What is acquired brain damage?

He Acquired brain damage ( DCA ) Refers to an injury occurring in a brain that has so far had normal or expected development and may be the result of different causes: head trauma, stroke, brain tumors, anoxia, hypoxia, Encephalitis, etc. (De Noreña et al., 2010).

In some cases, the scientific literature uses the term Brain damage ( DCS ) To refer to this same clinical concept of ACD.

Acquired brain damage

When an accident involving an ACD occurs, different neurological processes will be affected and acute injuries to the individual's nervous system will in many cases lead to a significant deterioration of health and functional independence (Castellanos-Pinedo et al. , 2012).

This is one of the most important health problems in developed countries. This is due, on the one hand, to the magnitude of its incidence And the impact Physical, cognitive Y Social Which causes people suffering from this type of injury (García-Molína et al., 2015).

Statistics of acquired brain damage

In Spain there are no concrete and current data on the number of people affected by this type of pathologies, since they include or exclude different etiologies.

However, the American literature shows that there are about 250 cases of Traumatic brain injury (TCE) per 10,000 inhabitants and in the case of Spain, Approximately 100,000 people a year suffer from it . However, these statistics refer to accidents of a traumatic nature (CEADAC, 2015).

In Spain, in 2008, 420,064 people With acquired brain damage. Within these, the 52% are women and the 48% men . In relation to the age, approximately 65% ​​have an age that Reaches or exceeds 65 years . It is estimated that 104,701 new cases per year Of acquired brain damage (FEDACE, 2013).

As for the causes, those that have a greater presence are: Ictus (53.36% in men and 46.64 in women), TCE (66.92% in men and 33.08% in women) and Anoxia (62.62% in men and 37.38% in women) (FEDACE, 2013).

A fact of great importance is that 113.132 people Of the total of more than 420,000 with DCA in Spain, have been recognized by public services with Different degrees of dicacity (73,584 with a grade higher than 65%, 31,272 with a grade higher than 33% and 8,276 people with a grade lower than 32%) (FEDACE, 2013).

Causes of Acquired brain damage

Normally, the ACD is essentially associated with Traumatic brain injury , In fact, in the English-speaking medical literature, the term brain damage ( Brain injury ) Are often used synonymously with traumatic brain damage ( Traumatic brain injury ) (Castellanos-Pinedo et al., 2012).

But in addition, the DCA can also have its origin in ictus , Brain tumors or infectious diseases (De Noreña et al., 2010).

Castellanos-Pinedo and collaborators (2012) show a wide List of possible causes of brain damage Depending on the agent causing them:

Injuries caused by external agents

  • Cranioencephalic injury
  • Toxic encephalopathy: drugs, drugs and other chemicals
  • Encephalopathy by physical agents: ionizing radiation, electrocution, hyperthermia or hypothermia.
  • Diseases of infectious type: meningoencephalitis

Injuries caused by endogenous causes

  • Hemorrhagic or ischemic stroke
  • Anoxic encephalopathy: due to diverse causes such as cardiorespiratory arrest.
  • Primary or secondary neoplasms
  • Autoimmune inflammatory diseases (connective tissue diseases-systemic lupus erythematosus, behçet's disease, systemic vasculitis and demyelinating diseases-Multiple sclerosis or acute disseminated encephalomyelitis-).

Depending on their incidence, it is possible to establish an order of importance of these causes, being the most frequent the traumatic brain injury and stroke / cerebrovascular accidents. Third, there would be anoxic encephalopathy. Less frequent would be the causes of the type infectious or derived from brain tumors (Castellanos-Pinedo et al., 2012).

Creneoencephalic trauma

Ardila & Otroski (2012), propose that the TCE occurs as a consequential impact of a blow on the skull. Generally, the impact on the skull is transmitted both to Meningeal layers As well as cortical structures.

In addition, different external agents can cause the impact: use of forceps at birth, bullet wound, blow-to-blow effect, extension of a mandibular blow, among many others.

Therefore, we can find Open trauma ( TCA ) In which there is an invoice of the skull and penetration or exposure of brain tissue and trauma Closed cranioencephalic , In which a fracture of the skull does not occur but serious damage to the brain tissue may occur due to the development of a edema , Hypoxia , Increased intracranial pressure or ischemic processes.

Cerebrovascular accidents

The term cerebrovascular accident (CVA) refers to an alteration in the blood supply of the brain. Within the VCA, we can find two groups: due to obstruction of the blood flow (obstructive or ischemic type accidents) and hemorrhages (hemorrhagic accidents) (Ropper & Samuels, 2009; Ardila & Otroski, 2012).

In the group of strokes produced by a Obstruction of blood flow We can find the following causes described by Ardila & Otroski (2012):

  • Thrombotic Accidents: The cause of obstruction is a Arteriosclerotic plaque Which is placed in an arterial wall. This can impede blood flow, causing an ischemic area (which does not receive blood supply) and an infarct in the area that the obstructed artery irrigates.
  • Cerebral embolism / embolic accidents : The cause of the obstruction is an embolus (blood clot, fatty, or gaseous) that obstructs the blood circulation of a brain vessel, causing an ischemic zone and an infarct in the area that the obstructed artery irrigates.
  • Transient ischemic attack : Occurs when the obstruction resolves in less than a 24-hour period. Norlmanelte, occur as a consequence of an arteriosclerotic plaque or thrombotic embolus.

On the other hand, Hemorrhagic accidents Tend to be the consequence of the rupture of a brain aneurysm (Malformation of a blood vessel) that may be generating hemorrhagic blood flows at the intrarecerebral, subarachnoid, subdural or epidural level (Ardila & Otroski, 2012).

Anechoic encephalopathy

The Anoxic or hypoxic encephalopathy Occurs when there is insufficient oxygen Central Nervous System (CNS) due to respiratory, cardiac or circulatory causes (Serrano et al., 2001).

