney Disease:
If you have diabetes, your blood glucose, or blood sugar, levels are too high. Over time, this can damage your kidneys. Your kidneys clean your blood. If they are damaged, waste and fluids build up in your blood instead of leaving your body.
Kidney damage from diabetes is called diabetic nephropathy. It begins long before you have symptoms. People with diabetes should get regular screenings for kidney disease. Tests include a urine test to detect protein in your urine and a blood test to show how well your kidneys are working.
If the damage continues, your kidneys could fail. In fact, diabetes is the most common cause of kidney failure in the United States. People with kidney failure need either dialysis or a kidney transplant.
You can slow down kidney damage or keep it from getting worse. Controlling your blood sugar and blood pressure, taking your medicines and not eating too much protein can help with keeping your weight within normal limits.
“We are continuously learning about the unpredictable powers of nature. This is nowhere more true than in the continuous evolution of new infectious threats to human health that emerge – often without warning – from the natural environment. Already in these first two decades of the 21st century, the world has been sharply reminded time after time of the degree to which people in all countries and on all continents remain chronically vulnerable to infectious diseases, known and unknown.”
Throughout the course of history, disease outbreaks have ravaged humanity, sometimes changing the course of history and, at times, signaling the end of entire civilizations. Here are 20 of the worst epidemics and pandemics, dating from prehistoric to modern times.
1. Prehistoric epidemic: Circa 3000 B.C.
About 5,000 years ago, an epidemic wiped out a prehistoric village in China. The bodies of the dead were stuffed inside a house that was later burned down. No age group was spared, as the skeletons of juveniles, young adults and middle-age people were found inside the house. The archaeological site is now called “Hamin Mangha” and is one of the best-preserved prehistoric sites in northeastern China. Archaeological and anthropological study indicates that the epidemic happened quickly enough that there was no time for proper burials, and the site was not inhabited again.
Before the discovery of Hamin Mangha, another prehistoric mass burial that dates to roughly the same time period was found at a site called Miaozigou, in northeastern China. Together, these discoveries suggest that an epidemic ravaged the entire region.
2. Plague of Athens: 430 B.C.
Around 430 B.C., not long after a war between Athens and Sparta began, an epidemic ravaged the people of Athens and lasted for five years. Some estimates put the death toll as high as 100,000 people. The Greek historian Thucydides (460-400 B.C.) wrote that “people in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath” (translation by Richard Crawley from the book “The History of the Peloponnesian War,” London Dent, 1914).
What exactly this epidemic was has long been a source of debate among scientists; a number of diseases have been put forward as possibilities, including typhoid fever and Ebola. Many scholars believe that overcrowding caused by the war exacerbated the epidemic. Sparta’s army was stronger, forcing the Athenians to take refuge behind a series of fortifications called the “long walls” that protected their city. Despite the epidemic, the war continued on, not ending until 404 B.C., when Athens was forced to capitulate to Sparta.
3. Antonine Plague: A.D. 165-180
When soldiers returned to the Roman Empire from campaigning, they brought back more than the spoils of victory. The Antonine Plague, which may have been smallpox, laid waste to the army and may have killed over 5 million people in the Roman empire, wrote April Pudsey, a senior lecturer in Roman History at Manchester Metropolitan University, in a paper published in the book “Disability in Antiquity,” Routledge, 2017).
Many historians believe that the epidemic was first brought into the Roman Empire by soldiers returning home after a war against Parthia. The epidemic contributed to the end of the Pax Romana (the Roman Peace), a period from 27 B.C. to A.D. 180, when Rome was at the height of its power. After A.D. 180, instability grew throughout the Roman Empire, as it experienced more civil wars and invasions by “barbarian” groups. Christianity became increasingly popular in the time after the plague occurred.
4. Plague of Cyprian: A.D. 250-271
Named after St. Cyprian, a bishop of Carthage (a city in Tunisia) who described the epidemic as signaling the end of the world, the Plague of Cyprian is estimated to have killed 5,000 people a day in Rome alone. In 2014, archaeologists in Luxor found what appears to be a mass burial site of plague victims. Their bodies were covered with a thick layer of lime (historically used as a disinfectant). Archaeologists found three kilns used to manufacture lime and the remains of plague victims burned in a giant bonfire.
