Tuesday, 10 December 2013
Governor Suntai And Traumatic Brain Injury By Stella Oritsejemite
I do not know Governor Suntai. I do not know Taraba state, and have no stake in it. However, I am fiercely Nigerian. I also recognize trauma and a Traumatic Brain Injury when I see one. I saw the photograph of the governor and his family last night: the first since his air crash and I just felt, and to my horror too, that we are going down the same irresponsible path which we walked during the Yar’adua saga. Just as I did then, I am going to write my medical opinion on this man and I hope those who want to kill the messenger will be more responsible.
We woke up to the news of this man's survival from a helicopter crash sometime late last year. Reports had it that he was initially thought to have died, but some pastoralists saw him at the scene of the accident and alerted the authorities that he still had some life in him. Whatever the truth may be, one thing is constant, the man was in an air accident.
Of course, he no doubt suffered TRAUMATIC BRAIN INJURY SECONDARY TO BLUNT FORCE TRAUMA as a result of the chopper accident. Please note that I did not say anyone hit him on the head. The brain weighs about 3-4 pounds under normal circumstance. It is encased in the cranium aka skull and floats in fluids. It comprises extremely delicate tissues and neurons. It has 3 layers of membrane which covers and protect the brain. Because the brain tissue is soft, it is therefore SUSCEPTIBLE TO PULLING, STRETCHING AND COMPRESSION in TBI. Thus, in the event of an accident such as air crash, the brain will JERK AROUND VIOLENTLY INSIDE THE SKULL resulting in injury.
Governor Suntai may have suffered a CLOSED HEAD INJURY since there was no report of any open gash on his head nor a penetrating injury to the head. CLOSED HEAD INJURY occurs as a result of sudden stop following a high speed movement as in an air craft or chopper crash. In the instance when that chopper crashed, the BRAIN WILL MOVE BACK AND FORTH, LEFT AND RIGHT, COLLIDING WITH THE BONY CRANIUM, Of course, the result will be BRUISING OF THE BRAIN TISSUES, DAMAGE TO THE NEURONS IN THE BRAIN, AND OR TORN BLOOD VESSELS. Injury may be SPECIFIC AND LOCALIZED or DIFFUSE AXONAL INJURY. I suspect the governor suffered DAI looking at the pictures posted on Sahara Reporters.
My conclusion is that he suffered TBI based on the news report of :
1. DOCUMENTED LOSS OF CONSCIOUSNESS AT THE CRASH SITE.
2. AMNESIA POST TRAUMA on account of his inability to recognize visitors.
3. SECONDARY INJURY AS A RESULT OF ANOXIA.
4. CONSISTENT LOW BLOOD PRESSURE.
5 INTRA CRANIAL PRESSURE SECONDARY TO BRAIN TISSUE SWELLING..
Since this man did not receive immediate medical help from any first res-ponders and was also air lifted to an ill prepared hospital in Yola I believe, that he lost too much time and must have also suffered many tissue and neuron deaths in the brain. In that case, GLASGOW SCORE may not be reliable if it was taken at all. We are not sure if he was able to spontaneously open his eyes at the scene of the accident ( reported to be unresponsive several days post accident) reported to be in coma even at the National Hospital in Abuja which means only one thing, HE WAS UNABLE TO COORDINATE HIS FINE MOTOR AND VERBAL SKILLS.It is not impossible for the verbal assessment to be impossible, because I expect that he must have been intubated for perfusion and in that case verbalizing anything will be next to impossible. Buy he should have been able to spontaneously been able to open his eyes, and follow simple commands. reports in the news papers indicated he was not able to do any of those. Then he had severe TBI. . His GLASGOW SCORE was definitely not 15, whichis the highest score a human being can have.
To estimate the severity of his brain injury, we want to rely on his reported POST TRAUMATIC AMNESIA. He was reportedly unable to recognize his visitors. Whao!. That is a red flag there no doubt. Any time there is a major blow to the head such as in an air crash, the following will happen almost all of the time:
1. PATIENT WILL NOT REMEMBER THE INCIDENT.
2. PATIENT WILL NOT REMEMBER THE INJURY AND RELATED EVENTS FOR SOMETIME ( read Suntai)
3. SHORT TERM MEMORY LOSS IS A MAJOR ISSUE. For example, they tend to repeat what was already said over and over again.
This is a period of POST TRAUMATIC AMNESIA. The danger in this period is that the longer the duration of the amnesia, the more severe the brain injury.
Because of the delicate chemistry of the brain, neuro malfunction takes place. This affects the THINKING AND BEHAVIORAL PROCESS OF THE PATIENTS. Therefore, it is nothing strange that Mr. Suntai was seen starring into space in the picture posted on SR, and no one should be perplexed that he was reported to be staring at his visitors without showing any sign of recognition..
It may take weeks, months years even for this man to come back to his pre accident state. It may take quite long for the brain to resolve its chemical imbalance as a result of the TBI The good news however, is that as the chemistry of the brain improves, so can the ability of the patient to function independently. Because the brain is a dynamic organ with incredible ability to adapt and change with time, the brain is able to set up new connections between the nerves. Plasticity of the brain occurs all through a life cycle. Therefore, it is still possible for to have an occurrence a neural system stimulation. Such can and should be encouraged in an atmosphere, which the man is familiar with and with family. Long term rehabilitation will be better in a home environment and not in the cold walls of a hospital.
It may take months and or even years for full recovery to take place. Therefore, we should avoid this silliness of DOCTRINE OF NECESSITY ( whatever that means) and all the voodoo interpretation of the Constitution by the political elites. I am not advocating for the man to be removed from office since am not a Taraba person, but I do know he is not going to be able to function effectively as a governor anytime soon as a result of his TBI.
Stella is a USA based Certified Advanced Trauma Specialist.