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Myth: There is only brain damage when it is visible on a scan

Myth: There is only brain damage when it is visible on a scan

Photographer:Fotograaf: Joey Roberts

Myth busters

It is estimated that 85 thousand people may suffer brain damage in the Netherlands every year. Of that number, approximately 30 thousand visit A & E. “Where subsequently a routine scan is made to determine whether they have suffered a concussion – a minor injury that will heal – or a brain contusion, which leaves permanent damage,” says Caroline van Heugten, professor of Clinical Neuropsychology. “But CT scans today are not sensitive enough to detect subtle damage. A bleeding is clear, but detecting damaged connections is a lot more difficult. That kind of damage is not in one place, the network has been affected. Compare it to a satellite photo of Europe. The effects of a volcano eruption in Italy can be seen in large parts of Southern Europe, but a flood in Borgharen or Itteren is not visible. The latter has definite consequences for how the area functions.” There is a new technique that can provide a much more detailed image, but it has not been in existence long enough to be part of the standard equipment in hospitals. “The analysis of those scans is still too expensive and time-consuming.”

Even with a detailed scan, some damage remains invisible. That doesn't mean that people who continue to experience problems are hypochondriacs. “There is no one-to-one relationship between a person's complaints and the visibility of damage on a scan. Someone who has spent a week in hospital after having had a stroke, may make a full recovery, while a patient who suffered a blow to the head and where nothing was discovered, may still experience problems, such as fatigue, forgetfulness and sensitivity to sound and light, a year later.”

There may be any of a number of explanations for why one person suffers worse than another after brain trauma. “For example, someone may not have taken sufficient time in the first weeks to recuperate, returned to work too soon. Or maybe someone is by nature slightly more fearful and thinks too much about the possibility of temporary complaints becoming permanent ones. A large study into the factors that determine whether someone will recover slowly and for example reports sick for a lengthy period after a head injury, showed that people who suffered from depression or felt anxious prior to the event, experienced these conditions later on as well. Whether someone had a history of reporting sick regularly, also plays a role.” But caution is advised, not everything is explainable. “There is also a group of people who were stable and healthy, but nevertheless become unbalanced and continue to suffer.”

According to Van Heugten, one of the founders of the Expertise Centre for Brain Injury in Limburg, (Expertisecentrum Hersenletsel Limburg), it is important that GPs can link possible brain injury to vague complaints. “When you have a cardiac arrest, there is a temporary loss of oxygen to the brain. These patients are treated as heart patients, but some symptoms can arise from lack of oxygen in the brain. We are therefore developing a tool to assist GPs in recognising and acknowledging these symptoms. We advise to always check the medical file to see if there has been a brain injury in the past and whether there has been a sudden change in a person's functioning. For example, if someone lost consciousness, this is an important indication.”

Mythbusters is a series in which academics shoot down popular myths on complex topics

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