Experts aren’t sure what disease caused the epidemic. “The bowels, relaxed into a constant flux, discharge the bodily strength [and] a fire originated in the marrow ferments into wounds of the fauces (an area of the mouth),” Cyprian wrote in Latin in a work called “De mortalitate” (translation by Philip Schaff from the book “Fathers of the Third Century: Hippolytus, Cyprian, Caius, Novatian, Appendix,” Christian Classics Ethereal Library, 1885).
5. Plague of Justinian: A.D. 541-542
The Byzantine Empire was ravaged by the bubonic plague, which marked the start of its decline. The plague reoccurred periodically afterward. Some estimates suggest that up to 10% of the world’s population died.
The plague is named after the Byzantine Emperor Justinian (reigned A.D. 527-565). Under his reign, the Byzantine Empire reached its greatest extent, controlling territory that stretched from the Middle East to Western Europe. Justinian constructed a great cathedral known as Hagia Sophia (“Holy Wisdom”) in Constantinople (modern-day Istanbul), the empire’s capital. Justinian also got sick with the plague and survived; however, his empire gradually lost territory in the time after the plague struck.
6. The Black Death: 1346-1353
The Black Death traveled from Asia to Europe, leaving devastation in its wake. Some estimates suggest that it wiped out over half of Europe’s population. It was caused by a strain of the bacterium Yersinia pestis that is likely extinct today and was spread by fleas on infected rodents. The bodies of victims were buried in mass graves.
The plague changed the course of Europe’s history. With so many dead, labor became harder to find, bringing about better pay for workers and the end of Europe’s system of serfdom. Studies suggest that surviving workers had better access to meat and higher-quality bread. The lack of cheap labor may also have contributed to technological innovation.
7. Cocoliztli epidemic: 1545-1548
The infection that caused the cocoliztli epidemic was a form of viral hemorrhagic fever that killed 15 million inhabitants of Mexico and Central America. Among a population already weakened by extreme drought, the disease proved to be utterly catastrophic. “Cocoliztli” is the Aztec word for “pest.”
A recent study that examined DNA from the skeletons of victims found that they were infected with a subspecies of Salmonella known as S. paratyphi C, which causes enteric fever, a category of fever that includes typhoid. Enteric fever can cause high fever, dehydration and gastrointestinal problems and is still a major health threat today.
8. American Plagues: 16th century
The American Plagues are a cluster of Eurasian diseases brought to the Americas by European explorers. These illnesses, including smallpox, contributed to the collapse of the Inca and Aztec civilizations. Some estimates suggest that 90% of the indigenous population in the Western Hemisphere was killed off.
The diseases helped a Spanish force led by Hernán Cortés conquer the Aztec capital of Tenochtitlán in 1519 and another Spanish force led by Francisco Pizarro conquer the Incas in 1532. The Spanish took over the territories of both empires. In both cases, the Aztec and Incan armies had been ravaged by disease and were unable to withstand the Spanish forces. When citizens of Britain, France, Portugal and the Netherlands began exploring, conquering and settling the Western Hemisphere, they were also helped by the fact that disease had vastly reduced the size of any indigenous groups that opposed them.
9. Great Plague of London: 1665-1666
The Black Death’s last major outbreak in Great Britain caused a mass exodus from London, led by King Charles II. The plague started in April 1665 and spread rapidly through the hot summer months. Fleas from plague-infected rodents were one of the main causes of transmission. By the time the plague ended, about 100,000 people, including 15% of the population of London, had died. But this was not the end of that city’s suffering. On Sept. 2, 1666, the Great Fire of London started, lasting for four days and burning down a large portion of the city.
10. Great Plague of Marseille: 1720-1723
Historical records say that the Great Plague of Marseille started when a ship called Grand-Saint-Antoine docked in Marseille, France, carrying a cargo of goods from the eastern Mediterranean. Although the ship was quarantined, plague still got into the city, likely through fleas on plague-infected rodents.
Plague spread quickly, and over the next three years, as many as 100,000 people may have died in Marseille and surrounding areas. It’s estimated that up to 30% of the population of Marseille may have perished.
