Have you ever banged your head and almost reeled from the pain? Random head trauma can happen to anyone at any time. I hear about friends who have had head trauma, or I see an occasional patient with a head injury, and the questions I get asked most frequently are:
When you experience a hard smack to the noggin, your first step is to take an inventory of what happened. This should include:
This inventory should also include other factors that may have contributed to the head trauma, such as whether the patient was drinking, sleep deprived, or taking medication. If your injury warrants a trip to the doctor, a thorough neurological exam should be included. Often I’ll ask accompanying family members or friends if they’ve noticed any change in behavior or cognition in my patient. Depending on the location of brain impact, there could be a change in personality, change in judgement, increased irritability or tendency to anger quickly. Additional changes could include anxiety, depression, apathy, or change in sleep pattern.
The physical exam should include examination of the eardrums (since blood in the ear canal can indicate a fractured skull), neck exam, and a careful eye exam. The eye exam can indicate if there is excessive pressure in the brain as a result of the trauma, or perhaps signs of retinal detachment if the head trauma was close to the eye. Your doctor should also perform a memory test. Based on your history and the results of your physical exam, further evaluation may be necessary, such as a CT scan to determine if there is any bleeding within the brain or other damage.
The good news is that on February 14, 2018, the FDA approved a blood test, known as Banyan BTI (Brain Trauma Indicator). This test looks for and measures two biomarkers in the brain that are released into the blood stream within 12 hours of a head concussion: ubiquitin carboxy-terminal hydrolase-L1 and glial fibrillary acidic protein. High levels of these proteins can indicate a CT scan abnormality 97.5 percent of the time, and a normal blood test will predict a normal CT scan 99.6 percent of the time. The advantage of the Banyan BTI test is that if it comes back normal, it spares patients unnecessary brain radiation (not to mention costs) from a CT scan.
Recent headline news about head trauma in football players has raised awareness of the association of traumatic brain injury (TBI) with progressive dementia. It has been found that amyloid-like proteins accumulate after TBI, which are the proteins associated with Alzheimer’s disease. The good news is that in a large study of 6,645 subjects ages 55 and older who had mild brain trauma, there was no increase in the risk of developing Alzheimer’s disease. However, studies indicate that just one single harmful incident to the brain may diminish one’s cognitive reserve, and could bring out the signs of early dementia in somebody already at risk.
I hope you or a loved one never have a significant head injury, but if so, see a doctor. If there is concern about serious brain injury, ask about having the Banyan BTI blood test before being rushed off to the CT scanner. An abnormal result could lead to life-saving intervention.
And conversely, normal results will make that pinprick of blood a small price to pay for peace of mind.
Jerry “Dr. J” Saliman is a contributing wellness writer for the Peninsula Jewish Community Center. He retired from Kaiser South San Francisco after a successful 30-year career and is now a volunteer internist at Samaritan House Medical Clinic in San Mateo.