Ask me about head & brain trauma!

[FarmerBrown]

I couldn't find a similar thread in my searching, but sorry if this is a duplicate. As the title says, feel free to ask me about head and brain trauma! My experience is limited to brain surgery I had eleven years ago and the short- and long-term limitations from that. Perhaps people who have had concussions or blunt-force trauma could chime in Fiction is fiction, so "realistic" head/brain trauma is not necessarily required for good storytelling, but this thread is for anyone wanting a real person's experience. Brain surgery probably has less of a place in fantasy than sci-fi, but brain trauma (from blunt-force trauma, accidents etc.) seems to be common in both. Obviously my experience is a very narrow window into the wide range of experiences with brain trauma, but there are some similarities regardless of the location or severity of trauma. Oh, and I love sharing the gory details, so be advised.....

P.S. Here are the 'stats' from my surgery: I had a palm-sized portion of my skull removed from the occipital/parietal region of my head and an arterio-venous malformation (AVM) removed about an inch deep into the occipital part of my brain. The skull piece was screwed back in with 3 small titanium squares and 12 titanium screws and my scalp was stitched back on with 37 stitches. No, they didn't shave my whole head even though I said they could :-( I was out for two days after that and almost died from my blood pressure failing to stabilize. I got to go home a week later and it took about two months to not feel "squishy" in the back of my head and over a year to feel "normal". I lost some vision from the surgery, so that took some adapting. Being young-ish helped with recovery.

Anyway, I'll just let this sit here and if anyone has questions, I'll respond. Cheers!

 

[Tom]

Hey, I needed this!

I have a character who sustains a nasty blow to the temple/forehead area via another person's fist. It's not enough to fracture the skull, but he's knocked unconscious for about ten minutes and wakes up disoriented. I want to realistically portray the lingering effects of the blow he'll continue to suffer, since I've heard that any blow to the head strong enough to knock a person unconscious won't just magically wear off after they wake up and leave them completely unharmed (as Hollywood would have us believe).

So what are the effects of that kind of head trauma, and how long would they last?

 

[FarmerBrown]

The temple is a sensitive area and a blow to the temple can pretty easily kill you. A secondary hematoma can also kill you ;-) However, without a fracture and with that kind of KO time, I'd say your character would probably feel "fuzzy" for a few days (headache, lacking mental clarity/confusion, possible blurred/spotty vision, staring off into space) minimum, and feel pretty much fine after 7-10 days, though it's possible it would affect him longer. Without breaking anything, it's unlikely there would be permanent damage, though not impossible. Inflammation/scarring from a hematoma could do a little damage to that area of the brain, which could cause any number of problems. Look at what that area of the brain does and pick and choose if you want long-term affects ;-)

KO's via head trauma are way too convenient (I used one myself in my story!), but you're right in that in reality, you never wake up completely unharmed and ready for more action!

 

[wordwalker]

Regarding knockouts in fiction, I always took that sort of for granted-- then a thread here mentioned that most blows either knock you out for only minutes or put you at some risk for longer damage. And suddenly I remembered all the boxing movies I've glanced past on my TV, and how we've all heard the fighter's friends start to worry if he stays down for more than a minute after being KOed.

Not the best general example, but it shows how actual facts can sometimes keep a grip in even the most commercial stories. We can even remember one version of them from one kind of story or "common knowledge," and another from another.

 

[FarmerBrown]

Yes and no. How many times do the boxers get up and fight the next round, or get up and walk away? That's the not-so-realistic part even if the actually 'knock-out' is more realistic. And that's fine! That's what makes a great movie or book. But it also feeds the misconception that the shorter the time unconscious, the less damage there really is, which isn't necessarily true. As far as I know, going 'unconscious' is one of the brain's self-defense mechanisms to minimize damage, but the initial blow isn't always the only thing doing damage. Secondary inflammation or a hematoma are just as deadly or damaging.