11. Russian plague: 1770-1772
In plague-ravaged Moscow, the terror of quarantined citizens erupted into violence. Riots spread through the city and culminated in the murder of Archbishop Ambrosius, who was encouraging crowds not to gather for worship.
The empress of Russia, Catherine II (also called Catherine the Great), was so desperate to contain the plague and restore public order that she issued a hasty decree ordering that all factories be moved from Moscow. By the time the plague ended, as many as 100,000 people may have died. Even after the plague ended, Catherine struggled to restore order. In 1773, Yemelyan Pugachev, a man who claimed to be Peter III (Catherine’s executed husband), led an insurrection that resulted in the deaths of thousands more.
12. Philadelphia yellow fever epidemic: 1793
When yellow fever seized Philadelphia, the United States’ capital at the time, officials wrongly believed that slaves were immune. As a result, abolitionists called for people of African origin to be recruited to nurse the sick.
The disease is carried and transmitted by mosquitoes, which experienced a population boom during the particularly hot and humid summer weather in Philadelphia that year. It wasn’t until winter arrived — and the mosquitoes died out — that the epidemic finally stopped. By then, more than 5,000 people had died.
13. Flu pandemic: 1889-1890
In the modern industrial age, new transport links made it easier for influenza viruses to wreak havoc. In just a few months, the disease spanned the globe, killing 1 million people. It took just five weeks for the epidemic to reach peak mortality.
The earliest cases were reported in Russia. The virus spread rapidly throughout St. Petersburg before it quickly made its way throughout Europe and the rest of the world, despite the fact that air travel didn’t exist yet.
14. American polio epidemic: 1916
A polio epidemic that started in New York City caused 27,000 cases and 6,000 deaths in the United States. The disease mainly affects children and sometimes leaves survivors with permanent disabilities.
Polio epidemics occurred sporadically in the United States until the Salk vaccine was developed in 1954. As the vaccine became widely available, cases in the United States declined. The last polio case in the United States was reported in 1979. Worldwide vaccination efforts have greatly reduced the disease, although it is not yet completely eradicated.
15. Spanish Flu: 1918-1920
An estimated 500 million people from the South Seas to the North Pole fell victim to Spanish Flu. One-fifth of those died, with some indigenous communities pushed to the brink of extinction. The flu’s spread and lethality was enhanced by the cramped conditions of soldiers and poor wartime nutrition that many people were experiencing during World War I.
Despite the name Spanish Flu, the disease likely did not start in Spain. Spain was a neutral nation during the war and did not enforce strict censorship of its press, which could therefore freely publish early accounts of the illness. As a result, people falsely believed the illness was specific to Spain, and the name Spanish Flu stuck.
16. Asian Flu: 1957-1958
The Asian Flu pandemic was another global showing for influenza. With its roots in China, the disease claimed more than 1 million lives. The virus that caused the pandemic was a blend of avian flu viruses.
The Centers for Disease Control and Prevention notes that the disease spread rapidly and was reported in Singapore in February 1957, Hong Kong in April 1957, and the coastal cities of the United States in the summer of 1957. The total death toll was more than 1.1 million worldwide, with 116,000 deaths occurring in the United States.
17. AIDS pandemic and epidemic: 1981-present day
AIDS has claimed an estimated 35 million lives since it was first identified. HIV, which is the virus that causes AIDS, likely developed from a chimpanzee virus that transferred to humans in West Africa in the 1920s. The virus made its way around the world, and AIDS was a pandemic by the late 20th century. Now, about 64% of the estimated 40 million living with human immunodeficiency virus (HIV) live in sub-Saharan Africa.
For decades, the disease had no known cure, but medication developed in the 1990s now allows people with the disease to experience a normal life span with regular treatment. Even more encouraging, two people have been cured of HIV as of early 2020.
18. H1N1 Swine Flu pandemic: 2009-2010
The 2009 swine flu pandemic was caused by a new strain of H1N1 that originated in Mexico in the spring of 2009 before spreading to the rest of the world. In one year, the virus infected as many as 1.4 billion people across the globe and killed between 151,700 and 575,400 people, according to the CDC.
