What You Should Know About Traumatic Brain Injury

Actor and comic, Bob Saget, died on January 9th, 2022 at age 65. He was discovered unresponsive in his Ritz-Carlton Resort room in Orlando, Florida. On the time, the reason for loss of life was unknown; a January tenth post-mortem report dominated out medicine or foul play. Now we all know what took the lifetime of this beloved entertainer, husband and father.

The report from the Orange County Medical Examiner, launched February tenth, revealed a number of indicators of head trauma, together with posterior scalp abrasions, cranium fracture-induced eyelid discoloration, a subdural hematoma in addition to a subarachnoid hemorrhage (extra particulars later).

The post-mortem report, obtained by People, additionally revealed that Saget was optimistic for Covid-19. In December 2021, The Full Home star had revealed that he had Covid-19. A PCR check can stay optimistic for a number of weeks. The toxicology report didn’t reveal illicit substances however was notable for clonazepam (a.okay.a. Klonopin), a benzodiazepine used to deal with circumstances reminiscent of panic dysfunction, seizures and nervousness. He additionally examined optimistic for trazodone, a drugs for treating insomnia. Power coronary heart illness (atherosclerosis of the aorta and coronary arteries), not an unusual discovering in Saget’s age group, was one other post-mortem discovering.

Based mostly on the post-mortem and toxicology stories, Chief Medical Examiner Joshua Stephany, MD concluded that Saget died from blunt head trauma: “His accidents have been most certainly incurred from an unwitnessed fall. A toxicology evaluation didn’t reveal any illicit medicine or toxins. The style of loss of life is accident.” His household believed that Saget “by accident hit the again of his head on one thing, fell backwards, thought nothing of it and went to sleep.”

As an dependancy medication physician, I deal with many sufferers who take sedating substances: opioids, antidepressants, sleeping meds and plenty of others (alcohol worsens sedation). I all the time present the usual warning about drowsiness, not driving or working heavy equipment. So, I couldn’t assist however surprise: did Saget journey and fall backwards after taking clonazepam and trazodone – two medicines recognized to trigger drowsiness? Or was he feeling lightheaded from his meds? It’s a moot level now for Mr. Saget’s household. But it surely’s an vital reminder for the hundreds of thousands of people that take sedating medicines and different substances together with alcohol which might impair each our steadiness and judgement.  

After the tragic discovery of head trauma as the reason for Saget’s loss of life and as an harm sustained by so lots of my sufferers and members of the family, I made a decision to put in writing about the important thing options about mind and cranium trauma.

Traumatic Mind Harm

In keeping with the CDC, traumatic mind harm (TBI) is a number one explanation for loss of life and incapacity in the US, killing roughly 166 folks every day. Males symbolize almost 80% of all reported TBI circumstances. The 2 predominant causes of TBIs embrace a bump, blow or jolt to the pinnacle; or a penetrating harm to the pinnacle reminiscent of a gunshot or knife wound.

“Falls stay the main explanation for TBI, adopted by motorcar accidents,” explains Isaac Karikari, MD, affiliate professor of neurosurgery at Duke College Hospital. “Sufferers who’re 65 years and older endure the very best mortality once they develop TBI.”

The CDC lists 3 predominant kinds of TBI. Delicate TBI or concussions are usually not life-threatening however can nonetheless be severe. Reasonable and extreme TBI can result in life-long well being issues (for individuals who survive) and lead to a considerable societal and financial toll. The lifetime financial value of TBI (together with medical prices) was about $76.5 billion in 2010.

Signs differ extensively and rely upon the severity of the pinnacle harm, starting from headache, confusion, vomiting and temper modifications to slurred speech, paralysis, coma and lack of bowel or bladder management.

TBI-Associated Accidents

The American Association of Neurological Surgeons (AANS) describes a number of accidents attributable to TBIs together with “mass lesions” which might improve stress inside the mind. A hematoma is a blood clot anyplace inside the mind; an epidural hematoma (which claimed the lifetime of actress Natasha Richardson) develops between the dura mater and the within of the cranium versus a subdural hematoma (skilled by Saget) which collects between the dura mater and the arachnoid layer.

