HEAD TRAUMA AND BRAIN DAMAGE

A healthy brain uses 20% of the blood and energy in our body. The brain is extremely sensitive to being deprived of oxygen and energy. Nerve cells in the brain begin to be damaged and die after 3 minutes. Unfortunately, dead nerve cells cannot be regenerated. However, with the new information we have learned, it is possible to regain the function of damaged cells.

What does brain damage due to head trauma mean?

If you deprive a healthy brain of oxygen, blood flow or energy for any reason, we call the death of nerve cells traumatic brain damage. A sudden traffic accident, sudden blockage of cerebral vessels and damage to the brain are the causes of traumatic brain damage. Pay attention, all the reasons we have listed are sudden causes. In these patients, the brain is damaged quickly and loses its function. Different clinical conditions can be observed in each patient.

The clinical picture seen in patients is primarily related to which part of the brain is affected. I have a patient who was brought to me with serious behavioral disorders such as aggression, forgetfulness, and the frontal lobe of the brain, which we call the prefrontal region, was damaged in a traffic accident. I have a patient who came to me bedridden because the brain area that allows our arms and legs to move was affected. Or I have a patient whose speech suddenly stopped because the speech center in the brain that provides the ability to speak was affected.

I have a patient whose center of consciousness was affected as a result of an electric shock and who was brought to me completely unconscious. All patients’ complaints started recently and suddenly. Is it so important for us doctors that the event started suddenly and is new? Now we are excited about a new development called synaptogenesis-neurogenesis.

Synaptogenesis means that neighboring cells take over the task instead of dead brain cells and the damage in the brain is healed. The event we call synaptogenesis can only be beneficial when we intervene in the patient in the first 1-3 months of the traumatic injury. Therefore, it is important to start treatment in these patients in the first 3 months of the event.

Brain injury treatment due to head trauma

What do we do in treatment? Our main goal is to maximize the capacity of the healthy nerve cell to take over the function of the damaged cell. For this purpose, we perform a three-stage treatment in ensuring synaptogenesis; increasing the blood flow of the brain, strengthening the brain’s energy resources and providing maximum protection to the brain tissue.

Memory and cognitive performance are important requirements for children’s success in both school and social life. However, although it seems like it can be easily solved with regular study, the lessons and exams that the child takes throughout his/her education life are not that easy. Here, a memory called working memory gains importance. Children with a good working memory are more successful in problem solving, planning and organizing tasks and many other points. However, children with working memory problems may have attention deficit and hyperactivity disorder. The good news is that families can increase memory and cognitive performance by applying some strategies.

What is working memory?

First, let’s talk about working memory. We generally know memory as short-term and long-term memory. However, there is also a type called working memory. The type of memory where acquired information is stored but also processed is called working memory. Working memory is very important for children’s academic success. If the child’s working memory is weak, attention deficit and hyperactivity disorder (ADHD) may be seen, but conversely, if the child has attention deficit and hyperactivity disorder, this may lead to a weakening of working memory and cognitive performance.

So how do we do this in children?

1. Increase cognitive stimulation and brain flexibility

The brain development of children between the ages of 3-6, which we call early childhood, is affected by environmental stimuli. The child’s learning ability, experiences, how many stimuli he/she encounters, how many social environments he/she enters, and the socio-economic level of the family affect this development. This fresh brain, which constantly establishes new neural connections, is affected and changes by new information and experiences in the first years of life. This change is actually called brain flexibility, or neuroplasticity. Neuroplasticity is the ability of the nerve cells in our brain to learn and change. This ability allows the acquisition of cognitive functions as well as the determination of motor skills, language skills, social and emotional abilities.

How to increase brain flexibility in children?

One of the most effective ways to stimulate a child’s brain is play. Play is a natural activity that allows the child to learn and relate to their environment. A game is a stimulating activity that requires the functionality of different components of child development, as well as being rewarding in itself.

What does play bring to a child?

