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Brain injury

Introduction

The brain is protected by the skull, the thick bone structure of the head, and is supplied with blood by a network of arteries.

Despite the protection afforded by the skull, the brain is vulnerable to tears, ruptured nerves and blood vessel damage. Any of these injuries can cause bleeding, swelling or fluid build-up in the head, putting extensive pressure on the brain and resulting in tissue damage.

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Symptoms

The symptoms of brain damage depend on the area of the brain affected and the extent of the damage.

The outer layer of the brain in which most of the higher functions take place is called the cerebral cortex. The cerebral cortex is the most vulnerable part of the brain, as it needs a lot of oxygen and energy to function. If oxygen is cut off, the cerebral cortex can die in just a few minutes. It is therefore possible for the brain stem to still be alive after the cerebral cortex has died. This is the most extreme form of brain damage and is called a persistent vegetative state (PVS).

Because the cerebral cortex controls most of the functions of the human body, apart from the very basics such as breathing, damage to it can affect almost any part of the body. Brain damage can affect the higher functions of the brain in a random way, disabling some functions and retaining others. It may result in:

  • paralysis and loss of sensation on one side of the body
  • epileptic seizures
  • speech disturbances or loss of communication skills
  • partial loss of vision.

Brain damage may also have a more general effect, impairing memory (amnesia), judgement, and interfering with thinking.

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Causes

The brain can be damaged in a number of ways. Brain damage usually occurs as a result of a knock or blow to the head, or after the blood supply is cut off, such as during a stroke. One of the most common causes of brain damage is a condition called stroke-in-progression. This describes brain damage caused by an obstruction to the blood supply that increases over a number of hours, days or weeks.

A knock or blow to the head, such as in a road traffic accident, can cause brain damage at the time of injury. This occurs as a result of damage to soft brain tissue when the brain rattles against the skull. There does not need to be a visible injury, such as a fracture to the skull, for brain damage to occur.

Some other possible causes of brain damage are:

  • Oxygen starvation due to lack of oxygen at birth
  • Cardiac arrest (heart attack)
  • Asphyxiation (suffocation)
  • Drowning
  • Carbon monoxide poisoning
  • Interruption of the blood supply to part of the brain, as in a stroke.
  • Blockage in the artery causes the part of the brain affected to die.
  • Serious infection such as meningitis or encephalitis.
  • Other conditions that can damage brain tissue, such as a brain tumour or muscular dystrophy.
  • Injury to brain tissue through a head injury or because of bleeding from a blood vessel in the brain.
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Diagnosis

The history of an injury or medical condition, combined with symptoms of impairment, usually provide the diagnosis. However, subtle brain damage due to a previously undiagnosed condition can often be difficult to detect.

To find out if there is a problem with one of the functions of the brain, a computerised tomography scan (CT scan) or magnetic resonance imaging (MRI scan) may be taken. These scans take pictures of the brain, which will show up any areas of damage.

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Treatment

People who have sustained a head injury should go to the Accident and Emergency (A&E) department of their local hospital if

  • the head injury has been caused by a road traffic accident, diving accident, or fall from a height greater than one metre or five stairs (or lower if it is a child).

Or if they experience any of the following:

  • unconsciousness, or lack of full consciousness (eg problems keeping the eyes open);
  • problems with speaking, reading or writing, hearing, balance, eyesight, memory, concentration or walking;
  • loss of feeling or general weakness;
  • fluid running from the ears or nose;
  • visible damage to the scalp;
  • a black eye with no associated damage to the eye;
  • bruising behind either of the ears with no associated damage;
  • a seizure (convulsion or fit);
  • a persistent headache since the injury; or
  • vomiting since the injury.

Depending on the cause, some people can have a good recovery from brain damage. The effects of brain damage as a result of stroke are often temporary and impairments can improve or even disappear over time. Recovery takes place over several months or even years, and it is usually impossible for medical professionals to predict the final outcomes, particularly in the early stages.

Recovery can be aided by speech therapy, physiotherapy, occupational therapy and counselling. Where impairments remain, practical help in the form of adaptations to the living environment and the provision of carers for example, can improve a person’s quality of life.

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Prevention

Many head injuries are the result of unforeseen accidents that would be very difficult to predict or prevent. However, there are some measures that can be taken to reduce the risk of brain damage in the event of a head injury.

Cyclists and motorcyclists can protect themselves by wearing properly fitting safety helmets. British standard safety helmets are a legal requirement for motorcyclists. Safety helmets can reduce the risk of serious head injury in the event of an accident by up to 85%. A cyclist’s safety helmet should absorb the impact of a blow or fall evenly, preventing one spot on the head from taking the full force of the impact.

Other ways to prevent brain damage include:

  • better care during pregnancy and childbirth to reduce birth trauma to the brain
  • increased awareness and vaccination against meningitis
  • increased awareness about preventing stroke
  • public education about the hazards of exceeding speed limits on the roads, the importance of wearing seat belts, and wearing safety helmets.
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Getting help

Headway, the brain injury association aims is to promote understanding of all aspects of brain injury; and to provide information, support and services to people with a brain injury, their family and carers.

They have a helpline and can offer information and support to carers, brain injury survivors, the public and professionals. The freephone number (from landlines) is 0808 800 2244.

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