Traumatic head injury, which my Hong Kong colleague Justine Lau describes so graphically in Saturday’s FT Magazine, is all too common.
In most industrialised countries the number of people admitted to hospital with a brain injury is similar to the number who suffer a stroke: around 135,000 a year in the UK. Around half a million Britons are living with long-term disabilities from head injuries, according to the charity Headway. Again, the number is similar to those disabled by stroke, except that most injury victims are much younger; half of all deaths in adults under 40 are due to traumatic brain damage.
The brain contains about 1.3kg of white matter, with a texture similar to soft blancmange, held together in the skull by several layers of membrane. The effect of a traffic accident such as Justine’s is like vigorously shaking a plate of blancmange. The brain shears and tears, disrupting the connections between neurons (nerve cells), while bony ridges underneath the skull can lacerate the front of the brain. At the same time blood vessels tear and bleed, leading to a dangerous build-up of pressure as clots form within the brain.
While a stroke tends to affect a specific area of the brain, accidental impact usually causes more general damage. Symptoms and outcome vary greatly, of course. The death of actress Natasha Richardson in March, after initially refusing treatment following a skiing accident in Canada, showed that what seems at first to be a relatively minor blow to the head can trigger fatal bleeding. Conversely, some people recover almost completely from horrific initial injuries.
However many patients suffer from a common range of distressing symptoms and Justine’s account illustrates several of them. One is post-traumatic amnesia, the period after the patient emerges from unconsciousness following the accident and appears to be conscious and awake – but is behaving or talking in a bizarre or uncharacteristic manner, and cannot remember what happened a few hours or even a few minutes ago. Justine’s talking and acting like a child is typical of this phase.
Another symptom, which often occurs during the period after the patient has emerged from post-traumatic amnesia and is coming to terms with the accident’s long-term consequences, is severe depression, including suicidal thoughts and actual suicide attempts.
On the positive side, the brain shows remarkable adaptability – plasticity in scientific parlance. Gradually, the neurons re-form broken connections or make new ones to bypass areas that have been permanently damaged.
The best sign of recovery is returning to work. A rule of thumb is that if someone does not get back to work within two years, he or she is unlikely ever to do so. Justine’s return to the FT Hong Kong bureau 10 months after the accident is an excellent sign for her long-term future.