Play provides many cognitive gains in addition to the child’s spiritual development. These are;

Reasoning

Stimulation of reflexive (thinking about oneself as an object) and representative thinking and understanding skills

Activation of memory and attention (For example: Hand games, stone games, etc.)

Development of imagination and creativity

Distinction between fantasy and reality

Increasing the development of language and abstract thinking

Development of personal autonomy

With the use of new technologies, various games such as riddles, mazes, and logical problems available for smartphones, computers, and tablets can also improve the child’s cognitive functions. However, games that the child plays with friends or family rather than individually are always more beneficial. If they are going to play individually, games that require imagination provide this flexibility and cognitive gain. If we consider toys, toys that offer all functions are not useful, but toys that allow children to do different things with their imagination, such as Lego or plain, not too colorful wooden blocks. In addition to these, games such as puzzles that require putting the pieces together provide the same benefit. In addition to toys, we have known for a long time the positive effect of playing a musical instrument on intelligence. Research shows that children who are involved in music have significantly more academic success than others.

2. Don’t skip physical exercise

We know that physical exercise has many benefits for the brain and keeps the brain sharp. Physical exercise does this both through the hormones and chemicals it secretes and by improving brain-hand coordination and motor skills. In addition, oxygen to the brain also increases. Thanks to exercise, the level of the hormone we call BDNF, known as the growth hormone, also increases and this initiates neuroplasticity by enabling the formation of new nerve connections. Directing children to exercises that will both challenge them and that they will enjoy, such as skating, skateboarding, and cycling, can be beneficial in this respect. Since children have much more energy than us, getting tired does not make it difficult for them to focus on the lesson. This situation creates an opportunity for their brains to develop and increase their learning capacity.

3. Pay attention to sleep

Sleep allows the information learned during the day to be processed and transformed into permanent information. Sleep deprivation directly negatively affects memory, creativity, problem solving and critical thinking skills. It also increases aggression, restlessness and hyperactivity in children. It is thought that children who do not sleep well do not sleep because they are hyperactive, but most often it is the opposite; children who do not sleep well are cranky, hyperactive and overactive. Therefore, sleep directly affects learning and school success. In order for your children to get enough sleep; Put them to bed at the same time and wake them up at the same time every day. Do not break the routine even on weekends and holidays. Let them stay away from all technological devices at least 3 hours before going to bed. Prevent them from eating too much sugar and carbohydrates.

4. Ensure that they socialize

Socialization and communicating with many people gives the child the opportunity to observe. This is something that develops the child’s intelligence. An isolated life and only living within the family is a great disadvantage for the child because social activities also stimulate our brains. Researchers from Harvard University discovered that people with the most active social life have the lowest rate of memory decline. Socialization, especially for children, provides memory-enhancing benefits. Therefore, it is better for them to be with their social circle even while having fun and playing games. Especially in children who become individualized with technology and lock themselves in their rooms, serious cognitive and emotional problems occur.

5. Pay attention to your diet for brain health

You need to fuel your brain with the best fuel. A diet based on fruits, vegetables, whole grains, “healthy” fats (such as olive oil, nuts, fish) and protein also improves memory. We know that omega-3 fatty acids are essential for brain health and have a positive effect on memory. Oily fish found in cold waters such as salmon, tuna, halibut, trout, mackerel, sardines and herring are also very rich sources of omega-3. In addition, omega-3 sources such as walnuts, flaxseed, pumpkin, kidney beans, spinach, broccoli and pumpkin seeds, which grow abundantly in our soil, can be alternatives for children who do not like fish. Supplements rich in DHA and EPA, which are found in omega-3 fatty acids, can also be beneficial for brain health. You can also ensure that your child takes food supplements containing these.

