September 20, 2009

[VIDEO] Kid Loses Half His Brain

In consonance with the last posting, I came across this segment of an American kid who lost half his brain/skull in a shooting incident:

September 14, 2009

Thugs left man with half a head

I don't often read tabloids, but I noticed this intriguing report in The Sun lately:

Thugs left man with half a head


Published: 11 Sep 2009

VICIOUS thugs who punched this man so hard he was left with HALF A HEAD have got off scot free.

Horrified Steve Gator had to have the front of his skull removed by stunned surgeons after his head was smashed against a pavement in the sickening attack. And now the 26-year-old has been told that the teen attackers who disfigured him will escape justice after his case was dropped.

Steve, of Romford, Essex, was attacked after confronting one of the yobs who had been taunting him about his cousin. Another of the violent louts hit him so hard that he was sent flying and struck his head on the path. Steve plunged into a coma for two weeks as his shattered mum and distraught family kept a bedside vigil at Queen's Hospital, Romford.

His brain quickly began swelling and surgeons were forced to remove the front half of his skull just hours after he was admitted.

Grief-stricken mum Nina Gator was warned her son had just a terrifying 15 per cent chance of survival. Two days later cops charged a pair of teenage boys with the savage attack which shocked the neighbourhood. Steve, who has had to quit his job, was left seriously brain damaged and now suffers frequent seizures, has difficulty talking, and his memory is seriously impaired. Mrs Gator, who is his main carer, last night blasted the shock move. The 47-year-old said: "I can't believe it. Everyone is entitled to their day in court."

CPS lawyers claim they needed more proof before going ahead with the case. But Mrs Gator stormed: "Our boy is walking around with half a head - what more evidence do they need? "His sparkle is totally gone. He used to be so independent but he can't work any more and he can't drive." She added: "He's got half a head and he's completely lost his confidence. There's absolutely nothing protecting his brain now it's just under his skin."

Just from looking at the picture, it seems obvious that with this traumatic brain injury (TBI) his frontal lobes are practically destroyed and quite possibly the front parts of his midbrain. The frontal lobe is an extremely important structure responsible for a variety of functions. It is the 'Command HQ' for emotions, and controls and regulates functions such as memory, language, movement, and problem-solving. It is also responsible for more subtle things like judgment, planning, reasoning, spontaneity or impulse control, and some effects on social and sexual behaviour. As such, the frontal lobe administrates much of our very personality and sense of identity. It is also the largest 'lobe' structure, meaning that there is more of it to carry a greater risk of damage. As the story mentions, Gator's "sparkle is totally gone". It is tempting to draw parallels with the tale of Phineas Gage, another individual dubiously famed for frontal lobe damage.

A friend, The Neurocritic, pointed out that Gator may need several cranioplasties in order to rebuild his skull, and highlighted a recent Neurosurgical Focus literature review that discusses the types of post-operative complications associated with the surgical procesure underwent by Gator. Known as a decompressive craniectomy, and consisting of a partial removal of the skull in order to allow the swelling brain to expand without being squeezed, we start with contusion blossoming; the surgery leaves massive bruises which can be observed via pre-op and post-op CT scans.

Lesions - a mass lesion may develop on the opposite side of the brain to the injury or elsewhere in the brain. As Gator's frontal lobes were destroyed, it is possible that a lesion may develop around the back end and possibly affect the parietal lobes, which deals generally with perception, orientation and recognition.

Herniation - a small protrusion (or more) of neural tissue may remain in the early period after swelling subsides, sometimes through the cranial defect as is observed with 'normal' skin hernias. Gator has no such defect though, as the front of the skull was smashed.

Subdural Effusions - a collection of pus beneath the outer lining of the brain. This condition usually results from bacterial meningitis, but because craniectomies affect the circulation of cerebrospinal fluid (CSF) it is possible that buildups may accumulate. Similar to blood clots. Hygromas may also occur, which are buildups of CSF without blood. To counteract these, a craniectomy should be accompanied with a duraplasty, a reconstructive operation on the dura mater, the outermost and fibrous membrance covering the brain and spinal cord. Duraplasties have been observed to lower the incidence of subdural effusions occurring.

Infection - this may seem a rather obvious effect of any medical procedure, to guard against, but craniectomies (bone removal) will necessitate cranioplasties (bone reconstruction). As such, opening old scars and exposing the brain upto or after a month after the incident runs the risk of contracting infection and delaying healing. The review suggests a minimum wait of 3 months before replacing the bone, and that storage of the bone in a freezer can also increase the risk of infection.

Hydrocephalus - "water on the brain", refers to accumulations of CSF in neural cavities. This is unfortunately a common occurrence beyond a month after the injury, and will need specialised procedures (shunt treatment) to deal with it if it occurs.

Syndrome of the Trephined - another unfortunate common occurrence after decompressive craniectomies, of which common symptoms include dizziness, headaches, concentration difficulties, mood disturbances, irritability, and memory problems. Because Gator's particular situation involved the destruction of his frontal lobes, he will unfortunately suffer much worse symptoms than these. However, in general terms when the motor functions are affected, this then becomes known as motor trephine syndrome.