The 2009 flu pandemic primarily affected children and young adults, and 80% of the deaths were in people younger than 65, the CDC reported. That was unusual, considering that most strains of flu viruses, including those that cause seasonal flu, cause the highest percentage of deaths in people ages 65 and older. But in the case of the swine flu, older people seemed to have already built up enough immunity to the group of viruses that H1N1 belongs to, so weren’t affected as much. A vaccine for the H1N1 virus that caused the swine flu is now included in the annual flu vaccine.
Related: How does the COVID-19 pandemic compare to the last pandemic?
19. West African Ebola epidemic: 2014-2016
Ebola ravaged West Africa between 2014 and 2016, with 28,600 reported cases and 11,325 deaths. The first case to be reported was in Guinea in December 2013, then the disease quickly spread to Liberia and Sierra Leone. The bulk of the cases and deaths occurred in those three countries. A smaller number of cases occurred in Nigeria, Mali, Senegal, the United States and Europe, the Centers for Disease Control and Prevention reported.
There is no cure for Ebola, although efforts at finding a vaccine are ongoing. The first known cases of Ebola occurred in Sudan and the Democratic Republic of Congo in 1976, and the virus may have originated in bats.
20. Zika Virus epidemic: 2015-present day
The impact of the recent Zika epidemic in South America and Central America won’t be known for several years. In the meantime, scientists face a race against time to bring the virus under control. The Zika virus is usually spread through mosquitoes of the Aedes genus, although it can also be sexually transmitted in humans.
While Zika is usually not harmful to adults or children, it can attack infants who are still in the womb and cause birth defects. The type of mosquitoes that carry Zika flourish best in warm, humid climates, making South America, Central America and parts of the southern United States prime areas for the virus to flourish.
As of 3/25/2o2o Coronavirus
So what can you do stay home, protect yourself when you go outdoors, stay outdoors in stores in the smallest amount time needed. Stay in touch with family, friends, and the outside world via phone and internet! It maybe a difficult time but history has gone though pandemics before and have survived and we are not touching many previous ones that have happened in numbers. When you panic logic and reasoning are terribly effected or just not used! Regarding COVID-19 you need to think logically and reasonably to help yourself and others.
“A person with a severe brain injury will need to be hospitalized and may have long-term problems affecting things such as: Thinking, Memory, Learning, Coordination and balance, Speech, hearing or vision, Emotions it depends also on the lobe of the brain affected.”
Common causes include falls, car or motorcycle crashes, vehicular accidents involving pedestrians, athletics, and assaults with or without a weapon.
Who is affected?
Approximately 1.5 to 2 million adults and children suffer a traumatic brain injury (TBI) each year in the United States. Most people who experience a head injury, about 1.1 million, will have a mild injury that does not require an admission to the hospital. Another 235,000 individuals will be hospitalized with a moderate to severe head injury, and approximately 50,000 will die.
How is a diagnosis made?
When a person is brought to the emergency room with a head injury, doctors will learn as much as possible about his or her symptoms and how the injury occurred. The person’s condition is assessed quickly to determine the extent of injury.
The Glasgow Coma Score (GCS) is a 15-point test used to grade a patient’s level of consciousness. Doctors assess the patient’s ability to 1) open his or her eyes, 2) ability to respond appropriately to orientation questions, (“What is your name? What is the date today?”), and 3) ability to follow commands (“Hold up two fingers, or give a thumbs up”). If unconscious or unable to follow commands, his or her response to painful stimulation is checked. A number is taken from each category and added together to get the total GCS score. The score ranges from 3 to 15 and helps doctors classify an injury as mild, moderate, or severe. Mild TBI has a score of 13-15. Moderate TBI has a score of 9-12, and severe TBI has a score of 8 and below.
Diagnostic imaging tests will be performed:
Figure 3. CT scan shows a blood clot (hematoma) collecting under the bone (red arrows) and displacing brain (yellow arrow) to the other side of the skull.
Computed Tomography (CT) is a noninvasive X-ray that provides detailed images of anatomical structures within the brain. A CT scan of the head is taken at the time of injury to quickly identify fractures, bleeding in the brain, blood clots (hematomas) and the extent of injury (Fig. 3). CT scans are used throughout recovery to evaluate the evolution of the injury and to help guide decision-making about the patient’s care.
