Wednesday, January 6, 2010

When an elite athlete gets hurt, it can make front page news but rarely does the story keep the public’s interest. We have a morbid interest in watching slow motion reruns of broken legs, torn knee ligaments and heads bouncing off the turf but the consequences of the injury, the rehabilitation and the lost careers are quickly forgotten.

With the Olympics beginning in February, the spotlight was shining on snowboards in Utah last week when Kevin Pearce missed a landing on the halfpipe, hitting his head on the ice and sustaining a life threatening injury. Trying to land a jump that begins twenty feet in the air leaves little margin for error and helmets may not offer enough protection from major damage. For Mr. Pearce, the trauma of the fall translated into brain swelling and coma.

When the head takes the force of an injury, people worry about bleeding in the brain and the need for an operation to remove blood clots. Subdural and epidural hematomas describe blood clots and the locations between the linings of the brain where they can collect. If there is enough bleeding, pressure within the skull increases and brain tissue is pushed up against the bony skull. Brain doesn’t like to be squashed and tends to stop working when it is irritated. This leads to decreased level of consciousness or coma. More frightening though, are brain injuries that cause shear injury and swelling without anything that can be fixed by an operation. Instead of bleeding causing pressure on the brain, the neurons that connect brain cells are damaged or sheared causing inflammation. The body doesn’t distinguish the inflammatory response based on location. An injured ankle will cause a cascade of chemicals that increase blood flow to the ankle resulting in fluid accumulation and swelling inside and outside cells. An injured brain causes the same cascade. The difference is that an injured ankle has the ability to stretch the surrounding skin to accommodate the swelling, while the brain is trapped inside the tight box of the skull. Increased swelling of the brain leads to increased pressure and a brain that is at risk for permanent damage.

Instead of an operation to fix the swelling, the pressure within the skull can be manipulated by medications. Drugs like mannitol can be used to shrink the amount of fluid in the body while steroids like decadron can try to decrease the inflammatory response. Many times the patient is kept paralyzed and on a ventilator or breathing machine as if they were in the operating room to make certain that all parts of the body can be adjusted to give the brain the best chance to survive and recover. Without the ability to repeatedly exam the patient, neurosurgeons may insert pressure monitors or bolts into the skull to help monitor pressure. Brain wave tracings (EEGs) may be used to assess function and look for abnormal or irritable activities like seizures.

While House and Gray’s Anatomy may use literary license to compress time for the story’s sake, the real world takes time, especially when it comes to brain recovery. And as time goes by, the story and lessons to be learned from Mr. Pearce’s injury fall from the front page. Perhaps there may be a human interest story done during the Olympics and hopefully, he will be awake to see and understand it. And perhaps he will be able to joke that flying is easy but the takeoffs and landing are tough.

May Kevin heal quickly and fully.

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