There are different mechanisms through which the supply of oxygen can be interrupted: Decreased cerebral blood flow (Cardiac arrest, CAD, severe hypotension, etc.); by Decreased amount of oxygen in the blood (Polyradiculoneuritisa guda, myasthenia gravis, pulmonary diseases, thoracic trauma, drowning or inhalation of toxins); Reduced ability to carry oxygen (Carbon monoxide poisoning) or Inability of brain tissue to use oxygen delivery (Cyanide poisoning) (Serrano et al., 2001).

Consequences of acquired brain damage

When an ACD occurs, most patients have serious consequences that affect multiple components: from the development of a Vegetative state The Minimal awareness until Deficits Important in components Sensorimotor , Cognitive or Affective

Frequently, the occurrence of Aphasia , Apraxia , Motor impairments, visuospatial Heminegligence (Huertas-hoyas et al., 2015). On the other hand, deficits of cognitive type often appear as the p Problems of attention, memory and executive functions (García-Molina et al., 2015).

Together, all these deficits will have a Functional impact Important and will be an important source of dependence ; Hindering Social relations and re-employment (García-Molina et al., 2015).

In addition, they will not only give consequences to the patient. At the family level The suffering of an ACD in one of its members will be the cause of a strong moral blow.

Generally, a single person, the Primary caregiver , Will assume most of the work, that is, assume most of the care to the patient in a situation of dependency. In only 20% of cases, care is taken care of by more relatives (Mar et al., 2011)

Different authors emphasize that the care of one in a serious situation of dependence supposes an effort that can be compared to a working day. Thus, the primary caregiver work overload Which negatively affects their quality of life in the form of stress Or inability to tackle tasks.

It is estimated that the presence of Psychiatric disorders In caregivers is 50%, among them are the anxiety , the depression , Somatizations and insomnia (Mar et al., 2011).

Diagnosis of Acquired brain damage

Due to the wide variety of causes and consequences of ACD, both the involvement of brain systems and the magnitude of this can vary considerably among individuals.

In spite of this, the working group headed by Castellanos-Pinedo (2012) proposes the following definition of DCA:

"Injury of any origin that occurs acutely in the brain, causing in the individual a permanent neurological deterioration, which conditions a deterioration of his functional capacity and his previous quality of life."

In addition, they extract Five criteria Which must be present so that a case can be defined as DCA:

  1. Injury Which affects part or all of the Encephalon (Brain, brain stem and cerebellum).
  2. He i Start is of the acute type (Occurs in an interval of few seconds to days).
  3. There is a Deficiency as a result of injury , Directly objectifiable through clinical examination and the use of diagnostic tests.
  4. There is a Deterioration of operation and quality of life Premóbidos of the person.
  5. Hereditary and degenerative diseases and lesions that occur in the prenatal stage are excluded.

Treatments

In the acute phase, therapeutic measures will be directed primarily at the physical sphere. At this stage the individuals are hospitalized and the objective will be to obtain the control of the vital signs and of the consequences of the ACD, such as hemorrhages, intracranial pressure, etc. At this stage, the treatment is developed from surgical and pharmacological approaches.

In the Post-acute phase , Will be intervened from a Physiotherapeutic level To deal with possible motor sequelae, such as the Neuropsychological To address the cognitive sequelae: orientation deficit, amnesia , Linguistic deficit, attention deficit, etc.

In addition, in many cases the psychological attention Since the event and its consequences can become a traumatic event for the individual and his environment.

CONCLUSIONS

Acquired brain damage has a strong personal and social impact. Depending on different factors such as the location and severity of the injuries, there will be a series of physical and cognitive consequences that can have a devastating impact on the social sphere of the individual.

Therefore, the development of post-acute intervention protocols that attempt to restore the functional level of the patient to a point close to the premorbid level are essential.

References

  1. Ardila, Alfredo; Otrosky, Feggy;. (2012). Guide for neuropsychological diagnosis.
  2. Castellanos-Pinedo, F., Cid-Gala, M., Duque, P., Ramírez-Moreno, J., & Zurdo-Hernández, J. (2012). Brain damage: proposed definition, diagnostic criteria and classification. Rev Neurol, 54 (6), 357-366.
  3. De Noreña, D., Ríos-Lago, M., Bombín-González, I., Sánchez-Cubillo, I., García-Molina, A., & Triapu-Ustárroz, J. (2010). Effectiveness of neuropsychological rehabilitation in acquired brain damage (I): attention, speed of preoccupation, memory and language. Rev Neurol, 51 (11), 687-698.
  4. FEDACE. (2013). People with Brain Injury Acquired in Spain.
  5. García-Molina, A., López-Blázquez, R., García-Rudolph, A., Sánchez-Carrión, R., Enseñat-Cantallops, A., Tormos, J., & Roig-Rovira, T. (2015) . Cognitive rehabilitation in acquired brain damage: variables that mediate the response to treatment. Rehabilitation, 49 (3), 144-149.
  6. Huertas-Hoyas, E., Pedrero-Pérez, E., Águila Maturana, A., García López-Alberca, S., & González-Alted, C. (2015). Functionality predictors in acquired brain damage. Neurology, 30 (6), 339-346.
  7. Mar, J., Arrospide, A., Begiristain, J., Larrañaga, I., Sanz-Guinea, A., & Quemada, I. (2011). Quality of life and overload of caregivers of patients with acquired brain damage. Rev Esp Geriatr Gerontol., 46 (4), 200-205.
  8. Serrano, M., Ara, J., Fayed, N., Alarcia, R., & Latorre, A. (2001). Hypoxic encephalopathy and cortical laminar necrosis. Rev Neurol, 32 (9), 843-847.


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