Every brain is different. We know this because each person’s brain develops with a unique personality. But the brain as an organ even differs from person to person, and reacts uniquely to injury.
“I know that if I examine a 28-year-old woman’s sprained ankle, it will look and function pretty much the same as an ankle on another woman of about the same age, height and weight who does about the same activities,” said Dr. Heechin Chae, director of the National Intrepid Center of Excellence satellite office at Fort Belvoir, Va. The center is one of nine special centers within the Military Health System that treat those suffering from traumatic brain injury, or TBI. “The brain is so much more complex and difficult to study. Even if a CT scan or MRI image looks the same between two brains, how each of those brains functions is totally different. You can’t predict recovery as easily.”
Brain injuries affect everyone differently as well.
“About 10 percent of people who hit their head, even in a mild way, will have chronic symptoms, such as headaches and sleep issues that can exceed a month,” said Dr. Anthony Panettiere, a clinical neurologist with the center at Walter Reed National Military Medical Center in Bethesda, Md. “Our focus ... is figuring out why some of these people still have symptoms months to years out.”
Most of the brain injuries suffered by U.S. military members are mild TBIs, better known as concussions. It’s a temporary disruption of normal brain function lasting for a few minutes to a few hours. But, said Chae, “There are certain injuries to the brain, whether you get hit or have bleeding in the brain, which disrupt normal function permanently. When you never have a moment after the injury when you feel back to normal, it’s not a concussion or mild TBI.”
Chae said even with mild, temporary TBIs, another issue is the cumulative effects of repeated injuries. The brain is still vulnerable, and the ability to withstand further trauma, whether a physical blow or a mentally stressing event, is diminished. When the brain is injured during this vulnerable state, the recovery is slower and even more unpredictable.
“Even after a person with a concussion feels normal again, many lose the ability to withstand these types of injuries for the next few days or weeks,” he said, adding it’s important to protect the brain from another injury during this vulnerable period. Also, during this time, the brain loses the ability to handle daily pressures it used to handle well. “It’s not the concussion itself that is the problem. But the brain goes through a period when the ability to handle what we call ’normal life stressors’ diminishes dramatically.”
What also makes it difficult to recognize a mild TBI is the brain’s ability to hide injuries – its resiliency – so how you feel might not match how much damage has been done and how vulnerable the brain really is. That’s why the military is transitioning people back to their normal routines at a slower pace. “As doctors, we’re trained if people feel normal after bonking their heads, they have recovered. We base our decision on the patient’s report,” said Chae. “But what we’re learning with the brain is that there’s a discrepancy between how you feel and vulnerability of the brain. Even if someone feels normal, we don’t put them back to work or in play right away, just like how football teams have instituted a concussion protocol, when players are kept out of practices and games, even if they say they feel OK.”
Panettiere said all head trauma is important. “It doesn’t take much of a hit to the head to be a concern, but fortunately, for most people, the symptoms will eventually resolve in time.”
Chae said the science is getting better, ironically helped by the fact the military environment has provided many cases to study, just like how battlefield conditions advanced medicine in general.
“We’re hoping our knowledge and attitudes toward brain injuries will evolve as we know more about the brain and as the science improves,” he said. “The bottom line is knowing that when the brain is injured, it is goes through a vulnerable stage and minimizing the risks of another injury or avoiding harmful things to the brain, such as alcohol, while doing things to promote healing: eating brain-healthy foods, sleeping and resting well, and gradually reintegrating the brain to regular life routines.”