Magnetic Resonance Imaging (MRI) is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of the brain. A dye (contrast agent) may be injected into the patient’s bloodstream. MRI can detect subtle changes in the brain that cannot be seen on a CT scan.
Magnetic Resonance Spectroscopy (MRS) gives information about the metabolism of the brain. The numbers generated from this scan provide a general prognosis about the patient’s ability to recover from the injury.
What treatments are available?
Mild TBI usually requires rest and medication to relieve headache. Moderate to severe TBI require intensive care in a hospital. Bleeding and swelling in the brain can become an emergency that requires surgery. However, there are times when a patient does not require surgery and can be safely monitored by nurses and physicians in the neuroscience intensive care unit (NSICU).
The goals of treatment are to resuscitate and support the critically ill patient, minimize secondary brain injury and complications, and facilitate the patient’s transition to a recovery environment. Despite significant research, doctors only have measures to control brain swelling, but do not have a way to eliminate swelling from occurring.
Neurocritical care is the intensive care of patients who have suffered a life-threatening brain injury. Many patients with severe TBI are comatose or paralyzed; they also may have suffered injuries in other parts of the body. Their care is overseen by a neurointensivist, a specialty-trained physician who coordinates the patient’s complex neurological and medical care. Patients are monitored and awakened every hour for nursing assessments of their mental status or brain function.
Figure 4. In the NSICU, the patient is connected to numerous machines, tubes, and monitors. The monitoring equipment provides information about body functions and helps guide care. Some equipment may take over certain functions, such as breathing, nutrition, and urination, until the patient’s body is able to do these things on its own.
Seeing a patient who has suffered a severe TBI can be shocking. It is possible that your loved one’s appearance will be altered because of facial injury and equipment that is used for monitoring. Numerous tubes, lines, and equipment may be used to closely monitor his or her heart rate, blood pressure, and other critical body functions. (Fig. 4)
Figure 5. A brain oxygen and cerebral blood flow monitor is inserted into the brain tissue and secured to the skull with a bolt. A catheter is inserted into the ventricle of the brain to monitor intracranial pressure (ICP). If pressure is too high, the CSF fluid can be drained from the ventricles.
Intracranial pressure (ICP) monitor. A catheter is placed through a small hole in the skull and positioned inside the ventricle (fluid-filled area deep within the brain) to measure pressure inside the head (Fig. 5). The ICP monitor allows the NSICU team to intervene quickly if the pressure becomes too high. Typical intracranial pressure is less than 20 mmHg. However, there are times when a higher number is safe and acceptable.
Brain oxygen monitor (Licox). A catheter is placed through a small hole in the skull and positioned within the brain tissue. The Licox measures the oxygen level and temperature within the brain. Adjustments in the amount of oxygen given to the patient are often made to maximize the brain’s oxygen level. A cerebral blood flow monitor, called a Hemedex, is a newer monitor that is placed with the Licox and helps the NSICU team evaluate blood flow through the brain.
Ventilator. Some patients may require a ventilator, a machine that helps them breathe. The ventilator is connected to the patient by the endotracheal tube, or ET tube. The tube is placed into the patient’s mouth and down into the trachea, or windpipe. The tube allows the machine to push air into and out of the lungs, thereby helping the patient breathe.
Feeding tube. When patients are on a ventilator or have a decreased level of alertness, they may not be able to eat or get sufficient nutrition to meet their needs. A nasal-gastric feeding tube may be inserted through the patient’s nose and passed down the throat into the stomach. It delivers liquid nutrition as well as any medication that is required.
Seizures and EEG monitoring. A seizure is an abnormal electrical discharge from the brain. Approximately 24% of patients who suffer a TBI will have a seizure that is undetected unless they are monitored by an electroencephalogram (EEG). Seizures that are not visible to the human eye are referred to as non-convulsive seizures. Because these seizures are serious, all patients with a severe TBI are monitored with continuous EEG for 24 to 72 hours after injury.
Sedation and pain. After a head injury it may be necessary to keep the patient sedated with medications. These medications can be turned off quickly in order to awaken the patient and check their mental status. Because patients often have other injuries, pain medication is given to keep them comfortable.
