Mild Brain Injury
Mild Brain Injury
Mild brain injury (MBI) is a disease that is commonly caused by a significant blow to the head from a sports-related injury, motor vehicle accident, an accidental fall, or an assault. Although the vast majority of concussive injuries improve through natural recovery, some require medical, psychological and rehabilitative efforts to manage lingering symptoms. Other causes of MBI, such as a loss of oxygen to the brain, intracranial bleeding, or surgical procedures for an aneurysm or brain tumor, also require specialized interventions. In either case, the moderate changes that people experience in their thinking, emotional or physical abilities may create feelings of worry and demoralization.
The Mild Brain Injury Program is designed to rehabilitate individuals who have sustained a recent brain injury or to work with those whose longstanding MBI-related symptoms have not resolved. Best outcomes occur when MBI is treated immediately, clear information is provided and consistent follow-up services are offered. However, for those who have not received such care and have lingering symptoms, much can be done to improve their daily functioning.
The following are problems that people may experience after a mild brain injury:
- Poor concentration
- Memory problems
- Dizziness
- Depression
- Irritability
- Headaches
- Blurry vision
- Anxiety
- Constant tiredness
- Confused thinking
- Sensitivity to bright light
- Sleep disturbance
Those who have sustained an MBI may experience some or many of these changes, depending on the type and location of the brain injury. In most cases, these symptoms resolve naturally over time with rest and relaxation. However, not everyone recovers at the same rate or has the same outcome. One’s age and health status may affect recuperation. In addition, having sustained previous concussions complicates the healing process. Doctors who treat brain injuries agree that the most important factor in patients' recuperation is that they receive MBI education that improves their understanding of the recovery process and how to manage symptoms. The benefit of early detection and management of MBI symptoms cannot be overstated.
The Mild Brain Injury Program at Sinai Rehabilitation Center is designed to thoroughly diagnose and treat symptoms of MBI. Early in recovery, medical care focuses on promoting proper rest and sleep, reducing pain from headaches or other sources, managing visual changes, and treating balance issues for safety purposes. When this approach is followed, most people with MBI show significant improvement in concussion-related symptoms in the first month after injury.
For those individuals whose MBI symptoms do not improve after the first 4–6 weeks post-injury, much can still be done to promote recovery and restore function. Diagnostic clarity is critical in treating lingering symptoms of MBI. A slow recovery may be caused by the nature of the injury itself or the indirect effects of consistently poor sleep, visual changes or headaches. Psychological reactions to the trauma may also play a negative role in recovery from MBI.
Using a comprehensive diagnostic approach, the Mild Brain Injury Program assists patients in understanding the root causes of symptoms and provides a full complement of therapeutic options necessary for recovery. Our interdisciplinary treatment team works together to decide on a collaborative clinical approach and regularly reviews progress during team conferences. This information is also shared with patients to promote a clear understanding. The goal in MBI treatment is to improve an individual’s everyday life and allow them greater satisfaction in their pursuits.
RELATED SERVICES
Menopause
Menopause
Menopause is the time in your life when you naturally stop having menstrual periods. Menopause happens when the ovaries stop making estrogen, the hormone that helps control the menstrual cycle. Menopause marks the end of the reproductive years. The average age that women go through menopause is 51 years.
The years leading up to menopause are called perimenopause. Beginning in your 30s and 40s, the amount of estrogen produced by the ovaries begins to fluctuate. A common sign of perimenopause is a change in your menstrual cycle. Cycles may become longer or shorter than usual. You may begin to skip periods. The amount of flow may become lighter or heavier. Although changes in menstrual bleeding are normal during perimenopause, you still should tell your provider. Abnormal bleeding may be a sign of a problem.
Symptoms
Some women do not have any symptoms of perimenopause or have only a few mild symptoms. Others have many symptoms that can be severe. Common signs and symptoms include:
- Hot flashes
- Sleep problems
- Vaginal and urinary tract changes
Treatments
Hormone therapy can help relieve the symptoms of — and prevent complications from — perimenopause and menopause. Hormone therapy means taking estrogen and, if you have never had a hysterectomy and still have a uterus, a hormone called progestin. Estrogen plus progestin is called “combined hormone therapy” or simply “hormone therapy.” If you do not have a uterus, estrogen is given without progestin. Estrogen-only therapy is called “estrogen therapy.”
