Festive season travelling - be aware of traumatic brain injury.
As holidaymakers get set to take to the country’s roads over the festive season, psychiatrists have warned not only of the tragic consequences of road accident fatalities but also the potential life-long impact of serious head injuries for accident survivors.
Traumatic brain injury (TBI) affects at least 300 per 100,000 people in South Africa every year, with road accidents a major cause of death, and lasting effects on surviving victims’ mental and physical health, employment and family life.
With deaths from road accident injuries in South Africa about double the global average, and a significant proportion of these deaths due to TBI, there is even more reason to be road-safety-aware, especially in high-volume periods like the holiday season, says Dr Anersha Pillay, a neuropsychiatrist and member of Psychiatry Management Group (PsychMG).
“The risk of death or the life-long impact of injury, coupled with unsafe roads, low traffic law enforcement and aggressive driving, with alcohol misuse a major contributor to traffic accidents, all add up to good reason to take the basic precautions: buckle up, don’t drink and drive, don’t speed, stay alert to the road surroundings at all times and take a break to sleep if needed.”
In addition to road accidents, South Africa’s high rate of traumatic brain injuries is also due to interpersonal violence – the leading cause of injury-related deaths in South Africa – as well as the high involvement of pedestrians in road traffic accidents, she said.
“There are two age-related peaks of those vulnerable to head injuries – the young (under 45) due to motor vehicle accidents, and the elderly due to falls,” she said.
The effects of TBI can range from mild “concussion” with brief loss of consciousness through to severe and permanent damage, affecting the victims’ mental and physical health and functioning, as well as their employment, family and social life.
“Mild TBI or concussion is not as innocuous as previously thought, and more attention is now being paid to recurrent mild head injuries, for example suffered in contact sports like boxing or rugby,” she said.
If symptoms such as headaches, fatigue, dizziness, difficulties in concentrating, depression, anxiety, changes in sleeping patterns, and irritability or a short temper persist after an accident or other head injury event, a medical professional such as a psychiatrist, neurologist or neurosurgeon should be consulted as soon as possible, Dr Pillay advises.
She said a traumatic brain injury could also lead to the onset of mental health disorders, depending on the severity of the head injury, exposure to recurrent head injuries and underlying factors such as a family history of psychiatric disorders.
“Depression, anxiety and post-traumatic disorders, as well as substance abuse, are more common in chronic TBI sufferers than in the general population, resulting either from the injury itself, the patient’s reaction to having been injured, or worsening of an underlying psychiatric disorder that was present before the injury,” she said.
The severity of a TBI is classified by assessing the patient’s state of consciousness using the Glasgow Coma Scale as well as the length of time it takes for post-traumatic amnesia (forgetfulness) to pass and the patient is able to remember day-to-day events.
The acute phase of a TBI usually lasts up to two months after the injury, depending on the severity, she said, but if symptoms persist for longer, the TBI would be considered chronic and a medical professional should be consulted.
In addition to headaches and disorders such as depression, symptoms can include personality changes, aggression, apathy or suicidal behaviour as well as neurocognitive disorders such as post-traumatic amnesia and problems with information processing, attention and concentration, poor short-term memory or difficulties in planning and organising routine events.
In vehicle accidents, the sheer force of the impact can cause the brain to collide with the hard bone of the skull as the result of “acceleration-deceleration” forces, where the head comes to a quick stop while the brain continues its momentum.
“The sudden movement of the brain in different directions after an impact damages the brain cells, causing the nerve cells to swell, and eventually leading to permanent damage. This type of injury – bruising (contusion) or internal bleeding - doesn’t necessarily involve fracturing of the skull, and so is not always immediately detectable,” Dr Pillay said.
A formal diagnosis of TBI is made based on the presence of neurological symptoms such as loss of consciousness, disorientation or confusion; neuropsychiatric symptoms such as behaviour changes, anxiety or depression, severe headaches or sleeping disturbances and/or detection of bleeding in the brain.
Dr Pillay warned that excessive alcohol use – leading to road accidents, assault and falls – heightened the risk of suffering a traumatic brain injury, and especially advised motorists and pedestrians to take safety precautions such as staying alert, awake, buckling up and not texting while walking or driving.
“Rather be safe than sorry, seek medical help sooner rather than later if symptoms persist or there is any cause for concern after an accident or head injury,” she concluded.