Wednesday, March 7, 2012

Brain Injury OR Concussion

Brain injury

For the scientific journal on brain injuries, see Brain Injury (journal).
Not to be confused with Nerve injury.
A CT of the head years after a traumatic brain injury showing an empty space where the damage occurred marked by the arrow.
A brain injury is any injury occurring in the brain of a living organism. Brain injuries can be classified along several dimensions. Primary and secondary brain injury are ways to classify the injury processes that occur in brain injury, while focal and diffuse brain injury are ways to classify the extent or location of injury in the brain. Specific forms of brain injury include:
Brain damage, the destruction or degeneration of brain cells.
Traumatic brain injury, damage that occurs when an outside force traumatically injures the brain.
Stroke, a vascular event causing damage in the brain.
Acquired brain injury, damage to the brain that occurs after birth, regardless of whether it is traumatic or non traumatic, or whether due to an outside or internal cause.

concussion
A concussion is a mild form of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head. Concussions can also occur from a fall or a blow to the body that causes the head to move rapidly back and forth.
Doctors may describe these injuries as “mild” because concussions are usually not life-threatening. Even so, their effects can be serious. Understanding the signs and symptoms of a concussion can help you get better more quickly.
Leading causes of concussion (seen in emergency departments):
•falls
•motor vehicle-related injury
•unintentionally being struck by or against an obstacle
•assaults
•playing sports
etc.

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Most people with a concussion recover quickly and fully. But for some people, symptoms can last for days, weeks, or longer.In general, recovery maybe slower among older adults, young children, and teens. Those who have had a concussion in the past are also at risk of having another one and may find that it takes longer to recover if they have another concussion.

DANGER SIGNS ADULTS
In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull.Contact your doctor or emergency department right away if you have any of the following danger signs after a bump, blow, or jolt to the head or body:
•Headache that gets worse and does not go away
•Weakness, numbness or decreased coordination
•Repeated vomiting or nausea
•Slurred speech The people checking on you should take you to an emergency department right away if you:
•Look very drowsy or cannot be awakened
•Have one pupil (the black part in the middle of the eye) larger than the other
•Have convulsions or seizures
•Cannot recognize people or places
•Are getting more and more confused, restless, or agitated•Have unusual behavior
•Lose consciousness (a brief loss of consciousness should betaken seriously and the person should be carefully monitored).

DANGER SIGNS CHILDREN
Take your child to the emergency department right away if they received a bump, blow, or jolt to the head or body, and:
•Have any of the danger signs for adults listed above
•Will not stop crying and cannot be consoled
•Will not nurse or eat
Young children can have the same symptoms of a concussion as older children, but it is harder for them to let others know how they are feeling. In addition to the symptoms mentioned on page 5, call your child’s doctor right away if your child seems to be getting worse or if you notice any of the following:
•Crying more than usual
•Headache that will not go away
•Change in the way they play, perform or act at school
•Change in nursing, eating, or sleeping patterns•Becoming easily upset or increased temper tantrums
•Sad mood
•Lack of interest in usual activities or favorite toys
•Loss of new skills, such as toilet training
•Loss of balance, unsteady walking
•Poor attention

Because concussions are often missed or misdiagnosed among older adults, be especially alert if you know that an older adult has fallen or has a fall-related injury, such as Chip fracture. Older adults may have a higher risk of serious complications from a concussion, such as bleeding on the brain. Headaches that get worse or increased confusion resigns of this complication. If they occur, see a doctor right away. Older adults often take blood thinners; if they do, they should be seen immediately by a health care provider if they have a bump or blow to the head or body even if they do not have any of the symptoms


Some people who have had a concussion find that at first it is hard to do their daily activities, their job, to get along with everyone at home, or to relax. Ignoring your symptoms and trying to “tough it out” often makes symptoms worse.
Although most people recover fully after a concussion, how quickly they improve depends on many factors. These factors include how severe their concussion was, their age, how healthy they were before the concussion, and how they take care of themselves after the injury.
Rest is very important after a concussion because it helps the brain to heal.You’ll need to be patient because healing takes time. Only when the symptoms have reduced significantly, in consultation with your doctor, should you slowly and gradually return to your daily activities, such as work or school. If your symptoms come back or you get new symptoms as you become more active, this is a sign that you are pushing yourself too hard. Stop these activities and take more time to rest and recover. As the days go by, you can expect to gradually feel better.