Controlling intracranial pressure. Hypertonic saline is a medication used to control pressure within the brain. It works by drawing the extra water out of the brain cells into the blood vessels and allowing the kidneys to filter it out of the blood.
Preventing seizures. Patients who’ve had a moderate to severe traumatic brain injury are at higher risk of having seizures during the first week after their injury. Patients are given an anti-seizure medication (levetiracetam or phenytoin) to prevent seizures from occurring.
Preventing infection. Although every attempt is made to prevent infection, the risk is always present. Any device placed within the patient has the potential to introduce a microbe. If an infection is suspected, a test will be sent to a laboratory for analysis. If an infection is present, it will be treated with antibiotics.
Surgery is sometimes necessary to repair skull fractures, repair bleeding vessels, or remove large blood clots (hematomas). It is also performed to relieve extremely high intracranial pressure.
Craniotomy involves cutting a hole in the skull to remove a bone flap so that the surgeon can access the brain. The surgeon then repairs the damage (e.g., skull fracture, bleeding vessel, remove large blood clots). The bone flap is replaced in its normal position and secured to the skull with plates and screws.
Figure 6. A large decompressive craniectomy is removed and the dura is opened to allow the brain to expand. Blood clots are removed and bleeding vessels are repaired. The bone flap is frozen and replaced about 6 weeks later.
Decompressive craniectomy involves removing a large section of bone so that the brain can swell and expand. This is typically performed when extremely high intracranial pressure becomes life threatening. At that time the patient is taken to the operating room where a large portion of the skull is removed to give the brain more room to swell (Fig. 6). A special biologic tissue is placed on top of the exposed brain and the skin is closed. The bone flap is stored in a freezer. One to 3 months after the swelling has resolved and the patient has stabilized from the injury, the bone flap is replaced in another surgery, called cranioplasty.
Other surgical procedures may be performed to aid in the patient’s recovery:
Tracheotomy involves making a small incision in the neck to insert the breathing tube directly into the windpipe. The ventilator will then be connected to this new location on the neck and the old tube is removed from the mouth.
Percutaneous Endoscopic Gastrostomy Tube (PEG) is a feeding tube inserted directly into the stomach through the abdominal wall. A small camera is placed down the patient’s throat into the stomach to aid with the procedure and to ensure correct placement of the PEG tube (see Surgical Procedures for Accelerated Recovery).
Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are found on the Web. Studies can be sponsored by the National Institutes of Health (see clinicaltrials.gov) as well as private industry and pharmaceutical companies (see www.centerwatch.com).
Recovery & prevention
The recovery process varies depending on the severity of the injury, but typically progresses through stages: coma, confusion / amnesia, and recovery.
When a patient is in a coma, his or her eyes are closed and they show minimal reaction when spoken to or stimulated. Movements that may be seen at this time are basic reflexes or automatic responses to a stimulus. The brain wave activity in a comatose person is very different from that of a sleeping person.
When a patient begins to awaken, the first natural response is that of bodily protection. Patients at this stage will move away from any stimulus or tend to pull at items attached to them in an attempt to remove anything that is uncomfortable or irritating. His or her eyes may be open more often, but they may not be aware of their behavior or be able to interact in a meaningful way. It is common for a patient to respond to each stimulus (hearing, seeing, or touching) in the same way. Responses may include increased rate of breathing, moaning, moving, sweating, or a rise in blood pressure.
As the patient continues to wake up, their interactions may become more purposeful. They may look at a person and follow them around the room with their eyes, or follow simple commands such as “Hold up your thumb.” Patients tend to be confused and may have inappropriate or agitated behaviors.
Not all head injuries are the same. Patients recover at different rates and to varying degrees. It is difficult to determine at what point a patient will start understanding and interacting with their caregivers or family in a meaningful way. It is important to have patience; recovery from a brain injury can take weeks, months, or even years.
The Family’s Role
Many family members express feelings of helplessness when their loved one is in the NSICU. You are not alone. Please take care of yourself and use your energy wisely.
Visiting hours are limited in the NSICU. Too much stimulation can agitate the patient and raise his or her blood pressure. You can most effectively convey your concern by sitting quietly and holding your loved one’s hand. Be aware that the patient, though silent, may hear anything you say. Never speak as if the patient were not there.
