Traumatic brain injury is generally classified into two categories: focal and diffuse. A diffuse brain injury occurs in multiple areas of the brain, whereas a focal brain injury refers to a single area of localized damage.
Focal brain damage can lead to a variety of secondary effects, depending on the severity and location of injury. Fortunately, many of these effects can be improved with a combination of treatments, which often includes a rigorous rehabilitation program.
This article will discuss the causes, symptoms, and treatments for a focal brain injury.
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What Is a Focal Brain Injury?
A traumatic brain injury is a broad term used to define a wide range of injuries to the brain. Injuries can be focal, meaning they are confined to only one area of the brain, or they can be diffuse which means the damage affects more than one area of the brain. In some cases, injuries can be both focal and diffuse, depending on the cause.
Some of the most common causes of focal brain injuries include:
- Falls
- Sport injuries
- Motor vehicle collisions
- Blow to the head by a sharp object
- A brain lesion that cuts off blood supply to a specific region of the brain
- A blood clot that deprives one area of the brain from oxygen
- Penetrating head wound
Focal brain injuries can occur at the site of impact or on the opposite side of the impact. When focal brain injuries occur on both sides (site of impact and the opposite side) they are called coup-contrecoup injuries.
Classification of Focal Brain Injury
Focal brain injuries can be classified into two main categories: open (penetrating) and closed. Open injuries refer to a fractured skull where the brain is exposed. Closed injuries, however, do not involve skull fractures.
Additionally, focal brain injuries can be further classified into different categories based on the types of hemorrhages or bleeding they cause.
Focal brain injury hemorrhages can include:
- Intraventricular hemorrhage: refers to bleeding inside the brain’s ventricles (muscular chambers that pump
sblood out of the heart and into the circulatory system). - Intracerebral hemorrhage: is characterized by bleeding in the cerebrum (the largest part of the brain responsible for coordinating movement and regulating temperature).
- Cerebral contusion: is a type of intracerebral hemorrhage that refers to a bruise on the brain which can occur when the brain hits the skull
Bleeding in the brain can increase the risk of complications and be life-threatening; therefore, timely treatment is crucial. Treatment will depend on the severity and the cause of the focal brain injury. For example, when a TBI is severe, surgery may be required to help relieve pressure from the brain and reduce bleeding.
Symptoms of Focal Brain Injury
Symptoms of a focal brain injury vary depending on the area of the brain affected. One region of the brain can control multiple functions. Therefore, even if only one area of the brain was directly impacted, multiple functions can still be affected.
For example, the frontal lobe is a large part of the brain that plays a role in behavior, language, and movement. When an individual sustains a frontal lobe injury, they may experience a combination of symptoms such as difficulty with speech and language or loss of voluntary movement.
Other symptoms of a focal brain injury can include:
- Sudden, intense headaches
- Paralysis
- Numbness or tingling on either side of the body
- Seizure
- Slurred speech
- Drowsiness or difficulty staying awake
- Changes in mood or personality
- Sudden feelings of fear, paranoia, or depression
While all symptoms of a focal lesion require urgent medical care, some symptoms may signal a life-threatening hematoma. Subdural hematomas are collections of blood on the brain that require immediate medical intervention. They can occur from both a diffuse brain injury and a focal brain injury.
For example, during a car accident the initial blow to the head may only cause focal damage. However, other secondary injuries such as oxygen deprivation can lead to widespread damage within the brain. Studies show that brain inflammation after TBI is not only restricted to focal lesions, but it can also spread to remote areas of the brain.
Therefore, all symptoms of a TBI should be taken seriously and treatment should be sought out as soon as possible.
Can Surgery Help Treat a Focal Brain Injury?
Initial treatment of focal brain injuries will involve monitoring and stabilizing the individual to ensure no life-threatening complications develop. For example, if there is swelling in the brain, doctors may need to perform emergency surgery to relieve the pressure.
In severe cases, focal brain injuries may require a decompressive craniotomy. This type of surgery involves removing the bone flap (a portion of the skull) to access the brain underneath. Once treated, the bone flap is reattached to the skull with metal plates and screws.