If you already had a medical condition at the time of your concussion (such as chronic headaches), it may take longer for you to recover from the concussion. Anxiety and depression may also make it harder to adjust to the symptoms of a concussion. While you are healing, you should be very careful to avoid doing anything that could cause a bump,blow, or jolt to the head or body. On rare occasions, receiving another concussion before the brain has healed can result in brain swelling, permanent brain damage, and even death,particularly among children and teens.

After you have recovered from your concussion, you should protect yourself from having another one. People who have had repeated concussions may have serious long-term problems, including chronic difficulty with concentration,memory, headache, and occasionally, physical skills, such as keeping one’s balance.
Facts.

TIPS FOR HEALING:
ADULTS

Tips to help you get better:
•Get plenty of sleep at night, and rest during the day.
•Avoid activities that are physically demanding (e.g.,heavy housecleaning, weightlifting/working-out) or require a lot of concentration (e.g., balancing your checkbook). They can make your symptoms worse and slow your recovery.
•Avoid activities, such as contact or recreational sports,that could lead to a second concussion. (It is best to avoid roller coasters or other high speed rides that can make your symptoms worse or even cause a concussion.)
•When your doctor says you are well enough, return to your normal activities gradually, not all at once.
•Because your ability to react may be slower after a concussion, ask your doctor when you can safely drive a car, ride a bike, or operate heavy equipment.
•Talk with your doctor about when you can return to work. Ask about how you can help your employer understand what has happened to you.
•Consider talking with your employer about returning to work gradually and about changing your work activities or schedule until you recover (e.g., work half-days).
•Take only those drugs that your doctor has approved.
•Do not drink alcoholic beverages until your doctor says you are well enough. Alcohol and other drugs may slow your recovery and put you at risk of further injury.
•Write down the things that may be harder than usual for you to remember.
•If you’re easily distracted, try to do one thing at a time.For example, don’t try to watch TV while fixing dinner.
•Consult with family members or close friends when making important decisions.
•Do not neglect your basic needs, such as eating well and getting enough rest.
•Avoid sustained computer use, including computer/video games early in the recovery process.
•Some people report that flying in airplanes makes their symptoms worse shortly after a concussion.

CHILDREN
Parents and caregivers of children who have had a concussion can help them recover by taking an active role in their recovery:
•Having the child get plenty of rest. Keep a regular sleep schedule, including no late nights and no sleepovers.
•Making sure the child avoids high-risk/ high-speed activities such as riding a bicycle, playing sports, or climbing playground equipment, roller coasters or rides that could result in a second bump, blow, or jolt to the head or body. Children should not return to these types of activities until the doctor says they are well enough.
•Giving the child only those drugs that are approved by the pediatrician or family physician.
•Talking with the doctor about when the child should return to school and other activities and how the parent or caregiver can help the child deal with the challenges that the child may face. For example, your child may need to spend fewer hours at school, rest often, or require more time to take tests.
•Sharing information about concussion with parents,siblings, teachers, counselors, babysitters, coaches, and others who interact with the child helps them understand what has happened and how to meet the child’s needs.

HELP FOR PEOPLE WITH CONCUSSION
There are many people who can help you and your family as you recover from a concussion. You do not have to do it alone.
Show this booklet to your doctor or health care provider and talk with them about your concerns. Ask your doctor about whether you need specialized treatment and about the availability of rehabilitation programs.
Your doctor can help you find a health care provider who has special training in treating concussion. Early treatment of symptoms by a specialist may speed recovery. Your doctor may refer you to a neuropsychologist, neurologist, or specialist in rehabilitation.
Keep talking with your doctor, family members, and loved ones about how you are feeling, both physically and emotionally. If you do not think you are getting better, tell your doctor.

HELP FOR FAMILIES AND CAREGIVERS
When someone close to you has a concussion or a moreserious brain injury, it can be hard to know how best to help.They may say that they are “fine,” but you can tell from howthey are acting that something has changed.
If you notice that your family member or friend hassymptoms of a concussion that are getting worse, talk tothem and their doctor about getting help. They may needhelp if you can answer YES to any of the following questions:
•Are any of the concussion symptoms substantiallyaffecting their life activities (such as feeling restricted intheir activities due to symptoms, performance in schoolor at work has changed, unhappy with life changes)?
•Has their personality changed?
•Do they get angry for no reason?•Do they get lost or easily confused?
•Do they have more trouble than usual making decisions?

