Shaken Baby Syndrome

Also known as SBS, shaken baby syndrome is a type of imposed head trauma. This trauma may occur from either throwing the child, or hitting the child on the head or by shaking the child too much. This is unlike regular head injuries because it can happen only if somebody harms the child. Many parents bring their children to the doctor very late, as they have not observed the problem in the infant in an early stage. SBS can also lead to severe brain injury, thus parents who leave their children with caretakers have to be on extra vigil for unusual symptoms. Depending on the duration of the harm caused the symptoms vary.

• Lassitude and nausea and petulance are the main symptoms.
  
• Poor sucking, decline in appetite and lack of smile.
  
• Breathing trouble and seizures.
  
• Unable to lift the head and to center the eyes or follow movement.
  
• Pupil sizes may vary and stiffness will occur.

When the baby is shaken continuously, the head rotates in frenzy as the infant neck muscles are hardly developed and offer very little support to the head. The movement causes the brain to move back and forth inside the skull and thereby causes injury to the nerves and blood vessels and also tears off the brain tissue. As the brain hits against the inside of the skull, damage is caused to brain in the form of bruising and bleeding. If the baby's head is hit against any hard object, then the damage caused is even worse. With less damage caused the injury will heal within a period of time. If the damage caused is severe, then specific treatment has to be provided depending on the area of damage. Speech loss and hearing impairment has to be treated accordingly. The child has to be given special care and kept under constant vigil under the right care for the right kind of support.

Intracranial Hematoma

Head injuries account for approximately 70% of traumatic accident deaths. Intracranial hematoma plays an important role in the death and disability that are associated with head injury. Intracranial hematoma is a serious and possibly a life threatening condition that often requires immediate medical attention. Many patients with intracranial hematoma harbor mass lesions that require emergency decompression. Other causes include brain tumors, liver disease, autoimmune syndromes and bleeding disorders.

The human brain floats within the skull. It is surrounded by cerebrospinal fluid which cushions the brain from the bounces of everyday movements. Sometimes it becomes impossible for the fluid to absorb the force of a sudden blow or a quick stop. Under such situations, the brain may slide forcefully against the inner wall of the skull and get bruised. An intra-cranial hematoma occurs when the blood vessel ruptures between the skull and the brain. The blood leaks between the brain and the skull. This collection of blood, hematoma, which is possibly clotted, compresses the brain tissue. Some hematomas require surgery to remove the blood clot whereas some others can be treated without surgery.

Symptoms of intracranial hematoma include headache, nausea, vomiting, lethargy and slurred speech. The pupils may appear of unequal size. Memory loss is often associated with head trauma. One may even forget that they have suffered a blow. These symptoms of intracranial hematoma may occur either immediately or several weeks or months after a blow has been received in the head.

Injury in the head is the most common cause of intracranial hematoma. Among elderly persons, even a mild head trauma is more likely to cause a hematoma in the brain. Hematoma resulting from injury in the head is classified as:

Subdural hematoma: This occurs when the blood vessels, most often the veins rupture between the brain and the dura mater which is the outermost of three membrane layers that covers the brain. The blood that leaks forms a hematoma. This compresses the brain tissue. The danger here is that if the hematoma keeps growing then there is a progressive decline in consciousness and possible death. The risk of subdural hematoma is greater in people who use aspirin or other anticoagulants regularly. Alcoholics and very young and very old people also stand to be affected by subdural hematoma. All types of subdural hematomas require medical attention as soon as the symptoms become apparent. Other wise permanent brain damage may be the result.

Epidural hematoma: This type of hematoma occurs when the blood vessel, usually the artery, ruptures between the surface of the dura mater and the skull. Morbidity and mortality from epidural hematoma is substantial unless immediate medical attention is given. The cause of epidural hematoma is most of the time road automobile accidents or any other traumatic injuries.

Intraparenchymal hematoma: When blood pools in the white matter of the brain, Intraparenchymal hematoma occurs. There may be multiple severe Intraparenchymal hematomas after a head trauma. Serious brain damage can occur, as the neurons can no longer communicate.

A physician may find it difficult to diagnose intracranial hematoma, as it may not be immediately apparent. It is better to seek medical advice after any significant blow has been received to the head and if the patient has lost consciousness or experiences symptoms such as headache, lethargy, nausea and vomiting. A CT scan or MRI scan is suggested to define the position and size of a hematoma.

After a head injury, doctors use medications such as corticosteroids and diuretics to control the edema in the brain after head injury. Often surgery is required. If the blood clot is localized and there is no excessive clotting, then perforation is made through the skull and the liquid is removed by suction. Large hematomas require opening of a section of the skull to remove blood clots.

It is essential to wear appropriate safety equipment and gadgets during sports, including helmet when riding, motorcycling, horseback riding, skating or doing any other activity that may result in injury to head. Chances of motor vehicle accidents can be minimized by wearing a seat belt.

Aphasia

Aphasia is the inability to communicate verbally or by written words. Aphasia can be usually due to brain injury or a stroke. It can also be the result of a brain tumor, Alzheimer or Encephalitis. Aphasia can be permanent or temporary (usually known as transient aphasia). Aphasia is sometimes confused with Apraxia which is a condition that affects the muscles used in speech rather than the language function.

Aphasia can be grouped as below based on the cause and the area of the brain affected:

• Global Aphasia : Occurs due to head trauma on the language areas of the brain. Language ability affected may vary based on the location and the extent of the injury.
  
  
• Wernicke's Aphasia : Partial or total loss of the ability to understand written or spoken words though the affected person may still retain the ability to speak - but with made-up words.
  
  
• Transcortical Aphasia : Partial or total loss of the ability to express verbally or by writing words although the individual may have the ability to repeat words, phrases or even sentences
  
  
• Conduction Aphasia : Affected person loses the ability to repeat words, phrases or sentences
  
  
• Subcortical Aphasia : Partial or total loss of the ability to express verbally or by using written words due to damage to the non-language dominated areas of the brain
  
  
• Anomic Aphasia : Partial or total loss of the ability to recall the names of persons or things.
  
  
• Broca's Aphasia : Hearing comprehension is not affected
  
  

As Aphasia develops following a head trauma, tumor, disease (Alzheimer's) or infection (encephalitis), the pathways for language comprehension or production are disrupted. This occurs in the left hemisphere of the brain. MRI (magnetic resonance imaging) and CT (Computed tomography) scans can show the extent of the damage and the area affected. Coupled with standardized tests like Boston Diagnostic Aphasia Examination, the Western Aphasia Battery and Porch Index of Speech Ability, can indicate the severity of Aphasia and probable course of speech therapy.