Why that headache could be fatal

 

“Many Kenyans are neglecting their heads,” says Dr Hiten Gadkari, a neurosurgeon, and he is not amused by this suicidal trend.

Dr Gadkari says he has noted an increase in the number of traumatic brain injury (TBI) patients at his Mediheal Group of Hospitals in Nairobi.

Brain trauma

And his concern is justified, given that the ominous warning by the global health agency in 2002 seems to have come to pass.

The World Health Organization (WHO) had projected brain trauma would surpass many diseases as the major cause of death and disability by 2020.

Motor accidents and falls from heights have caused the most traumatic brain injuries.

And the country’s rising road crash casualties -- by last October, accidents had killed 3,114 compared to 2,942 in the same period in 2019 -- suggest a worrying situation.

Dr Gadkari says head injuries sustained in road accidents, domestic falls -- especially in showers -- assault, sports activities and firearm related incidents have led to several deaths.

He explains that road accidents are the greatest causes of traumatic brain injury patients (44 per cent), followed by domestic falls (26 per cent).

Worrying situation

Physical assault accounts for nine per cent, firearm-related causes (eight per cent) and unknown causes are to blame for 13 per cent of the brain injuries, according to Dr Gadkari.

“The situation is worrying. Accident victims should be careful about what appears as less traumatic but can progress to a more serious internal injury,” he cautions.

Kenyans should pay much more attention to their heads, he says. Many patients, he says, miss the tell-tale signs of an impending severe traumatic brain injury by ignoring headaches, constant vomiting, loss of consciousness and smell, epileptic bouts as well as ear, nose and throat bleeding.

“Any patient with any of these signs and symptoms should go to the doctor and get checked. They should have a routine lab investigation, which will greatly help diagnose any case of traumatic brain injury,” he explains.

No head trauma should be ignored, Dr Gadkari cautions, saying that sporting activities such as soccer and rugby, which often see players getting knocks on the head, pose a huge risk to their health.

Lucid injury

“Sometimes a football player gets a head injury when playing, the player gets unconscious then he is resuscitated and he heads back to the hotel only to be found dead the next day. This is an example of a lucid injury,” Dr Gadkari reveals.

Lucid injury is when a patient keeps losing and regaining consciousness as a result of trauma to the head.

“Anyone with loss of consciousness must go to hospital, get a CT scan or stay in hospital for observation and should not go home,” he says.

Recent data by WHO indicates that traumatic brain injury is responsible for more than 4.5 million deaths a year, which translates to about one in every 10 deaths in the world.

At the turn of the millennium, cases had spiraled so much that WHO in 2002 predicted that by 2020, the condition would be the leading cause of mortality and disability in the world, surpassing chronic diseases and other leading causes of death.

The increase was then projected to be even more pronounced in developing countries where that trend is already evident.

Dr Gadkari says: “Owing to an increase in motor vehicle accidents, the morbidity and mortality attributed to TBI is set to increase in low and middle-income countries where access to neurosurgical care remains very limited.”

“Latin America and Sub Saharan Africa demonstrate a higher TBI-related incidence rate varying from 150-170 per 100,000 respectively due to RTIs compared to a global rate of 106 per 100,000,” states a 2019 publication titled ‘Determinants of the outcome on traumatic brain injury patients at Kenyatta National Hospital.’

“In Kenya, motor vehicle accidents, assaults and motorcycles are significant causes. Traumatic brain injuries are high among young individuals (and) represent the leading cases of morbidity and death among a predominantly young and productive population,” states the report.

An earlier study by Benson Kinyanju, a certified brain injury specialist, reported that although there are no accurate numbers available on the prevalence of TBIs in Kenya, the significantly high rate of traffic-related deaths and disabilities, most of which result from brain injuries, point to the scale of the problem.

“The high frequency of motor vehicle-related injuries and fatalities … point to a high occurrence of brain injuries in the country,” reads Traumatic Brain Injury in Kenya: A Preliminary Review of the Literature published in 2016.

