Brain Injury Basics: What You Need to Know

More Concussion Questions Answered

So why, in some cases, does it take only a single head injury to do so much damage? I mean, think of all of the professional football players whose heads get knocked around week after week for 20 years? And in most cases, they walk off the field alive.

Of course, there are cases where football players can get an injury and be dead in a few hours. In those cases, they are hit from an angle, and the brain can whip around inside the skull, tearing and stretching, which causes a large hemorrhage and they don't get to the hospital in time.

But the ones who get multiple injuries and still walk off the field are getting tiny tears repetitively over time. A leading cause of Alzheimer's disease and dementia is head injuries.

There are plenty of different ways to fall, and different consequences for each. What's the difference between hitting your forehead from a forward fall versus hitting the back of your head on a backward fall?

It's not just the force, it's the way it's applied. In a rotational shearing of the brain from whiplash, you hit the head and the whole brain rotates and causes tears. You can think of it as the brain stretching. Parts of it are moving faster than others, and that stretching causes a tearing of the tissue -- even deep tissue that's responsible for being awake. The fibers in the front part of the brain are most likely to get stretched, and those are the ones that correlate with attention and memory.

The really bad injury comes from being hit on the side. If you're hit in the front, the brain goes back and forth in a linear fashion. If you hit the side of your head, it's more likely to rotate in the dangerous manner I just described. If a woodpecker hit a tree at an angle, it would pass out. That's why it hits the tree straight on.

So what does happen when you're hit straight on?

People can get a nose fracture, eye fractures or a forehead bruise, and that absorbs a lot of the energy. And it's very rare to get a traumatic brain injury from being hit on the back of the head. The back part doesn't stretch very much because it's part of the neck. If it did, people after a concussion would complain of being blind, because that's the part of the brain that controls vision.

Can Immediate and proper care at the hospital make a huge difference?

Seventy-five percent of trauma centers now monitor brain pressure. But one out of four don't routinely follow best practices, and we're trying to get this number up. When following best practice guidelines, for example, you want to know that the brain's getting oxygen. If care centers take certain steps, mortality falls by 50 percent.

Immediate care can also prevent a fatality. I strongly encourage everyone to take a CPR course because that is life-saving. ... If there's a lot of pressure in the brain, you're not going to be breathing properly.

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