Fruits and vegetables are full of antioxidants that protect us from toxins and the damage they cause. Especially colorful fruits and vegetables are good sources of antioxidants. You can make sure that your child’s plate contains fruits and vegetables of various colors such as red, green, and yellow. Consuming too many carbohydrates, especially processed carbohydrates containing white flour, can damage memory. In addition, these foods with a high glycemic index, which cause blood sugar to rise quickly and then drop quickly, cause your child to be sleepy, low in energy, and have trouble focusing. Research also confirms this. A diet full of refined carbohydrates causes a decline in memory and cognitive functions. A study conducted on 317 healthy children found that those who consumed more processed carbohydrates such as white rice, noodles, and fast food had reduced cognitive capacities, including short-term memory and working memory. Eating too much sugar causes the part of the brain that stores short-term memory in particular to weaken and decrease in volume. Therefore, it is important to reduce sugar. However, this does not only help memory, it also improves general health. In fact, it is not enough for children to just avoid sugar. The hippocampus, the memory-related part of babies born to mothers with high blood sugar during pregnancy, does not develop normally. These babies may have worse memory than babies of the same age.

Vitamin D plays many vital roles in the body, as well as being important for brain health and cognitive capacity. Low levels of vitamin D are linked to decreased cognitive function. One study found that those with insufficient levels of vitamin D in their blood had decreased memory and other cognitive abilities. Vitamin D deficiency is especially common in colder climates and those with darker skin. You can find out if your child needs a vitamin D supplement by getting a blood test.

What is stroke?

The clot that goes to the brain does not only come from the heart, but also the brain veins age as we age, and a process called arteriosclerosis occurs. This can create clots on the veins, and these clots go to the brain. Let’s think of the main vein coming out of the heart as a tree root. Let the end branches of the tree be small veins, and clots can come out of the root and cause blockages on the way. If the branches are blocked, the brain’s nutrition is disrupted, if the small vein is blocked, it causes less damage, and if the large vein is blocked, it causes more serious damage. These vein branches coming out of the heart narrow as they go deeper into the brain. The larger the clot, the earlier it blocks the vein and the more damage it causes. Stroke is a condition that occurs suddenly and results in loss of brain functions.

Stroke/paralysis in our country

Approximately 200,000 people have a stroke in our country every year. Every 40 seconds, one person has a stroke; and one person loses their life due to stroke in three minutes. Stroke was the third leading cause of death on the World Health Organization list until the last 20 years. However, especially in the last 20 years, thanks to rapid developments in diagnosis and treatment, it is a treatable disease and early action is vital for this treatment to be successful. In emergency cases, centers with experience in stroke should be determined for rapid and successful treatment and the emergency service should transport patients to these centers. Stroke treatment is a personalized treatment due to both the good evaluation of the process and the fact that the treatment methods to be used vary from patient to patient. In the fight against stroke, it is important not to have a single physician but a competent multidisciplinary team. There are diseases in medicine where we race against time, stroke is one of these diseases. We say that every passing time is the brain because the longer we delay reaching the health center as time goes by, we lose a part of our brain, stroke is such a disease. When we say stroke, it is considered distant from us but it can be very close to you. It can happen to anyone at any time. We are not disabled today but we can be tomorrow. Especially people in the risk group are important.

CAN STROKE BE PREVENTED?

Approximately 200,000 people have a stroke in our country every year. One person has a stroke every 40 seconds, and one person dies of a stroke every three minutes. Until the last 20 years, stroke was ranked 3rd among the causes of death on the World Health Organization list. However, especially in the last 20 years, it has become a treatable disease thanks to rapid developments in diagnosis and treatment. Therefore, acting early is vital for the treatment to be successful.
In emergency cases, centers experienced in stroke should be determined for fast and successful treatment and the emergency service should transport patients to these centers. Stroke treatment is a personalized treatment due to both the good evaluation of the process and the fact that the treatment methods to be used vary from patient to patient. In the fight against stroke, not a single physician but a multidisciplinary, competent team is of great importance…

There are diseases in medicine where we race against time. Stroke is one of these diseases… We say that every passing time is the brain because as time goes by, the more we delay reaching the health center, the more we lose a part of our brain, stroke is such a disease. It seems distant from us, but it can be very close to you. It can happen to anyone at any time. We are not disabled today, but we may be tomorrow. Especially people in the risk group are very important in this respect…

STROKE GIVES INFORMATION IN ADVANCE

Stroke often gives in advance that it will come. Preventive treatment of people at risk before a stroke develops should be the most important approach. Among the lifestyle changes in preventing stroke, nutrition is especially important. Avoiding foods containing saturated fatty acids and simple carbohydrates, taking care to eat fiber-rich foods, eating a diet rich in fruits and vegetables, and limiting salt are important. It has been shown that the Mediterranean diet is especially protective against stroke (a diet containing olive oil and vegetables).

