Handle with Care:

Traumatic Brain Injuries

By Angela Marion Lee

A soft, gray mass of tangled nerve tissue contained in the cranium, the brain is the control centre of the body, its fragility evident when a traumatic injury disrupts both physical and cognitive function, the degree of which can only be determined by prompt, precise and prescriptive medical intervention.

Every year in Quebec, approximately 5,000 people are hospitalized due to head trauma; of these, almost 200 die and about 100 remain in a vegetative state, while more than 400 are permanently handicapped.

A traumatic brain injury is “the destruction or dysfunction of the cerebral parenchyma [tissue] due to a penetrating object or a blow to the head, causing a sudden contact between the brain and the skull,” according to the Marie-Robert NeuroTrauma Foundation, which funds neurological research throughout the province with a focus on developing new techniques in early evaluation and therapeutic surgery.

Established in 1993, the Marie-Robert NeuroTrauma Foundation specializes on the first 15 days following a brain injury; a critical period that determines the patient’s future. “It’s important to support this research and to develop new surgical techniques to improve quality of life for patients,” says founding President Marie Robert.

Making Strides

“Twenty years ago, every hospital received patients with head trauma,” says Dr. Judith Marcoux, a neurosurgeon with the McGill University Health Centre (MUHC) who specializes in traumatic brain injury. “Now, very few hospitals are specialized for head trauma in the province─ in Montreal, it’s the Montreal General and l’Hopital Sacre Coeur. It became very centralized. Reorganizing and quickly directing patients to the right place, with the right equipment, and the right people, dramatically decreased the mortality rate among injured people. Patients dying from trauma, in general, used to be 50 per cent and now it’s down to eight or nine per cent.”

A dedicated trauma centre, like the Montreal General Hospital, has experience in dealing with traumatic injuries from shootings and construction site mishaps to falling infrastructure. This hospital is familiar with the need for a specialized team standing by to process the incoming injured.

“I’m not the only one taking care of the traumatic brain injury,” continues Dr. Marcoux, “it’s the whole team that is taking care of the injured person. They’re experienced and it makes a difference in the outcome for these patients.”

The team includes of neuropsychologists, physiotherapists, occupational therapists, nutritionists, and speech therapists.

New Technology

Advances in cranial imaging have also improved; before technicians would use a CT scan. Later on, the MRI was used after the patient was stabilized.

“Diffusion Tensor Imaging is a special technique using the MRI that allows us to see if the axons the tails of the neuron are disrupted or not. It’s quite new. It’s still under research protocol. Eventually, it will become the standard. Currently in use, the Functional MRI lights up a part of the brain when a specific task is performed, like counting. It’s like the old psychology tests but at the same time, the brain is imaged. Inflammatory response to specific medications is currently under study,” concludes Dr. Marcoux.

Fall 2011, Vol 3 N°4

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