As patients recover, they need help understanding what has happened to them during this “lost period of time.” Keep in mind that the recovery of consciousness is a gradual process – not just a matter of waking up. Progress is usually tracked in three areas: movement, thinking, and interacting. You can help by keeping a diary of their progress. Family photos may help with regaining memory.
Most patients are discharged from the hospital when their condition has stabilized and they no longer require intensive care. A social worker will work closely with the family as preparations are made for a return home or for transfer to a long-term care or rehabilitation center.
A long-term acute care (LTAC) facility is a place for patients who have stabilized from their initial injury but who still require a ventilator or frequent nursing care. Many patients are discharged to an LTAC to continue being weaned from the ventilator. Once off the ventilator, they can be moved to a rehabilitation or skilled nursing facility.
A rehabilitation facility is a place for patients who do not require a ventilator but who still require help with basic daily activities. Physical and occupational therapists work with patients to help them achieve their maximum potential for recovery. Rehab facilities are either Acute Inpatient Rehab that require patients to participate in 3 hours or more of rehab a day or a Skilled Nursing Facility (SNF) that provide 1-3 hours of rehab a day depending on what the patient can tolerate.
Recovering from a brain injury relies on the brain’s plasticity—the ability for undamaged areas of the brain to take over functions of the damaged areas. It also relies on regeneration and repair of nerve cells. And most importantly, on the patient’s hard work to relearn and compensate for lost abilities.
A physical therapist helps patients rebuild and maintain strength, balance, and coordination. They can work with the patient in any facility.
An occupational therapist helps patients to perform activities of daily living, such as dressing, feeding, bathing, toileting, and transferring themselves from one place to another. They also provide adaptive equipment if a patient has difficultly performing a task.
A speech therapist helps patients by monitoring their ability to safely swallow food and helping with communication and cognition.
A neuropsychologist helps patients relearn cognitive functions and develop compensation skills to cope with memory, thinking, and emotional needs.
Tips to reduce the risk for a head injury:
Always wear your helmet when riding a bicycle, motorcycle, skateboard, or all-terrain vehicle.
Never drive under the influence of alcohol or drugs.
Always wear your seat belt and ensure that children are secured in the appropriate child safety seats.
Avoid falls in the home by keeping unsecured items off the floor, installing safety features such as non-slip mats in the bathtub, handrails on stairways, and keeping items off of stairs.
Avoid falls by exercising to increase strength, balance, and coordination.
Store firearms in a locked cabinet with bullets in a separate location.
Wear protective headgear while playing sports.
Reference for Part I and Part II: Mayfield Brain & Spine at 513-221-1100.
“Over 3 decades, the Brain Injury Association of America (BIAA) has proudly led the nation in observing Brain Injury Awareness Month by engaging public awareness campaign in March of each year. The theme for the 2018 to 2020 campaign is Change Your Mind. Second impact syndrome, also termed “recurrent traumatic brain injury,” can occur when a person sustains a second traumatic brain injury before the symptoms of the first traumatic brain injury have healed. The second injury may occur from days to weeks following the first. ”
Traumatic brain injury (TBI) is sudden damage to the brain caused by a blow or jolt to the head. Common causes include car or motorcycle crashes, falls, sports injuries, and assaults. Injuries can range from mild concussions to severe permanent brain damage. While treatment for mild TBI may include rest and medication, severe TBI may require intensive care and life-saving surgery. Those who survive a brain injury can face lasting effects in their physical and mental abilities as well as emotions and personality. Most people who suffer moderate to severe TBI will need rehabilitation to recover and relearn skills.
What is a traumatic brain injury?
TBI is an injury to the brain caused by a blow or jolt to the head from blunt or penetrating trauma. The injury that occurs at the moment of impact is known as the primary injury. Primary injuries can involve a specific lobe of the brain or can involve the entire brain. Sometimes the skull may be fractured, but not always. During the impact of an accident, the brain crashes back and forth inside the skull causing bruising, bleeding, and tearing of nerve fibers (Fig. 1). Immediately after the accident the person may be confused, not remember what happened, have blurry vision and dizziness, or lose consciousness. At first the person may appear fine, but their condition can decline rapidly. After the initial impact occurs, the brain undergoes a delayed trauma – it swells – pushing itself against the skull and reducing the flow of oxygen-rich blood. This is called secondary injury, which is often more damaging than the primary injury.
