Tranexamic Acid May Prevent Death From Head Injury

Researchers of the CRASH-2 Intracranial Bleeding Study have uncovered the possibility that tranexamic acid may be able to prevent people from dying of head injuries. This hypothesis was derived from the examination of 270 adult trauma patients with traumatic brain injury and with, or at risk of, significant extracranial bleeding within 8 hours of injury. Results of the study were persuasive enough that a CRASH-3 study is needed to test the reliability of this drug among patients with head trauma.

Tranexamic acid, otherwise known as Lysteda or Cyklokapron in the U.S., is often prescribed for excessive bleeding. “It is an antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin, a molecule responsible for the degradation of fibrin. Fibrin is the basic framework for the formation of a blood clot in hemostasis.” In addition to its value for treating trauma patients, it has been used to treat cases of excessive menstrual bleeding, to reduce blood loss during orthopedic surgery, as a mouthwash following dental surgery, as well as in obstetrics, cardiac surgery, hemophilia and hereditary angioedema.

If approved, tranexamic acid could be used immediately following trauma when bleeding typically progresses and causes more and more brain damage by reducing the breakdown of blood clots and decreasing the amount of bleeding into the brain thereby preventing brain damage and even death.

“Although the results are not definitive they provide hope about the potential effectiveness of this simple drug for head injury patients. If such an inexpensive and widely practicable treatment were found to improve patient outcomes after head injury this would have major implications for clinical care” Said Dr Pablo Perel.

Hopefully, CRASH-3 trials will unveil conclusive results so that such a simple treatment could be incorporated immediately following traumatic brain injuries to increase survival rates and reduce disability, not to mention avoiding extensive and challenging rehabilitation.

Potential of Simple Injection On Patients With Head Injury
Tranexamic acid

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It's Not a Concussion; It's a Brain Injury

The term concussion originates from the Latin concutera, which means to shake violently or the Latin concussus, which refers to the action of striking together. It is the most common type of traumatic brain injury. The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), and minor head trauma and concussion are often used interchangeably.


The American Academy of Neurology Guidelines ranks the severity of a concussion into 3 grades:

Grade I - Confusion, symptoms last < 15 minutes, no loss of consciousness

Grade II - Symptoms last > 15 minutes, no loss of consciousness

Grade III - Loss of consciousness

Concussion Symptoms:

• Headache
  
• Dizziness
  
• Vomiting
  
• Nausea
  
• Lack of motor coordination
  
• Difficulty balancing
  
• Light sensitivity
  
• Seeing bright lights
  
• Blurred vision
  
• Double vision
  
• Tinnitus
  
• Convulsions
  
• Confusion
  
• Disorientation
  
• Difficulty focusing attention
  
• Loss of consciousness
  
• Post-traumatic amnesia
  
• Confusion
  
• Slurred or incoherent speech
  
• Changes in sleeping patterns
  
• Difficulty with reasoning, concentrating, and performing everyday activities
  
• Crankiness
  
• Loss of interest in favorite activities or items
  
• Tearfulness
  
• Displays of emotion that are inappropriate to the situation

**Common symptoms in children include restlessness, lethargy, and irritability.

Typically symptoms will go away without treatment. Roughly 1% of treated concussions require surgery for a brain injury. Most often plenty of rest is prescribed with a gradual return to normal activities at a pace that does not cause symptoms to worsen.

Medications may be prescribed to treat symptoms associated with the concussion, such as sleep problems and depression. Analgesics such as ibuprofen can be taken for headaches that frequently occur after a concussion, but acetaminophen is preferred to minimize the risk for complications, such as intracranial hemorrhage. Individuals are advised not to drink alcohol or take drugs that have not been approved by a doctor as they may interfere with the healing process.

Observation to monitor for worsening condition is an important part of treatment. Unconsciousness or altered mental status, convulsions, severe, persistent headache, extremity weakness, vomiting, or new bleeding or deafness in either or both ears suggests that another visit to the doctor is needed. No conclusive evidence suggests that it is necessary to wake a patient up every few hours or not.

Symptoms usually go away entirely within three weeks, though they may persist, or complications may occur. Although the mortality rate is almost zero, repeated concussions can cause cumulative brain damage such as dementia pugilistica or severe complications such as second-impact syndrome.