Bone resorption - when one undergoes a decompressive craniectomy, you're likely to have stray bone fragments swimming around and there's around a 50% chance that bone resorption will occur, which is when bone cells (known as osteoclasts) break down the bone and release minerals like calcium directly into the blood.

Persistent vegetative state - clearly the saddest effect of all extreme brain injuries. While decompressive craniectomies are effective at ameliorating intra-cranial pressure and reducing the risk of death, they offer no guarantee of restoring brain function once the patient suffers a TBI. The risks of surviving into a vegetative or minimally conscious state after undergoing craniectomy range upwards of 15-20%.

It may be that Steve Gator's clinicians need to be vigilant and ensure that his treatment is as risk-free as possible. And of course, wishing him all the best to recover well.
Stiver, S. (2009). Complications of decompressive craniectomy for traumatic brain injury Neurosurgical FOCUS, 26 (6) DOI: 10.3171/2009.4.FOCUS0965

September 8, 2009

Ain't Taking This Lying Down..!

Apologies for the lack of activity in recent months, I have been absorbed in a number of promising projects as well as taking a much-needed vacation.

ResearchBlogging.orgAn interesting report in New Scientist magazine suggests that insults are handled better when lying down rather than sitting or standing up. According to the article, University students who were insulted while seated exhibited neural activity consonant with "approach motivation", which describes to desire to approach and explore. This activity appeared absent in a control group insulted while lying down. Eddie Harmon-Jones, a cognitive scientist at Texas A&M University, interprets this as suggesting that one might be more inclined to attack if one were in the upright state, whereas while lying down we may be more inclined to brood.

At first glance this seems a little odd to me. Brooding is quite different to receiving insults and possibly reacting to them. Brooding means a certain amount of thinking and contemplation is occurring. It isn't the done thing to offer or accept anecdotal evidence as important fact, but from personal experience I've sometimes become more enraged over an incident by brooding about it (while lying down) than I have reacted to insults while sitting or standing upright. Would that mean my reactions contradict this research? The real value of psychological research lies in the ability to translate insights and findings into our lives and observe how relevant or useful they are, and I also have to consider these things personally. I downloaded and read the paper for this experiment; technically it is not an actual paper but a 'short report', a brief description of the subject and experimental method followed by conclusions. A mini-paper. Here's an extract:

"Body movements affect emotional processes. For example, adopting the facial expressions of specific emotions (even via unobtrusive manipulations) affects emotional judgments and memories (Laird, 2007). Manipulated body postures can affect behavior: slumped postures lead to more ‘‘helpless behaviors’’ (Riskind & Gotay, 1982). Simple body postures may also affect other emotive responses and the neural activations associated with them."

That's from the very first paragraph, and to me it seems to get more unreal every time I think about it. I don't dispute that body postures can affect neural activation (anything can affect neural activation, that's kind of what the brain does in the first place, reacting and responding to stimuli) but it seems overstated a bit much. The link between body posture and affectability on emotional reaction looks tenuous when compared with something as fundamental as the availability of oxygen and the human requirement to inhale it to live. But let's take a look at the study: 23 females and 23 males (n = 46) were randomly assigned to write a polemical essay featuring their views on a hot topic (e.g. smoking in public, abortion, etc.) and were told assessment would be carried out by another participant. After attaching EEG sensors, participants were randomly assigned to the upright or lying positions on a reclining chair while hearing themselves being rated on six characteristics including intelligence (1 = unintelligent, 9 = intelligent). Needless to say, participants heard negative reviews of themselves and fumed.

To be more specific, all 'reclined' participants heard negative reviews of themselves while only half 'uprights' heard negative. The other half heard slightly positive reviews. It's good to add a little variety to these things to account for different causes and effects, but I think the total sample size here was too small. Gender effects were accounted for too; males and females were randomly assigned to the two conditions, and male participants heard male-voiced feedback with females hearing female-voiced feedback. For future research, switching gender-voice feedback would make an interesting manipulation.

The results showed that for those in the upright position, the left prefrontal cortex (PFC) was substantially activated more than those who were reclining. Even though both sets of participants expressed similar levels of anger in response to the negative feedback, the left PFC has been linked to anger and approach motivation. This suggests a marked reduction in approach motivation when lying down.

What this means in reality remains under question: Does body posture really affect emotional reactions that much? Similar levels of anger existed between both groups, but those who were lying down appeared less inclined to do something about it? How might those students have reacted with the absence of inhibitory factors? I know that this is preliminary research but these are just some of the questions that need to be researched and accounted for.

Why? Because although some people may consider a study like this to be "fluff psychology" and a little boring, clinicians need to take these types of things a little more seriously when you consider that a large proportion of serious neuroscience is carried out with reclining participants in fMRI-scanners. So I agree with the conclusion of Harmon-Jones' paper; that research is required to help evaluate neuroimaging techniques requiring supine positions. There may not be much to it, but it's worth an exploration.
Harmon-Jones, E., & Peterson, C. (2009). Supine Body Position Reduces Neural Response to Anger Evocation Psychological Science DOI: 10.1111/j.1467-9280.2009.02416.x