Kind of unrelated, but one time playing volleyball I got a direct hit to the back of my head where my surgery area is. It wasn't a very hard hit, but I was "stunned" for about thirty seconds. Fully awake, but my knees gave out and I was down for a little bit, and kind of just felt like, "whooooaaoooahh". There wasn't any damage, but it's another example of what getting hit in the head can do ;-)

 

[SeverinR]

There is good and bad in a fractured skull.
If no fracture the brain swelling can cause permanent damage.
Without fracture, the skull is pretty much a closed space, if there is swelling inside the skull there is little release and one section of brain swelling crushes another part of the brain.
With a fracture the brain swells, pushing the fracture out relieving the pressure. There could still be brain damage, depending on how much pressure it takes to move the bone.
Closed Head Injury - Causes, Symptoms and Treatment

I believe some period "doctors" did do burr holes to release the demon in peoples heads, but actually they were relieving increased pressure in the skull. Relieve the pressure and the person comes back to normal, but then might have to deal with an infection in their head/brain from the surgery. They also would have a hole in their head and have the potential for direct brain injury at the spot of the burr hole.

Striking the head can cause different affects depending on the part of the brain affected and its opposing side. Remember the brain gets hit, it can splatter against the opposing side of the skull for two sights of injury. So even if not knocked out some different affects can happen. Hit the right area, short term memory can be jumbled for a short while. (the trope of amnesia is the basis of this. But in reality amnesia is short lived or permanent(the memories are so scrambled they are lost) Motor function can be lost also. Short term paralysis or permanent can be from a brain injury as well as spinal.
Brain injury can cause a stroke (CVA) also.

 

[Russ]

Reaction to brain trauma really varies with the individual. Being knocked out for ten minutes can mean nothing or be devastating.

One of the key factors neuropyschologists look at is pre-and-post lost of consciousness (LOC) loss of memory. The more you have the worse the prognosis.

The "coup contra coup" injury discussed by SeverinR above is still controversial in some medical circles.

Even short periods of unconsciousness can result in life long memory loss, personality changes, headaches, sensory losses, loss of inhibitions etc. Very tricky stuff.

But with the variability of how brain injuries work it leaves an author a great deal of license to do what suits the storey.

 

[Malik]

I have boxed for most of my life. If you get KO'd these days, you go to the ER. Do not pass Go, do not collect your runner-up ribbon. At amateur bouts nowadays, there's an ambulance standing by outside.

When I was a kid back in the late 70's, they'd let you "walk it off" if you got KO'd or got your bell rung; that changed while I was in high school, when we got a new coach who would make us take a few days off. When I took up boxing again in my 30's -- because I'm an idiot -- the paramedics were in and out of the gym all the time. If you got KO'd while sparring or just got your bell rung really good, the coaches stopped everything, they called 911, you got a neck brace, a stretcher, the whole she-bang. No one screws around with this stuff anymore.

My wife noticed that during the weeks leading up to a match, when I'd be sparring a lot, I'd misplace my car keys, forget words, drift off in the middle of sentences, leave the front door unlocked, leave my headlights on, and so on. I never got badly concussed, but I was taking a couple of dozen full-force hits to the head per week by which I mean an athletic 200-lb man punching you in the head as hard as he physically can. (Even if your opponent hits your glove, and your glove hits your headgear, it has a cue-ball effect and transfers the blow to your brain, although the refs don't count it.)

What I'm getting at is, it adds up.

A few weeks after a fight, I'd be back to normal.

I once caught a left hook to the face -- caught it square, full-force; I had my right arm down to block a liver shot that never came -- that not only put me on the canvas horizontal, I came up talking to my coach thinking he was my third-grade teacher and I was in trouble for writing in my math book. I was 34.