Figure 1. During impact to the head, the soft brain crashes back and forth against the inside of the hard skull causing bruising, bleeding, and shearing of the brain.
Traumatic brain injuries are classified according to the severity and mechanism of injury:
Mild: person is awake; eyes open. Symptoms can include confusion, disorientation, memory loss, headache, and brief loss of consciousness.
Moderate: person is lethargic; eyes open to stimulation. Loss of consciousness lasting 20 minutes to 6 hours. Some brain swelling or bleeding causing sleepiness, but still arousable.
Severe: person is unconscious; eyes do not open, even with stimulation. Loss of consciousness lasting more than 6 hours.
Types of traumatic brain injuries
Concussion is a mild head injury that can cause a brief loss of consciousness and usually does not cause permanent brain injury.
Contusion is a bruise to a specific area of the brain caused by an impact to the head; also called coup or contrecoup injuries. In coup injuries, the brain is injured directly under the area of impact, while in contrecoup injuries it is injured on the side opposite the impact.
Diffuse axonal injury (DAI) is a shearing and stretching of the nerve cells at the cellular level. It occurs when the brain quickly moves back and forth inside the skull, tearing and damaging the nerve axons. Axons connect one nerve cell to another throughout the brain, like telephone wires. Widespread axonal injury disrupts the brain’s normal transmission of information and can result in substantial changes in a person’s wakefulness.
Traumatic Subarachnoid Hemorrhage (tSAH) is bleeding into the space that surrounds the brain. This space is normally filled with cerebrospinal fluid (CSF), which acts as a floating cushion to protect the brain. Traumatic SAH occurs when small arteries tear during the initial injury. The blood spreads over the surface of the brain causing widespread effects.
Hematoma is a blood clot that forms when a blood vessel ruptures. Blood that escapes the normal bloodstream starts to thicken and clot. Clotting is the body’s natural way to stop the bleeding. A hematoma may be small or it may grow large and compress the brain. Symptoms vary depending on the location of the clot. A clot that forms between the skull and the dura lining of the brain is called an epidural hematoma. A clot that forms between the brain and the dura is called a subdural hematoma. A clot that forms deep within the brain tissue itself is called an intracerebral hematoma. Over time the body reabsorbs the clot. Sometimes surgery is performed to remove large clots.
Although described as individual injuries, a person who has suffered a TBI is more likely to have a combination of injuries, each of which may have a different level of severity. This makes answering questions like “what part of the brain is hurt?” difficult, as more than one area is usually involved.
Secondary brain injury occurs as a result of the body’s inflammatory response to the primary injury. Extra fluid and nutrients accumulate in an attempt to heal the injury. In other areas of the body, this is a good and expected result that helps the body heal. However, brain inflammation can be dangerous because the rigid skull limits the space available for the extra fluid and nutrients. Brain swelling increases pressure within the head, which causes injury to parts of the brain that were not initially injured. The swelling happens gradually and can occur up to 5 days after the injury.
What are the symptoms?
Depending on the type and location of the injury, the person’s symptoms may include:
Loss of consciousness
Confusion and disorientation
Memory loss / amnesia
Poor attention / concentration
Dizziness / loss of balance
Irritability / emotional disturbances
Feelings of depression
Diffuse injuries (such as a concussion or diffuse axonal injury) will typically cause an overall decreased level of consciousness. Whereas, focal injuries (such as an ICH or a contusion) will have symptoms based on the brain area affected (Fig. 2).
Lobes of the brain that can get affected by TBI:
Figure 2. The brain is composed of three parts: the brainstem, cerebellum, and cerebrum, which is divided into lobes. The table lists the lobes of the brain and their normal functions as well as problems that may occur when injured. While an injury may occur in a specific area, it is important to understand that the brain functions as a whole by interrelating its component parts.
Every patient is unique and some injuries can involve more than one area or a partial section, making it difficult to predict which specific symptoms the patient will experience.