A contusion is bruising of mind tissue consisting of injured or swollen mind combined with blood leaked from arteries, veins or capillaries. A subarachnoid hemorrhage (SAH), additionally discovered on Saget’s post-mortem, happens when blood enters the subarachnoid area and is generally delicate; extreme SAH can result in hydrocephalus, a buildup of fluid within the ventricles or cavities deep inside the mind.

“Epidural hematomas are infamous for inflicting a lucid interval,” describes Christa Swisher, MD, a neurocritical care doctor at Atrium Health. “Chances are you’ll seemingly really feel fantastic however then later because the hemorrhage exterior the mind steadily worsens and will increase stress on the mind, it causes an increasing number of signs and will finally result in loss of life if not acknowledged and handled in time.”

When to Name 911 – Particularly Amongst Aged Adults

As a reassuring reminder, most falls and head accidents are benign and do NOT lead to severe or long-term penalties. But when the affect was important (i.e. not only a mild faucet) or if regarding signs develop (dizziness, blurry imaginative and prescient, habits modifications, and so forth.), then 911 must be referred to as.

“Sufferers must be monitored at house for brand spanking new or worsening signs reminiscent of a extreme headache, confusion or vomiting,” states Dr. Swisher. “In a state of affairs like this, 911 must be referred to as instantly.”

Dr. Karikari concurs: “Any aged one who falls and strikes his or her head must be monitored carefully by members of the family or caretakers. Any change of their psychological standing, headache complaints and extreme sleepiness ought to immediate fast medical analysis.”

TBIs may be missed or misdiagnosed in older adults who usually tend to be hospitalized and die from head trauma. Signs of TBI usually overlap with different medical circumstances generally skilled by older adults reminiscent of dementia. Take particular be aware of older people who take anticoagulants reminiscent of warfarin (Coumadin), apixaban (Eliquis) or rivaroxaban (Xarelto); or antiplatelet medicines like Aspirin or clopidogrel (Plavix). These meds can improve the danger of a mind bleed following a TBI. Have a low threshold for calling 911.

Prevention

Many head accidents are preventable, in accordance with the Cleveland Clinic. Evaluate your medicines along with your physician or pharmacist – discover out which of them trigger dizziness and improve your threat of falls. Fall-proof your property by clearing away toys, eradicating unfastened rugs and putting in bathtub seize bars and staircase handrails. Put on a helmet when biking, skating, driving a bike or taking part in sports activities like hockey or soccer. Buckle up when behind the wheel utilizing seat belts, or use automotive seats or booster seats for youths; keep away from driving when beneath the affect or feeling drowsy. Optimize your imaginative and prescient by getting common eye exams and organising good lighting in stairwells and hallways. Construct muscle and enhance steadiness via actions reminiscent of yoga, tai chi and power coaching. Use strolling assistive gadgets, if wanted, reminiscent of canes and walkers to be steadier in your ft.

*****

On a private be aware, I wished to share my story with the legend himself. I had the chance to see Mr. Saget carry out dwell final June at a comedy membership, Levity Dwell, in West Nyack, NY. The cherished comedian couldn’t comprise his jubilation on the sight of a dwell viewers…and utilized his distinctive model of sarcasm: “I imply, who goes out on a Wednesday evening to see comedy in an deserted mall?” All of us laughed as a result of all of us certainly drove out to the Palisades Middle in the course of the week as a result of we beloved Bob! And he reciprocated: “YOU do. And I really like you.” I bought it. The outpouring of affection from his fellow comedians and closest friends – Jeff Ross, Steve Martin, Mindy Kaling, George Wallace and numerous others – echoed loud and clear in my damaged coronary heart. I ship my deepest condolences to Mr. Saget’s household and family members…and hope Bob’s having a hearty snigger in heaven.