Certain factors may lengthen recovery time, such as longer periods of amnesia or loss of consciousness, substance abuse, clinical depression, poor health or additional injuries sustained and life stress. For unknown reasons, having had one concussion significantly increases a person's risk of having another. Having previously sustained a concussion has been found to be a strong factor increasing the likelihood of a concussion in the future. The prognosis is likely to differ between adults and children; however little research has been done on concussion in the pediatric population. Concern exists that severe concussions could interfere with brain development in children.

A 2009 study published in Brain found that individuals with a history of concussions might demonstrate a decline in both physical and mental performance for longer than 30 years. Compared to their peers with no history of brain trauma, victims of concussion exhibited the following effects:

• A decrease in episodic memory (times, places, associated emotions, and other contextual knowledge)
• A decrease in response inhibition
• Delayed P3a/P3b waves recorded via EEG
• An increase in the cortical silence period
• Reduced muscle speed otherwise known as bradykinesia (slow movement)

In recent news, Canadian researchers suggest that the term concussion is scraped from medical terminology as doctors and parents quite often underestimate the severity of these types of injuries.

“Carol DeMatteo, an occupational therapist and associate clinical professor in the School of Rehabilitation Science at McMaster University in Hamilton, Ont., says children diagnosed with concussions are treated differently from kids with other mild brain injuries.” These children are often sent home from the hospital and returned to school much sooner than those treated for mild brain injuries.

The term mild brain injury takes on a more negative connotation that concussion, which tends to suggests that the prognosis is obviously good. Concussion should not be taken as lightly as evidence suggests people who have experience multiple concussions risk neurological damage or even Alzheimer's disease and other dementias.

Natasha Richardson’s tragic death is a perfect example of what might happen when brain injuries are not taken seriously enough. On 16 March 2009, Richardson sustained a head injury when she fell while taking a skiing lesson at the Mont Tremblant Resort in Quebec. The injury was followed by a lucid interval, when she appeared to be fine as she was able to talk and act normally. Paramedics were told they were not needed. She returned to her hotel room and about three hours later was taken to a local hospital in Sainte-Agathe-des-Monts after complaining of a headache. About 7 hours following her fall, she was transferred by ambulance to Hôpital du Sacré-Cœur, in Montreal, in critical condition. The following day she was flown to Lenox Hill Hospital in New York City, where she died on 18 March. An autopsy conducted by the New York City Medical Examiners Office on 19 March revealed the cause of death was an "epidural hematoma due to blunt impact to the head", and her death was ruled an accident. There is a lot of controversy surrounding her death as many believe it could have been prevented with proper medical care.

If the term "mild traumatic brain injury" replaced "concussion", it would help people understand that this type of injury is serious and that it is an injury to the brain, not just the head. It could also save lives and prevent more serious complications later in life.

'Concussion' underplays severity of injury: doctors
Concussion
Natasha Richardson

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Sweet Dreams vs. Stinky Nightmares

Researchers have recently discovered that subjects report having more emotionally pleasant dreams when they smell the scent of roses while dreaming. Conversely, subjects who experienced the scent of rotten eggs while dreaming reported more negatively charged dreams. Actually, subjects tended to rate their dreams more positively when the aroma was pleasant.

Each subject was tested with three different odours; roses, rotten eggs, and no odour at all. Oddly, "there was hardly any kind of a dream dealing with smelling and tasting". And, it seemed that the more impacted your mood is by a smell while awake, the more so it affects you in dreamland.

Tubes were attached to the nostrils of 15 healthy women in their twenties where an olfactometer pumped constant streams of air into their noses and a ten second shot of a specific odour during REM periods.

How exactly does the brain smell?

Essentially, smell enters the nose and confronts the cell body dendrites of some 10,000 sensory neurons. The odour molecules bind to receptors on a few different classes of neurons, which are, in effect, randomly located in the nose. The binding of the scent alters the electrical properties of these neurons down their axons, which extend to the olfactory bulb. The axons from these activated neurons synapse to a few glomeruli (globular tangle of axons and dendrites) in the olfactory bulb. The synapsing of the activated axons at these glomeruli sends signals, which are transmitted to the brain areas such as the olfactory cortex, hippocampus, amygdala, and hypothalamus in the limbic system, which is involved with emotional behaviour and memory.