You might want to talk with people who share yourexperience. The Brain Injury Association of America can putyou in contact with people who can help

Wednesday, November 23, 2011

The Architecture of Brain

The hindbrain includes the upper part of the spinal cord,
the brain stem, and a wrinkled ball of tissue called the
cerebellum (1) . The hindbrain controls the body’s
vital functions such as respiration and heart rate. The
cerebellum is responsible for learned rote movements.
When you play the piano or hit a tennis ball you are
activating the cerebellum. Above the hindbrain lies the
midbrain, which controls some reflex actions and is part
of the circuit responsible for voluntary movements.
The forebrain is the largest and most highly developed
part of the human brain; it consists primarily of the
cerebrum and the structures hidden beneath it
(see "The Inner Brain").

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When people see pictures of the brain it is usually the
cerebrum that they notice. The cerebrum sits at the
outermost part of the brain and is the source of
intellectual activities. It holds your memories, allows you
to plan, enables you to imagine and think. It allows you
to recognize friends, read books, and play games.
The cerebrum(2) is split into two halves (hemispheres) by
a deep fissure. Despite the split, the two cerebral
hemispheres communicate with each other through a
thick tract of nerve fibers that lies at the base of this
fissure. Although the two hemispheres seem to be mirror
images of each other, they are different. For instance, the
ability to form words seems to lie primarily in the left
hemisphere, while the right hemisphere seems to control
many abstract reasoning skills.
For some unknown reason, nearly all of the signals from
the brain to the body and vice-versa cross over on their
way to and from the brain. This means that the right
cerebral hemisphere primarily controls the left side of the
body and the left hemisphere primarily controls the right
side. When one side of the brain is damaged, the opposite
side of the body is affected. For example, a stroke in
the right hemisphere of the brain can leave the left arm
and leg paralyzed.
The Geography of Thought
Each cerebral hemisphere can be divided into sections,
or lobes, each of which specializes in different functions.
To understand each lobe and its specialty we will take a
tour of the cerebral hemispheres, starting with the two
frontal lobes (3), which lie directly behind the forehead.
When you plan a schedule, imagine the future, or
use reasoned arguments, these two lobes are working.
One of the ways the frontal lobes seem to do these things
is by acting as short-term storage sites, allowing one idea
to be kept in mind while other ideas are considered.
In the rear portion of each frontal lobe is a
motor area(4) , which helps control voluntary
movement. A nearby place on the left frontal lobe called
Broca’s area (5) allows thoughts to be transformed
into words.
When you enjoy a good meal—the taste, aroma, and
texture of the food—two sections behind the frontal lobes
called the parietal lobes (6) are at work. The
forward parts of these lobes, just behind the motor areas,
are the primary sensory areas (7) . These areas
receive information about temperature, taste, touch,
and movement from the rest of the body. Reading and
arithmetic are also functions in the repertoire of each
parietal lobe.
As you look at the words and pictures on this page, two
areas at the back of the brain are at work. These lobes,
called the occipital lobes (8), process images
from the eyes and link that information with images
stored in memory. Damage to the occipital lobes can
cause blindness.
The last lobes on our tour of the cerebral hemispheres
are the temporal lobes (9) , which lie in front of
the visual areas and nest under the parietal and frontal
lobes. Whether you appreciate symphonies or rock
music, your brain responds through the activity of these
lobes. At the top of each temporal lobe is an area
responsible for receiving information from the ears.
The underside of each temporal lobe plays a crucial role
in forming and retrieving memories, including those
associated with music. Other parts of this lobe seem
to integrate memories and sensations of taste, sound,
sight, and touch.

Monday, May 2, 2011

Brain

This article is about the brains of all types of animals, including humans. For information specific to the human brain, see Human brain. For other uses, see Brain (disambiguation).

The brain is the center of the nervous system in all vertebrate and most invertebrate animals. Some primitive animals such as jellyfish and starfish have a decentralized nervous system without a brain, while sponges lack any nervous system at all. In vertebrates the brain is located in the head, protected by the skull and close to the primary sensory apparatus of vision, hearing, balance, taste, and smell.

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Brains can be extremely complex. The cerebral cortex of the human brain contains roughly 15–33 billion neurons, perhaps more, depending on gender and age, linked with up to 10,000 synaptic connections each. Each cubic millimeter of cerebral cortex contains roughly one billion synapses. These neurons communicate with one another by means of long protoplasmic fibers called axons, which carry trains of signal pulses called action potentials to distant parts of the brain or body and target them to specific recipient cells.

