[Neuroscience] Re: mild brain injury

John H. via neur-sci%40net.bio.net (by j_hasenkam At yahoo.com.au)
Mon Nov 6 20:48:18 EST 2006


That the MRI found nothing says more about the limitations of the
technology than your wife's condition. In mild brain injury it can be
very difficult to detect brain damage, sometimes a type of SPECT scan
can help. The neurologist who immediately referred her to a psych was
not being thorough, should have looked harder. A neuropsych workup is
recommended.

The memory loss points to a temporal lobe issue, quite common in brain
injury for axonal shear stress to create all sorts of problems. The
memory problem is usually the prominent one but you should also be
looking for:

planning ability, is your wife have more difficulty planning her day
and organizing things?
emotional lability: does your wife display periods of moodiness, more
quickly to anger, more inclined to depression?
sleep: are her sleep patterns the same as before the accident?

Given the time period a full recovery is unlikely but given the lack of
rehab one should not give up hope of any recovery. In the meantime,
perhaps your wife could start using a PDA or voice recorder so that she
doesn't have to remember things but can simply refer to the device. You
could also place stickers in places signalling where your wife is to
leave things, alternatively she could record the location of objects.
Routine is very important. The simple practice of doing this may even
help improve her memory.

Careful attention should be paid to diet and lifestyle factors:

Following any sort of neuronal injury cell membrane integrity can be
compromised, leading to loss of some essential fatty acids,
supplementation with omega 3's is worth thinking about. Avoid trans
fats like a plague, boost monounsaturates, moderate omega 6's, keep
saturated fat low.

A diet very rich in fruit and vegetables is very important, with a
particular focus on maximising antioxidant intake.

Anything that boost acetylcholine is worth thinking about. For example,
a recent report advised that apples contain compounds which boost this
memory enhancer.

Selenium deficiency is common and this micronutrient is very important
for intrinsic antioxidant protection. Brazil nuts are an excellent
source, very difficult to overdose on natural sources. If you choose
supplement, no more than 200mcg per day, probably safer at 100mcg. Must
be selenium methionine. Vitamin E supplementation will go well with it.


As you live in England don't neglect vitamin D, deficiencies are very
common and it plays a vital role in modulating the immune response,
which can go out of kilter post brain injury and this is not good for
the brain or the body.

In the very least she should be taking a slow release multi-vitamin.

Exercise is very important, though not vigourous and not competitive.
Something enjoyable and preferably in a natural environment.

Your wife must learn some stress management techniques, over the long
term stress is a big brain cell killer. If possible, a holiday is a
good idea. It would be interesting to see if there is any improvement
following a sustained rest from stress.

There are some supplements worth thinking about (alpha lipoic acid and
acetyl l carnitine mix(look up "juvenon" www.juvenon.com). But don't go
in for "miracle cures", juvenon is based on solid research by Prof
Bruce Ames. I tried the mix a couple of years ago and even in healthy
individuals it provides a noticeable effect. Avoid ginkgo, ginseng,
these could do far more harm than good.

Studies indicate that social and emotional support can be important in
aiding recovery. She needs positive environments, enjoyable pastimes,
and the frequent opportunity to forget about her troubles. In short, go
out and have some fun.

---

That she is getting worse suggests further investigation is required,
there may still be some pathology there that needs to be addressed.
Typically one would expect some degree of recovery not ongoing decline.
This perceived decline however may say more about your perceptions than
her condition. What should have happened post accident is a neuropsych
workup to establish a baseline, that way one could be sure of her
progress or lack thereof. I strongly suggest this be done now with
follow ups. If there is an ongoing decline, it needs to be confirmed
and investigated. Another imaging study is worth undertaking now,
particularly as there is evidence of ongoing decline.

You really need to focus on rehab. She has brain injury, I'm at a
complete loss as to why she was referred to a psychiatrist. However it
wasn't that long ago when people with mild brain injury were regarded
as malingering, this occurring because of no detectable organic
pathology. Such bias may continue to exist. At least the psychiatrist
was on the ball by referring her on to other avenues.

Sometimes, just sometimes, recovery is long and slow. One can never
know. Give up hope and you'll never know. Given no rehab, you should
not at this time assume that this is how things are going to stay.

Get her into rehab. Get yourself there too, you will play a very
important role in her recovery.


John.




colinberry1 wrote:
> My wife has a severe short-term memory loss she does not remember
> anything about what had been spoken a few minutes later, this all
> happened after a severe injury she received on 5th April 2003 an
> extremely heavy object hitting her after falling from a height of 30ft
> fracturing three of her vertebras and hitting her head on a concrete
> floor.
>
> I have grave concern that three and a half years have passed and she
> seemed to be getting worse rather than better, she has not received any
> rehab after her accident there have been long delays in achieving rehab
> for her by the doctors involved.
>
> I do believe that she had a mild brain injury but it had been taking a
> long while for any real help to come along, the doctors involved had
> arranged for her two go to a local rehab clinic but three and a half
> years later we are still waiting.
>
> She had an MRI scan of her head, about a year after her accident but
> the neurologist said that he could not find anything wrong with the
> scan but referred my wife to a local psychiatric center.
>
> The psychiatrist in charge referred her to a psychologist the
> psychologist requested that a clinical psychologist make a report of
> different test that she took on my wife. The clinical psychologist
> referred my wife to the National Hospital for Neurology and
> Neurosurgery at Queens Square University College London on the 24 May
> 2006 where she saw a neuropsychologist that made another report
> recommending that she should obtain rehab at a local hospital in
> Barnet.
>
>
>  Would there any possible chance of my wife getting over this problem
> with her memory loss, or will I have to come to terms that this is how
> she will be forever.
>
> My wife not being able to remember anything has put a great strain on
> me, I worry what she is going to forget next, she is like a walking
> catastrophe everything she touches is somehow missing because she
> cannot remember where she has put it, sometimes as we are going out the
> door to pay a bill and it would suddenly go missing and we could spend
> an hour looking for it.
>
> Does anybody know how to cope with such a situation, I tell her not to
> touch anything but before her accident she used to take care of all my
> paperwork for my business and make sure all the bills are paid so she
> still tries to go through that process but it causes havoc now, but I
> am not allowed to say anything because it upsets her a great deal and
> it causes a great conflict between the both of us.



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