Head or brain injuries are very common and often life threatening if proper and prompt medical intervention is not done. Dr P V Ramana, head of the department of neurosurgery and spinal surgery at Seven Hills Hospital, replies to commonly asked questions related to head injury:1. How does one recognise head injury in a road accident victim?In a road accident, if any person has a visible injury on the head or above the neck or if the person is drowsy, unconscious, non-responsive or has fits, one should suspect injury to the brain (traumatic brain injury or TBI). Also, if the victim is vomiting, complains of headache, bleeds from the nose or ear, TBI can be suspected.2. What can cause brain injury other than accidents?Vascular insufficiency due to blockage of blood supply to the brain, bleeding in the brain, lack of oxygen supply to the brain or infection of the brain can also cause brain injury.3. What are the types of brain injuries?They are generally divided into mild, moderate and severe. When there is no structural damage to the brain and the patient recovers fast, it is called concussion injury. Having microscopic and deep-seated damage but no gross structural damage is called diffuse axonal injury (DAI). Generally, these patients have long term bad outcomes. Other injuries are contusion, bleeding in the brain and its outer surface. Bleeds are operable.4. What goes into the treatment of brain injuries? Are surgeries required in most cases? Most road accident victims have head injuries that are not serious. Many do not require admission, while some require observation and a few need active treatment. There are also surgical options such as removing blood clot or a bone to relieve high intracranial pressure. The outcome depends on various factors including force on the brain during the accident, extent of neuronal damage and arrival of the patient in the golden hour to the hospital.5. What are the differences between mild and moderate head injuries? When a patient is conscious, it's mild head injury, when semi-conscious it's moderate head injury and when fully comatose, it's called severe head injury. The grading depends on the Glasgow Coma Scale, which doctors note down, which in turn depends on the number of neurons that are damaged.6. Can complications surface years after the injury has been treated?Sometimes late onset of seizures or fits can occur. Rarely hydrocephalus (accumulation of cerebrospinal fluid in brain) or accumulation of blood (chronic subdural haematoma) can occur. These conditions may require surgery.7. What are the fallouts of a brain injury? To what extent psychological damage is possible?When TBI occurs, anything to do with the brain is potentially affected. That means basic body functions like eating and sleeping can also be altered. It also means that the complex parts of life such as emotions, thoughts and ability to communicate can be disrupted. In serious cases, TBI can affect the brain's electrical system, causing fits. Such a condition is commonly known as epilepsy. TBI is also known to increase the risk for other conditions such as Alzheimer's and Parkinson's disease as age increases. Behavioural disturbances, problem in decision making and learning skills, mood swings, memory disturbances and lack of social skills can also occur.8. When does a head injury patient slip into coma?When the neuronal damage is severe, intracranial pressure increases and the most vital part of the brain, the brainstem gets damaged, a patient slips into coma. Outcome of such a patient is not good.9. What are the ways to prevent/minimise risk of brain injuries? Wearing a helmet and seatbelt can help prevent head injury in most road accidents. Moreover, protecting the person from further damage and reaching the hospital at the earliest is important. Make sure the victim's mouth and nose are clear. Prevent choking by not pouring water into the mouth. If active bleeding is seen, put pressure with some cloth to prevent blood loss. If a person has a helmet, do not remove it as removing it may cause injury to the spine. Use a plank to shift the victim and do not let the neck hang at any moment. Instead of one person handling the patient, four to five persons handling to shift is better. Make sure someone takes care of the neck and head. Shifting to a hospital by ambulance is best. However, if it's not available, use the back seat of a car to keep the spine flat and not let it bend. Don't shift on a three-wheeler or two-wheeler.10. What is the golden hour and why is it important?In a traumatic brain injury, some nerves in brain are fully damaged, some are partially damaged and some are healthy. If a blood clot or pressure in the brain continues to increase, the normal nerves will get damaged and partially damaged ones will get fully damaged. Timely surgery or treatment will halt this damaging process. Time is nerve. Nowadays we call it golden hour, diamond minutes and platinum seconds.11. Will the person/persons helping a road accident victim get involved in legal issues?Fifty per cent of lives can be saved if patients reach the hospital within the golden hour. But, people are afraid to get involved in accident cases thinking they may have to go to police stations or courts and hospitals will ask for their personnel details. In a landmark move, the Supreme Court approved the guidelines issued by the Centre for the protection of Good Samaritans on March 30, 2016. Persons helping a victim reach a hospital in time need not reveal his or her personal details, name nor any force will be applied on him or her. He/she can leave the hospital soon after providing the information available. He need not wait for the police to arrive. This is called The Good Samaritans' Law.(Compiled by Sulogna Mehta)

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