The brain controls the other organ systems of the body, either by activating muscles or by causing secretion of chemicals such as hormones and neurotransmitters. This centralized control allows rapid and coordinated responses to changes in the environment. Some basic types of responsiveness are possible without a brain: even single-celled organisms may be capable of extracting information from the environment and acting in response to it. Sponges, which lack a central nervous system, are capable of coordinated body contractions and even locomotion. In vertebrates, the spinal cord by itself contains neural circuitry capable of generating reflex responses as well as simple motor patterns such as swimming or walking.[6] However, sophisticated control of behavior on the basis of complex sensory input requires the information-integrating capabilities of a centralized brain.

Despite rapid scientific progress, much about how brains work remains a mystery. The operations of individual neurons and synapses are now understood in considerable detail, but the way they cooperate in ensembles of thousands or millions has been very difficult

Vertebrate brain regions

Neuroanatomists usually consider the brain to consist of six main regions: the telencephalon (cerebral hemispheres), diencephalon (thalamus and hypothalamus), mesencephalon (midbrain), cerebellum, pons, and medulla oblongata. Each of these areas in turn has a complex internal structure. Some areas, such as the cortex and cerebellum, consist of layers, folded or convoluted to fit within the available space. Other areas consist of clusters of many small nuclei. If fine distinctions are made on the basis of neural structure, chemistry, and connectivity, thousands of distinguishable areas can be identified within the vertebrate brain.

Some branches of vertebrate evolution have led to substantial changes in brain shape, especially in the forebrain. The brain of a shark shows the basic components in a straightforward way, but in teleost fishes (the great majority of modern species), the forebrain has become "everted", like a sock turned inside out. In birds, also, there are major changes in shape. One of the main structures in the avian forebrain, the dorsal ventricular ridge, was long thought to correspond to the basal ganglia of mammals, but is now thought to be more closely related to the neocortex.
Several brain areas have maintained their identities across the whole range of vertebrates, from hagfishes to humans. Here is a list of some of the most important areas, along with a very brief description of their functions as currently understood (but note that the functions of most of them are still disputed to some degree):

The medulla, along with the spinal cord, contains many small nuclei involved in a wide variety of sensory and motor functions.
The hypothalamus is a small region at the base of the forebrain, whose complexity and importance belies its size. It is composed of numerous small nuclei, each with distinct connections and distinct neurochemistry. The hypothalamus is the central control station for sleep/wake cycles, control of eating and drinking, control of hormone release, and many other critical biological functions.
Like the hypothalamus, the thalamus is a collection of nuclei with diverse functions. Some of them are involved in relaying information to and from the cerebral hemispheres. Others are involved in motivation. The subthalamic area (zona incerta) seems to contain action-generating systems for several types of "consummatory" behaviors, including eating, drinking, defecation, and copulation.
The cerebellum modulates the outputs of other brain systems to make them more precise. Removal of the cerebellum does not prevent an animal from doing anything in particular, but it makes actions hesitant and clumsy. This precision is not built-in, but learned by trial and error. Learning how to ride a bicycle is an example of a type of neural plasticity that may take place largely within the cerebellum.
The tectum, often called "optic tectum", allows actions to be directed toward points in space. In mammals it is called the "superior colliculus", and its best studied function is to direct eye movements. It also directs reaching movements, though. It gets strong visual inputs, but also inputs from other senses that are useful in directing actions, such as auditory input in owls, input from the thermosensitive pit organs in snakes, etc. In some fishes, such as lampreys, it is the largest part of the brain.
The pallium is a layer of gray matter that lies on the surface of the forebrain. In reptiles and mammals it is called cortex instead. The pallium is involved in multiple functions, including olfaction and spatial memory. In mammals, where it comes to dominate the brain, it subsumes functions from many subcortical areas.
The hippocampus, strictly speaking, is found only in mammals. However, the area it derives from, the medial pallium, has counterparts in all vertebrates. There is evidence that this part of the brain is involved in spatial memory and navigation in fishes, birds, reptiles, and mammals.
The basal ganglia are a group of interconnected structures in the forebrain, of which our understanding has increased enormously over the last few years. The primary function of the basal ganglia seems to be action selection. They send inhibitory signals to all parts of the brain that can generate actions, and in the right circumstances can release the inhibition, so that the action-generating systems are able to execute their actions. Rewards and punishments exert their most important neural effects within the basal ganglia.
The olfactory bulb is a special structure that processes olfactory sensory signals, and sends its output to the olfactory part of the pallium. It is a major brain component in many vertebrates, but much reduced in primates.