The National Transport and Safety Authority (NTSA) last year noted there was an overall 6.9 per cent increase in road accident deaths, majority of the casualties being pedestrians, motor cycle riders and their passengers.

A research conducted by the Lancet Neurology in 2016 titled ‘Global, regional and national burden of traumatic brain injury and spinal cord injury, 1996-2016: a systematic analysis for the Global Burden of Disease Study 2016’ also highlighted the crisis.

“In 2016, there were 27.08 million new cases of TBI and 0.93 million new cases of spinal cord injury (SCI), with age-standardised incidence rates of 369 per 100,000 population for TBI and 13 per 100,000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million and of SCI was 27·04 million,” the report says.

“TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles,” the report states.  

In hospitals, doctors often refer to TBI as “the silent epidemic” since most of its consequences are not obvious. About 80-90 per cent of patients with severe TBI die.

However, there’s hope.

With 25 years in neurosurgery, Dr Gadkari, who has dealt with brain tumours, spinal cord injuries, head injuries, congenital malfunctions, and other complex neurological medical conditions, says that nearly 92 per cent of all his patients diagnosed with mild traumatic brain injury go home within 14 hours of treatment. 

It takes about a week or two for the moderate patients to leave the hospital and often, no surgeries are required to treat them.

Proper medical diagnosis and investigation is key to success in managing a patient, Dr Gadkari says.

A patient will first be subjected to an X-ray of the scalp to detect any skull fractures. Next is a CT scan- a medical imaging technique that uses computers and rotating X-ray machines to create cross-sectional images of the body.

Should the CT scan miss anything, then a patient should be subjected to an MRI (magnetic resonance imaging) scan, which is a radiology technique that uses magnetism, radio waves and a computer to generate images of the organs of the body.

“The MRI scan is very good at detecting microscopic injuries, which can be missed by the CT scan. So all these processes (of testing) are the basic investigations that are done to get to understand the extent of TBI,” Dr Gadkari explains.

Efficient management of traumatic brain injury at the first point of contact with the healthcare system is very critical for the survival of patients.

The brain specialist believes it is time the transport sector was redefined and traffic discipline enforced to reduce the number of road accidents.

“Driving is a serious business; while driving you can kill pedestrians, your passengers, cyclists and yourself. Follow the traffic rules, vehicles should be properly maintained to prevent accidents. Wearing of helmets (for motorcyclist and pillion passengers) is mandatory, so is the use of seat belts,” the medic recommends.

“There has to be improvement of infrastructure, like quality roads with proper lanes and markings. All these can prevent head injuries,” he adds.

Should one be the first to arrive at an accident scene, Dr Gadkari advises you should ensure that the victims maintain a flat position and should they have fractures, proper bandaging on the fractured point.

“After doing these initial procedures, arrange for their safe transportation to hospital. Remember, the unconscious victims should get priority to be taken to hospital,” Dr Gadkari says.

Having practiced neurosurgery in Nairobi, Eldoret and Nakuru, he noted that patients from the Rift valley towns tend to suffer more from traumatic brain injuries compared to those from the capital city who often suffer from brain tumours.

He is still baffled by this scenario. 

He says that most patients, upon hearing that they have to undergo brain surgery, recoil assuming that the treatment will be expensive. He explains the National Hospital Insurance Fund and other medical insurers can cater for the expenses, urging every Kenyan to get a medical insurance cover.

To properly manage head injuries, Dr Gadkari says that hospitals must be well-equipped with Intensive Care Units, theatre facilities, a neurosurgeon, CT scans as well as MRI machines.

And to those given to binge drinking, the doctor has a warning.

“Do not drink excessively, do not intoxicate yourself with drugs. Have enough sleep, be in good mental health, otherwise, you will damage your head,” Dr Gadkari concludes.  BY DAILY NATION