Elusive Head Injuries

The more that doctors learn about head injuries, the more concerned they are that not nearly enough is being done to protect accident victims from the long-lasting, possibly paralyzing or fatal effects of insidious brain damage. The main reason is that gross injuries to the brain often go undetected and even unsuspected.

The severity of the head-injury problem is increasing with spreading industrialization. Accidents have become the leading cause of death among Americans aged one to 37, and head injuries are among the commonest and deadliest of all accidents. They cause at least 15,000 U.S. deaths each year, and, are suspected of causing many more, notably in auto accidents where there are multiple injuries.

No Symptoms. At the Third International Congress of Neurological Surgery, just concluded in Copenhagen, doctors from all over the world reported with alarm on the difficulty of diagnosing head injuries. "Among the problems," said Baltimore's Dr. A. Earl Walker, "is that one-third of all patients suffering from blood clots inside the skull have no symptoms of them. We have developed highly technical means of determining whether there is a blood clot, and then locating it, but this needs expensive equipment which is not generally available, as well as expert personnel. It can't be done in every small town. But we suggest that centers be set up and kept open 24 hours a day with these facilities."

One of the newer detection methods is echoencephalography, working on the same principle as sonar. When sound waves are bounced in and out of the head and converted into a light pattern, the neurologist can see whether the brain has been shoved to one side by blood or a clot. Injections of radiopaque dye also help X rays to show whether arteries have been displaced or damaged enough to deprive part of the brain of its blood supply. Even using these techniques, doctors do not always discover everything.

Treacherous Crash. How elusive damage can be is shown by the case of a garageman, cited by Neurosurgeon Arthur Winter of East Orange, N.J. The young mechanic was hit on the head when a car slipped off a jack, but he did not become unconscious or even dizzy, went right back at work underneath the car. That evening he lost his dinner and seemed dazed. At the hospital, no mark was found on the skull, so surgeons had to drill holes in it and search for the trouble. They discovered a mass of blood and drained it. The mechanic eventually recovered his mental alertness but, four years later, he still has only limited use of his right arm.

Post-mortem studies show that, with prompt detection and proper treatment, half of those who die of head injuries could have been saved. Lasting or delayed disability could be similarly reduced, reported Pakistani-born Dr. Ayub K. Ommaya, of the National Institute of Neurological Diseases and Blindness at Bethesda, Md. Detection, however, is doubly difficult in the peculiar and treacherous kind of injury known as "whiplash"--the result of the sudden forward-and-backward snapping of the head that is common in rear-end auto accidents.

Invisible Damage. Many neurologists are now convinced that whiplash, without a direct blow on the head and leaving no scratch on the skull, may nevertheless cause bruises and hemorrhages in the brain.

In experiments to determine the effects of the lash, Dr. Ommaya's group of researchers produced whiplash injuries in monkeys. A compressed-air gun, fired behind the animals' heads, created the snap movement. The monkeys had been anesthetized before the test, and then were killed painlessly before they could recover consciousness. Autopsies showed that whiplash bruised some of the animals' brains, caused swelling and hemorrhaging. In several cases, it also injured nerve centers in the brain stem that are important in controlling heartbeat, circulation and breathing.

People who have had whiplash accidents sometimes complain of blinding headaches, partial paralysis, dizziness, deafness, blindness--and inability to tolerate alcohol. But because it has been difficult or impossible in most cases to detect physical damage to the brain, lawyers for insurance companies--as well as some doctors--have argued that such symptoms are psychologically induced by the "blow from behind," and are more imaginary than real. Experiments like Dr. Ommaya's go far to confirm the possibility of severe and lasting, though invisible, damage.

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