Mammals

The cerebral cortex is the part of the brain that most strongly distinguishes mammals from other vertebrates, primates from other mammals, and humans from other primates. The hindbrain and midbrain of mammals are generally similar to those of other vertebrates, but dramatic differences appear in the forebrain, which is not only greatly enlarged, but also altered in structure. In non-mammalian vertebrates, the surface of the cerebrum is lined with a comparatively simple layered structure called the pallium. In mammals, the pallium evolves into a complex 6-layered structure called neocortex or isocortex. In primates, the neocortex is greatly enlarged, especially the part called the frontal lobes. In humans, this enlargement of the frontal lobes is taken to an extreme, and other parts of the cortex also become quite large and complex. The hippocampus of mammals also has a distinctive structure.

Unfortunately, the evolutionary history of these mammalian features, especially the 6-layered cortex, is difficult to trace.[34] This is largely because of a missing link problem. The ancestors of mammals, called synapsids, split off from the ancestors of modern reptiles and birds about 350 million years ago. However, the most recent branching that has left living results within the mammals was the split between monotremes (the platypus and echidna), marsupials (opossum, kangaroo, etc.) and placentals (most living mammals), which took place about 120 million years ago. The brains of monotremes and marsupials are distinctive from those of placentals in some ways, but they have fully mammalian cortical and hippocampal structures. Thus, these structures must have evolved between 350 and 120 million years ago, a period that has left no evidence except fossils, which do not preserve tissue as soft as brain.

Primates

The brains of humans and other primates contain the same structures as the brains of other mammals, but are considerably larger in proportion to body size. Most of the enlargement comes from a massive expansion of the cortex, focusing especially on the parts serving vision and forethought. The visual processing network of primates is very complex, including at least 30 distinguishable areas, with a bewildering web of interconnections. Taking all of these together, visual processing makes use of more than half of the primate neocortex. The other part of the brain that is greatly enlarged is the prefrontal cortex, whose functions are difficult to summarize succinctly, but relate to planning, working memory, motivation, attention, and executive control.

For basic information about brains

The human brain is the center of the human nervous system. Enclosed in the cranium, the human brain has the same general structure as that of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Most of the spatial expansion comes from the cerebral cortex, a convoluted layer of neural tissue which covers the surface of the forebrain. Especially expanded are the frontal lobes, which are associated with executive functions such as self-control, planning, reasoning, and abstract thought. The portion of the brain devoted to vision, the occipital lobe, is also greatly enlarged in human beings.

Brain evolution, from the earliest shrew-like mammals through primates to hominids, is marked by a steady increase in encephalization, or the ratio of brain to body size. The human brain has been estimated to contain 80 or 90 billion (~85 109) non-neuronal cells (glial cells) and an approximately equal number of (~86 109) neurons, of which about 10 billion (1010) are cortical pyramidal cells. These cells pass signals to each other via as many as 1000 trillion (1015, 1 quadrillion) synaptic connections. Due to evolution and synaptic pruning, however, the modern human brain has been shrinking over the past 28,000 years.

The brain monitors and regulates the body's actions and reactions. It continuously receives sensory information, and rapidly analyzes these data and then responds accordingly by controlling bodily actions and functions. The brainstem controls breathing, heart rate, and other autonomic processes that are independent of conscious brain functions. The neocortex is the center of higher-order thinking, learning, and memory. The cerebellum is responsible for the body's balance, posture, and the coordination of movement.

Despite being protected by the thick bones of the skull, suspended in cerebrospinal fluid, and isolated from the bloodstream by the blood-brain barrier, the human brain is susceptible to many types of damage and disease. The most common forms of physical damage are closed head injuries such as a blow to the head, a stroke, or poisoning by a wide variety of chemicals that can act as neurotoxins. Infection of the brain, though serious, is rare due to the biological barriers which protect it. The human brain is also susceptible to degenerative disorders, such as Parkinson's disease, multiple sclerosis, and Alzheimer's disease. A number of psychiatric conditions, such as schizophrenia and depression, are widely thought to be associated with brain dysfunctions, although the nature of such brain anomalies is not well understood.