Estrogen can be given in several forms, including pills, skin patches, and gels and sprays applied to the skin. Progestin can be given separately or combined with estrogen in the same pill or patch. Women who only have vaginal dryness may be prescribed “local” estrogen therapy in the form of a vaginal ring, tablet or cream.
Hormone therapy may increase the risk of certain types of cancer and other conditions.
RELATED SERVICES
Memory Loss and Dementia Care
Evaluating Memory Loss
Changes in memory and brain health can have several causes. The most important part of making a diagnosis is to obtain accurate information from close family members and friends who know the patient well. We need to establish that a decline in a level of functioning has occurred that cannot be explained by depression or systemic illnesses such as renal or heart failure, and that the process is progressively worsening. The baseline of each individual is unique and determines the level with which we establish if there has been a deterioration.
A urinary tract infection can cause major confusion in an elderly person and should not be labeled as dementia. Pneumonia, head trauma and medication side effects often cause memory problems too, but patients get better over time and as such they do not meet the diagnostic criteria for dementia.
Memory problems are ubiquitous and by themselves are not worrisome for the onset of dementia. We all forget our keys, may have difficulty finding our car in the parking garage, or walk into the basement and not remember why we went there. Memory problems are concerning, and a sign of dementia, when a patient forgets major events, names or things that are significant. Not showing up at a daughter's wedding, forgetting names of grandchildren or not remembering how to drive are concerning enough to warrant a dementia evaluation.
Tests
To help determine the cause of your or your loved one’s memory loss, your provider may recommend:
- blood tests for thyroid and B12 levels
- brain imaging with CT scan or MRI
- paper-pencil tests to measure memory, learning, language, orientation and other brain functions such as drawing or abstract thinking
Treatments
Medications helpful for making a person with mild dementia talk more, have more interest in interacting with family members, and show less agitation or paranoid thoughts include Aricept, Razadyne and Exelon. Aricept is the most commonly used drug in this class. It helps patients live in their own homes for a longer period of time and delay transfer to a nursing home for two years or more. Numerous studies have shown that the earlier treatment starts the more the patient benefits.
Patients who have increasing difficulty with taking care of their basic needs such as getting dressed, eating or using the bathroom can benefit from taking a drug called Namenda. Clinical trials indicate that patients with moderate to severe dementia benefit the most if they take a combination of Aricept and Namenda together.
Caring for the Caregiver
It is critical that caregivers of patients with dementia take care of themselves, too. Family members often feel guilty about not spending enough time with their loved one and may give up their own free time to provide care. Over time, this can lead to high stress, increased blood pressure, depression and burnout. But reliable support can help you sustain long-term care.
Helpful resources for caregivers include:
- The Alzheimer’s Association, which offers free education, support groups and a 24/7 helpline. More information is available at www.alz.org or by calling 1-800-272-3900.
- "The 36-Hour Day", a trusted and practical guide for families caring for someone with dementia.
- Medicare caregiver supports, which are also available at no cost;
Learn More Here.
RELATED SERVICES
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging (MRI) uses a powerful magnetic field, radio waves and a computer to produce more detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. This painless, non-invasive test may be used to help diagnose or monitor treatment for a variety of conditions affecting the abdomen, brain, breasts, chest, pelvis, prostate, spine and more. After the MR scanner captures the series of images, the images can then be studied from different angles by the radiologist.
Before the Procedure
Unless you are told otherwise, you may follow your regular daily routine and take food and medications as usual. You should tell the technologist if you have medical conditions, have had surgery recently or have medical or electronic devices in your body. Women should always inform their radiologist if they are breastfeeding/if they may be pregnant. If you have claustrophobia or anxiety, you may want to ask your physician for a mild sedative prior to your exam. You may be given a gown to wear and asked to remove jewelry, hearing aids and removable dental work.
During the Procedure
The technologist begins by positioning you on the moving exam table. Straps and bolsters may be used to help you stay still and maintain the correct position. If your radiologist wants to use a contrast dye during your MRI, an intravenous (IV) line will be put in a vein in your hand or arm and the dye will be injected into the IV line during the scan. You will be placed into the magnet of the MRI unit and the radiologist and technologist will perform the exam while working at a computer outside of the room. The entire exam is usually completed within 45 minutes.
After the Procedure
When the exam is complete, you will be asked to wait until the technologist verifies that the images are of high enough quality for accurate interpretation. Once this has been confirmed, the IV line will be removed, and you can return to your normal activities. Depending on the results of the MRI, additional tests or procedures may be scheduled to gather further diagnostic information.