Predicting Outcome After Brain Injury
Predicting outcome after brain injury can be very ironic. Here are some of my thoughts about “the miracles in severe brain injury cases” and the “tragedies in so called ‘mild’ brain cases.”
In many severe TBI cases, there is severe damage to a localized part of the brain “focal injuries”, but if the brain surgeon intervenes, the secondary damage to the brain can be significantly reduced. Thus, even though brain surgery was required, the injury may be somewhat localized. The result is that that the other parts of the brain, through the process of neuroplasticity, may have the ability to compensate for the injury.
In contrast, when there has been more diffuse brain injury, which often is the case in MTBI, there is likely no medical intervention. Yet despite the seemingly milder damage, there could be significant of permanent damage. These are some of the reason why predicting outcome after brain injury is very difficult.
Swelling may be occurring, but since no interventions were mandated, no one is there to document it. While this swelling has likely not reached the level that it is life threatening it could be sufficient to cause widespread cell damage or cell death. Swelling can also occur on the microscopic level without significant increases in ICP.
Second, there may be diffuse axonal injury (or more likely, multi-focal axonal injury) but not severe enough to cause coma. While the secondary injury may not occur here, the damage to the brain’s internal connectivity may be so widespread that the brain cannot find alternative ways to compensate. While overall function may not be grossly impaired, nothing works as it should.
We can hope that medical advances will someday provide miracles for those didn’t appear to need them at the time of their injury.
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