On Tuesday evening, May 27, the Navigating the Medical System Lecture Series featured a virtual lecture hosted by Congregation Etz Chaim. Dr. Margaret Huynh, an Assistant Professor of Neurology at Weill Cornell Medical College and an attending neurointensivist and neurologist at NewYork-Presbyterian/Weill Cornell Medical Center, shared many valuable facts about traumatic brain injury (TBI).
TBI is an injury to the brain caused by an external force. It can result from a penetrating brain injury, external trauma, or a blast injury. TBI may impair thinking, language, memory, attention, and behavior. It impacts how a person interacts with and perceives his or her environment.
The most frequent causes of TBI include falls, motor vehicle accidents, sports injuries, assaults, and gun-related incidents.
Dr. Huynh then explained the different classifications of brain injuries. The mildest form is a mild concussion, which can cause disorientation and may include loss of consciousness for less than 30 minutes. Most people with this type of injury recover within weeks or months.
Moderate brain injury presents with confusion, drowsiness, and difficulty articulating. In this category, a person can lose consciousness for up to 24 hours. Doctors will often see signs of the injury on a CT scan.
In the most severe category, the person is comatose for more than 24 hours due to the severity of the injury. These patients tend to have significant complications.
Symptoms of TBI include headaches, seizures, nausea, sleep disturbances, balance and walking difficulties, blurry vision, trouble swallowing, cognitive issues (such as impaired judgment and decision-making), slower information processing, and speech difficulties.
Following a TBI, one in four individuals develops depression, anxiety, or impulsivity. If someone with a brain injury experiences repeated vomiting, confusion, difficulty walking, sleepiness, or a severe headache, he or she should seek immediate attention at the Emergency Room.
Dr. Huynh noted that the most common long-term symptoms include memory and concentration difficulties, balance problems, persistent headaches, movement issues, and emotional challenges such as depression and anxiety.
Every nine seconds, someone in the United States suffers a brain injury. Each year, 190 deaths are attributed to TBI. Those most vulnerable are individuals aged 75 and older, who have the highest rates of hospitalization and death related to TBI.
TBI can significantly impact quality of life. In childhood, it can affect development, and on a societal level, the economic burden is vast. A decade ago, TBI-related costs were estimated at $76 billion – and they are even higher now.
Anyone can suffer a TBI, but certain age groups are at highest risk: children aged 0–4, adolescents aged 15-24, and adults 65 and older. Dr. Huynh noted that 20 percent of high school students have reported experiencing a sports-related concussion – most of them male.
Treatment for mild TBI includes rest, allowing the brain time to recover, and pain relief for headaches. A gradual and progressive return to work, school, or activity is recommended.
Patients with moderate or severe TBI are considered high risk due to complications. They are admitted to the hospital for monitoring, especially for brain bleeding. Some may require surgery. Brain swelling is common in these cases, and doctors monitor, treat, and attempt to prevent this life-threatening condition. Vascular injury, stroke, and seizures are potential complications, so medication is administered to prevent seizures.
Dr. Huynh explained, “Our goal in the neuro ICU is to minimize any secondary injury. We monitor and try to prevent complications, optimize blood flow to the brain, and ensure optimal oxygen delivery. We are a Level 1 trauma center with multiple modalities of monitoring. We monitor for seizures and any changes on brain wave monitors.”
They also use more advanced monitoring techniques, including a fiber optic probe to assess brain oxygenation.
Unfortunately, many patients do not recover well. Dr. Huynh added, “Our hope is to maximize those who can do well with a functional outcome.”
She emphasized that prevention is critical, because traumatic brain injury is preventable.
Children aged 10-14 and older adults are at highest risk for pedestrian injuries. Dr. Huynh reviewed essential pedestrian safety tips:
Obey traffic signals and make double-takes before crossing.
Never run into the street; cross only at designated areas.
Be alert to turning vehicles and make eye contact with drivers.
Always walk on sidewalks.
Wear reflective or white clothing at night.
She also emphasized:
Always wear seatbelts.
Wear helmets during construction, sports, cycling, skateboarding, and other contact activities.
Never drive under the influence of drugs, alcohol, or marijuana.
Fall prevention tips, especially for older adults, include:
Evaluate your fall risk with your doctor.
Visit the National Council on Aging website for fall risk assessments.
Schedule annual eye and foot exams.
Do strength and balance exercises regularly.
Make your home safer by:
Removing clutter on the floor or stairs.
Fixing uneven surfaces.
Ensuring good lighting, especially on staircases.
Minimizing use of high surfaces like ladders and chairs.
Modifying bathrooms for fall safety.
Child safety measures:
Install window guards and safety gates at the top of stairs.
Avoid unsupervised access to elevated areas.
Keep firearms locked.
Use playgrounds with soft flooring.
Never shake a baby.
Car safety guidelines:
Use age-appropriate car seats and seatbelts.
Ensure that the car seat is not expired or second-hand (if avoidable).
Verify that the car seat is properly installed.
Adjust harnesses snugly to the baby’s chest.
As always, thank you to Dr. Breite and Congregation Etz Chaim for providing this valuable and informative lecture.