The following is an interesting article that explains the olfactory system in greater depth: How the olfactory system makes sense of scents

A few questions come to mind after reading about this new research. I wonder how this new information might differ for people with brain injuries to areas of the brain associated with smell or even those with nasal problems. Also, could this really mean that we could all sleep better with scented air fresheners in our bedrooms?

Source

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The Rolling Stones: A Form of Music Therapy

In recent news, a 60 year old grandfather of Stoke, England, awoke from a 10 week coma when he heard the sound of "I Can’t Get No (Satisfaction)" by the Rolling Stones pumping through his headphones.

Sam Carter slipped into a coma after developing severe anaemia. Doctors were not very hopeful about his recovery. In fact, his survival rate was a mere 30%. His wife was reluctant to use a 'music therapy' approach, but all else was failing.

After many weeks of silence, Sam said:

I can't remember much from being in a coma, but I do remember that when that song came on it took me right back to when I was a youngster. I could remember how excited I was to get it down at the record shop. I suddenly had a burst of energy and knew I had a lot more life left in me and that's when I woke up - to the sound of the first song I ever bought.

When I heard about this miracle, it reminded me of how music therapy is sometimes used in cases of acquired brain injury, autism, emotional traumas, geriatric care, hearing impairments, speech and language impairments, substance abuse, and many other areas of mental health. This form of therapy does not seem to get the attention and credit it might deserve. Music therapy uses music and musical elements to treat physical, emotional, cognitive and social problems. The music can facilitate contact, interaction, self-awareness, learning, self-expression, communication, and personal development.

Many questions come to mind regarding the efficiency of music therapy. How does it work and does it work in the same way for everyone? What type of music works best? What sort of brain injuries respond better to this form of therapy? When is it the best treatment option? Who should perform this type of therapy and is there a certified body governing its use? Are success rates linked to age, severity of damage etc?

Unfortunately, the answers to most of these questions are rarely black or white. In terms of an exact methodology; none seems to exist. There is no step by step approach. Instead, many differing methods are used to develop communication, language and intellectual development, assist in the grieving process, relieve stress, motivate rehabilitation, aid memory and imagination etc. Music therapy works by keeping the patient's attention, structuring time, providing an enjoyable method of repetition, helping memory, encouraging movement, and tapping into memories and emotions. Many studies attest to these findings, such as, a Finland study suggesting that listening to music shortly after a stroke can facilitate cognitive and emotional recovery.

But, how exactly does music affect the brain? Researchers at Georgetown University Medical Center demonstrated that

one brain system, based in the temporal lobes, helps humans memorize information in both language and music— for example, words and meanings in language and familiar melodies in music. The other system, based in the frontal lobes, helps us unconsciously learn and use the rules that underlie both language and music, such as the rules of syntax in sentences, and the rules of harmony in music.

Still, it is not easy to identify when this alternative treatment is most appropriate. It appears to be used most often when all else has failed, as was the case with Sam Carter, however since it doesn’t cause any harm it might be best not to leave this option as a last resort.

I have also discovered that the Canadian Association for Music Therapy (CAMT) is a national body that lists accredited University educated music therapists for anyone seeking this form of therapy.

Some interesting facts:

The information most adults consistently recall from childhood is songs and rhymes.

Emotional engagement is the key to effective learning. Music therapy engages the emotions; thus unlocking the brain and preparing it for learning.

People have at least seven distinct intelligences. One of these intelligence areas is the musical area. Often people with special needs learn best through music because that part of the brain is an older part of the brain and less likely to be damaged from birth defects, accidents, etc.

Research studies have shown that 80 - 90% of individuals with autism respond positively to music as a motivator.

Research has shown that music is a valued tool for stimulating the right side of the brain; and also is helpful in encouraging bilateral activity between the brain hemispheres.

The area of the brain that responds to music is located in a different area than the speech and language area.

The following video depicts how music therapy can help to develop new ways of communicating and teach new skills to children with severe disabilities:



Sources:

Riverbend Down Syndrome Parent Support Group
Music Therapy - Getting Cured Through Melody
Listening To Music Improves Stroke Patients' Recovery, Study Shows
Rolling Stones classic wakes grandfather from coma
Music And Language Are Processed By The Same Brain Systems
Canadian Association for Music Therapy

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