In other cases, a craniectomy may be required. Unlike a craniotomy, the bone flap is not immediately replaced after surgery to help relieve some pressure on the brain. Instead, individuals are required to wear a helmet to provide protection to the brain and prevent it from harmful substances.
While both types of surgery can be helpful, there is a rare complication after removing a piece of the skull known as “Syndrome of the Trephined.” This syndrome is associated with sensorimotor deficits and neurological deterioration.
Symptoms of Syndrome of the Trephined can often include:
- Headaches
- Fatigue
- Loss of motivation and/or concentration
- Sensitivity to noise and vibration
- Anxiety
There may also be other motor, cognitive, and language deficits associated with Syndrome of the Trephined. While this is a rare complication of decompressive surgery, all symptoms should be taken seriously. Doctors can provide survivors with more information regarding surgical interventions and other potential treatments for focal injuries.
Treatments for Focal Brain Injury
After discharge from the hospital, treatment may include a combination of rehabilitation therapies to help manage any potential secondary effects from a focal brain injury. This can include physical, cognitive, emotional, and/or behavioral effects, depending on the area(s) of the brain affected.
Rehabilitation is a key part of TBI recovery because it helps stimulate the brain and activate neuroplasticity – the brain’s ability to naturally heal and rewire itself. Neuroplasticity works by strengthening existing neural connections and creating new ones for a specific skill. It is best activated by massed practice of rehabilitation exercises.
The more a skill is practiced, the more the brain will recognize that skill and strengthen its neural connections, which can help restore communication between the brain and the affected muscles.
Therefore, it’s important to practice high repetition of therapeutic exercises, which can include:
- Physical therapy: focuses on improving balance, coordination, and overall mobility. Physical therapists understand how to assess a person’s unique needs and select specific rehab exercises that target those needs, such as gait training exercises for survivors that struggle with walking. They may also recommend establishing a proper home rehabilitation program to practice in between therapy sessions.
- Occupational therapy: helps survivors improve mobility while also finding safe and effective ways to perform the activities of daily living such as eating and bathing. A therapist can provide individuals with adaptive equipment recommendations and/or rehabilitation exercises to help maximize independence after a focal brain injury.
- Speech & language therapy: helps individuals with a broad range of physical and cognitive communication disorders like impaired speech or difficulty swallowing. A speech-language pathologist can distinguish between different speech conditions and provide survivors with appropriate exercises.
- Cognitive training: helps improve any cognitive functions that may have been affected by a focal brain injury, especially damage to the frontal lobe. Cognitive exercises may help improve short-term memory, attention, problem-solving, and other executive functioning skills.
- Home therapy: helps keep the brain stimulated and neuroplasticity activated in between therapy sessions. To increase motivation and help survivors achieve massed practice at home, therapists may suggest using interactive rehabilitation equipment like FitMi home therapy. FitMi was designed to improve full-body mobility after a TBI. It provides survivors with full-body exercises based on their level of ability.
Every focal brain injury is different, and every person’s recovery process will vary. Usually, the stronger the rehabilitation regimen, the higher the chances of improving function and even lowering the risk of further complications. Therefore, obtaining a proper rehabilitation plan is essential for TBI recovery.
Understanding Focal Brain Injuries
Focal brain injuries affect only one region of the brain, unlike diffuse injuries that affect multiple areas. However, depending on where the focal brain injury occurred, survivors may experience a wide range of secondary effects including physical, cognitive, and emotional effects.
Fortunately, these effects can all be managed with a proper rehabilitation program to help stimulate the brain and activate neuroplasticity. There are also other treatments available to help minimize the risk of complications after a TBI. Consult with a doctor to obtain a unique recovery plan that is safe and effective.
We hope this article helped you understand the causes, symptoms, and potential treatments for focal injuries.
The post Focal Brain Injury: Understanding the Causes, Symptoms, & Treatments appeared first on Flint Rehab.
