Brain Injuries

A traumatic brain injury can occur at any age and it can have multiple different causes. Any significant interruption in blood flow or oxygen to a part or all of the brain will cause an injury to the brain. A brain injury can be focal, which means it affects only a specific part of the brain, or global, which means that it affects the entire brain. The area of brain injury and degree of brain injury will determine the effect on the patient. Focal brain injuries are usually caused by either direct trauma or by a problem with a specific blood vessel that supplies blood and oxygen to specific parts of the brain. A focal brain injury is sometimes referred to as a stroke and it can occur at any age, although it occurs more frequently in the elderly due to the consequences of blood vessel fragility or other underlying conditions.

When a brain injury occurs at birth or a young age, the effect of such an injury has consequences over the entire life of that individual. There are two main categories of brain injury in the newborn or young child - a progressive brain injury and a non-progressive brain injury. A progressive brain injury is usually due to some type of underlying genetic or developmental problem in the brain where both the injury and its effects get worse over time. A non-progressive brain injury, such as cerebral palsy, is usually caused by a specific incident, such as hypoxia, where the injury-producing event is self-limited and does not continue, but the effects of such a brain injury continue to show as the child gets older. Thus, a child who is diagnosed with cerebral palsy will usually show significant delay in normal development and some brain-related functions, like walking or talking, may never develop.

Traumatic injuries to a baby will usually occur during a vaginal delivery as a result of the improper use of a vacuum or forceps to deliver the baby’s head. These instruments can cause direct injuries to the baby’s head and brain, and in some cases, lead to death. The most common type of traumatic birth injury involves a stretching of the nerves of the brachial plexus, which is known as an Erb’s palsy. This injury is usually a result of the baby’s size in relation to the birth canal.

Whenever such a cephalo-pelvic disproportion (CPD) is diagnosed or suspected prior to delivery, the obstetrician will usually decide to deliver the baby by cesarean section. However, when such a baby is delivered vaginally, the delivery process will be difficult and prolonged, with evidence of a shoulder dysyocia. Once the head is delivered, the obstetrician can cause injury to the nerves in the baby’s neck (brachial plexus) by pulling and turning the head in an attempt to complete the delivery process. If the doctor’s twisting and turning of the head is with sufficient force, the nerves to the arm can be avulsed, or pulled out of their attachment to the spinal cord. More often, these maneuvers result in a stretching or tearing of the nerves and, over time, there can be some recovery. It can often take nine months after delivery to fully assess the degree of permanent injury.

For a video summary of brain injuries featuring Dr. Fagel, click here. Additionally, click here to watch Dr. Fagel interviewed by a local news team regarding the brain damage of a teenage girl.