I was critically injured downrange in 2012. I'd aspirated sand when I went down and developed ARDS (shock lung) which has a hideously low survival rate and was far more of a concern than my actual wounds. By the time they got me on the chopper my O2 sats were in the 30's and had been there for about an hour -- this was in the ass end of Africa and for reasons I can't go into we had a bitch of a time getting the bird in to where I'd gone down. When I came out of the coma several days later, I had lost a standard deviation in my IQ.

Since the injury my ELO has dropped about three hundred points according to various chess programs on my laptop and phone -- this is a major thing, because now I literally can't visualize more than a couple of moves ahead, whereas before I could see possibilities stretching out like a sort of holographic overlay -- and now it's like I'm boxing all the time: I can never find things, I can't remember words or names. I have to put everything in a specific place every time, and write things down or speak them into a recorder on my phone in order to remember them.

I think the most frightening thing was that, for awhile after waking up, I lost the ability to read out loud. I could read silently, and I could speak, but I had severe aphasia when I'd try to put the two together. It was like that particular connection had burned out. It took months of working with a speech therapist to get it back. What was really weird was, I play the piano and I found that I could read music just fine. This even stumped the neurologist. So . . . yeah. My anecdotal experiences are that brain damage has idiosyncratic, oddly specific, and often amusing manifestations. This bodes well for the writer. Have fun with it.

 

[Jabrosky]

In the past, I did have characters getting KO'd and then waking up after a long coma to find themselves in a totally different place. For example, I might have a queen get KO'd in a fight on her palace, and then wake up in a ship's cargo hold way the hell out to sea. It came in handy for transitions, but now I'm not sure how plausible it even is. How would she get food, water, and address bladder issues in a coma that long?

 

[FarmerBrown]

I was out for two days and had a catheter and IV, but no food tube. Technically I was in a coma (you need to be unconscious for more than 6-8 hours, I think). So, for your character it depends how long it takes to get her from A to B. If more than a few hours, she'd need someone to take care of those things because you lose bodily control while unconscious. Also, take a look at coma statistics. Long-term survival rates are about 50/50 (short coma is much higher), and most coma survivors have issues, usually brain and nerve damage. As I mentioned in my first post, I lost some vision, but I (ironically) forgot to mention I also have long-term memory problems (on the one hand, I can't remember high school which is nice, but on the other hand I have difficulty recalling how exactly I met my husband eight years ago, which is not so nice).

As the few posters above mentioned, each case is different so you get a lot of leeway when writing about brain damage and comas etc. I think most readers wouldn't bat an eye at a transition like the one above, even though in real life it would be very dangerous to move someone in that state and not care for their bodily needs. Behold: creative license!

 

[Tom]

Last year, I was KO'd in a snowmobile incident. The trail I was riding hadn't been thoroughly cleared, and a branch whipped my visor. I blinked and jerked the handlebars on instinct, and ran the snowmobile into a tree. The impact wasn't much--my helmet jerked forward and hit the handlebars--and I couldn't have been out for more than a full minute, tops.

Nobody else was riding with me, and, being me, I shook it off and kept riding. I never told anyone about it, because when it happened I had no memory of being KO'd. I thought I had just hit my head. Looking back, I now realize that it was a KO, and I probably should have gone to the ER just to make sure I was okay.

So, yeah, I didn't think much of it at the time. It wasn't until I got home that I started to notice the affects of getting KO'd. I couldn't focus when I wrote, when I spoke my words were delayed as I tried to piece together a sentence in my mind, and I often trailed off in the middle of my sentences. On and off that week I had headaches. I also found that I couldn't read if the print was too small or the light too dim. My math skills also suffered, but for me that isn't saying much.

After about a week and a half, I was back to normal. The only lingering affects that I can see are semi-frequent headaches, and a tendency to "lose" a thought in the middle of thinking it. The latter is especially annoying; I've had to develop mental backtracking techniques and free association webs to guide me back to whatever I was thinking about before I forgot it. Overall, though, it could have been much worse. I'm thankful that I'm okay.