On the other hand, increasing physical activity and doing aerobic exercises outdoors without straining are associated with a decrease in the risk of stroke. It is recommended that individuals regularly practice outdoor walking exercises for 45 minutes-1 hour 4 days a week or at least 30 minutes a day.

It is important to control risk factors such as hypertension, diabetes, high cholesterol, keep blood pressure below 140/90 mmHg, completely stop smoking and limit alcohol consumption, and reduce excess weight to appropriate limits with diets. Regular use of medications recommended by your doctor for these risk factors reduces the risk of stroke.

8 simple changes to reduce your risk of stroke:

Be active.
Keep your cholesterol under control.
Eat healthier.
Keep your blood pressure under control.
Lose weight.
Lower your blood sugar.
Quit smoking.
Reduce alcohol.

Even one of these is effective, but controlling all of them has been shown to significantly reduce the risk of stroke. So the more changes you make, the more your risk drops. For example, lowering your blood pressure to normal levels reduces your risk of stroke by 50 percent. Not smoking or quitting smoking reduces the risk by 40 percent.

EMERGENCY STROKE TREATMENT

Since it is generally not known whether stroke can be treated, it is very late to take patients to the hospital. There is a lack of information about the treatment of this disease. Unfortunately, there is a prejudice in society that ‘stroke cannot be treated’.

However, today, if a patient who has a stroke is taken to the hospital in the first hours and the sooner that patient is treated, the chance of treatment increases. It seems much easier for patients to return to their social life even if they have a stroke. Our society is not yet aware of this treatment, we need to increase awareness of this treatment.
Stroke treatment is a new approach in terms of intervention, it is necessary to save the brain tissue that is sensitive to lack of oxygen after the formation of the clot and to prevent the damage that will occur. Every minute that passes after a stroke means millions of cell deaths. Clot-dissolving treatments via veins must be applied to the patient in the first 4.5 hours of the stroke, and the method of removing the clot in the vein by performing cerebral angiography, i.e. mechanical clot removal, must be applied to the patient in the first 8 hours. When the treatment is applied within the first 3 hours, 1 out of 7 patients recover completely, when it is applied within the first 4.5 hours, 1 out of 11 patients recover completely.

SHOULD WE USE ASPIRIN IN CASE OF A SUDDEN STROKE?
The cause of a stroke may be a brain hemorrhage or a vascular occlusion. When we give a blood thinner, we may increase the bleeding. Therefore, we should not take a blood thinner drug on our own.

SHOULD WE MEASURE BLOOD PRESSURE IN STROKE AND GIVE BLOOD PRESSURE MEDICATION?

There is definitely no need to give a drug to lower blood pressure if such a patient has high blood pressure. The main problem here is that stroke mostly develops in those with high blood pressure, but if the blood pressure is high when we have a stroke, it should not be lowered because a vein is blocked and the vein carries blood to the brain. If we give medication for blood pressure, the blood pressure drops and the blood flowing to the brain decreases. In case of a sudden stroke, blood pressure medication should not be given.

SHOULD WE POUR COLOGNE ON THE PATIENT?

Giving the patient water, pouring cologne on them seem like things done to bring the patient back to his senses, but in fact, these waste doctors’ time. They steal time, but we need to act quickly, and time is limited for what we can do in the emergency room. We need to get the patient to the emergency room as soon as possible. When the patient has a stroke, their swallowing function may have been impaired. Therefore, we should not feed them or give them water to drink, otherwise it can get into the lungs and cause pneumonia, causing the disease to worsen rapidly.