Warning Signs Head Injury

What did Henry the Eighth and Howard Hughes have in common?

Both Henry the Eighth and Howard Hughes were rich and famous men. Both were brilliant and dynamic while young, but later they became deeply disturbed individuals. Both men suffered recurrent episodes of significant head injury as young adults. Henry the Eighth was a powerful young man, and like most strong, young men in his era, he was passionate about jousting. He had multiple head injuries sustained during jousting matches, the first occurred in March 1524. Over time he changed into a cruel tyrant with cognitive impairment and impulsivity.  Howard Hughes was multi-talented and had many interests including a passion for aviation. He was involved in four airplane crashes and suffered several head injuries as a result. His behavior also became erratic and unpredictable later in life.

Warning Signs Head Injury

We have all become aware of the hazards of recurrent head concussion in sports such as football and boxing. For anyone who survives acute head injury, there is a risk of cognitive and psychological problems later.  Medical calculators and analytics can assist in assessing risk for consequences from head injury. A sampling of analytics on these topics are listed below.

  • Post-Traumatic Migraine in Sport-Related ConcussionPost-Traumatic Migraine in Sport-Related Concussion
  • Graded Symptom Checklist (GSC) for an Athlete Following Sport-Related ConcussionGraded Symptom Checklist (GSC) for an Athlete Following Sport-Related Concussion
  • Late Central Neurologic Complications in BoxersLate Central Neurologic Complications in Boxers

Consequence of Head Injury

Head injury can cause a broad range of neurologic injury depending on its severity and distribution. Damage may be diffuse or localized, mild or severe. Recurrent head injury can result in cumulative damage.

Diffuse brain damage can result in cognitive impairment and dementia. Localized trauma can result in specific syndromes depending on which specific part of the brain is affected.

Some syndromes of localized brain injury include Russell Syndrome, paramedian diencephalic syndrome, frontal convexity syndrome, medial frontal syndrome and Kluver-Bucy Syndrome. Damage to the frontal or temporal lobes could explain some of the findings seen in these two men. Possible diagnoses to consider are the orbitofrontal and ventromedial prefrontal cortex syndromes. Without a brain scan or brain exam it is difficult to determine which precise areas were damaged.

  • Orbitofrontal Syndrome Following Frontal Lobe InjuryOrbitofrontal Syndrome Following Frontal Lobe Injury
  • Ventromedial Prefrontal Cortex (VMFPC) SyndromeVentromedial Prefrontal Cortex (VMFPC) Syndrome

There are other reasons for rich and powerful people to undergo a personality change, Court intrigue, post-traumatic stress disorder, substance abuse, syphilis, and the corruption of absolute power may have had roles to play. Unfortunately, our social systems allow such behavior to continue with little interference.

Take Home Message

Head injuries can have both short and long-term sequelae. Predicting, diagnosing and managing the wide range of possible conditions is a challenge even for experts. Medical algorithms can help the rest of us deal with these patients better.

  • Leeds Prognostic Score for Severe Head InjuryLeeds Prognostic Score for Severe Head Injury
  • Differential Outcome Scale (DOS) After Head InjuryDifferential Outcome Scale (DOS) After Head Injury
  • Modified Sequelae Score Following Head InjuryModified Sequelae Score Following Head Injury
  • Clinical Risk Score for Persistent Postconcussion Symptoms Among Children with Acute Concussion in the Emergency DepartmentClinical Risk Score for Persistent Postconcussion Symptoms Among Children with Acute Concussion in the Emergency Department