Talking Heads

The young man was working as part of a survey crew when he was hit by the speeding truck. The truck’s driver, tired of sitting in traffic, tore through the median, striking the young man and running over his body. I was a new medic; the patient was one of my first. He was alert and talking despite missing a large chunk of his forehead. The pale grayish surface of his frontal lobe glinted in the late afternoon sun.

During transport, I stabilized him as best I could - oxygen, cardiac monitor, two large-bore IVs - before concentrating on the open wound. I flushed it with saline and wrapped his head in a bulky bandage as we rushed full-throttle to the trauma center. 

His prognosis was grim. The surgeon explained to me they would have to remove a significant part of his frontal lobe to rid the area of grit and debris. The patient would probably never be the same.

This call was the first of many head injuries I treated during my career as a medic. It launched my fascination with brain trauma because, unlike other injuries, those to the head can result in a completely different person and steal one’s identity – their personality, warmth, humor – leaving behind a shell of an individual.

 I’ve witnessed a wide range of head injuries, both as a paramedic treating live patients and as a bioarchaeologist examining ancient skeletons. As a medic, head injuries commonly came in the form of shootings, crashes, and blunt force trauma. Barely a week went by without some significant trauma call, for the transients of Orlando’s west side never passed up an opportunity to exchange thorough thumpings.

As a bioarchaeologist, I’ve examined head injury among people living thousands of years in the past. And although these ancients lacked the modern weaponry of today’s gang violence, their skulls indicate they pummeled each other on a regular basis.

It doesn’t take much to damage the brain. Those handy-dandy containers our brains reside in are actually quite fragile. 

We tend to think of the skull as a singular bony compartment. Not so. The skull is actually composed of eight cranial bones that are joined via fibrous articulations known as sutures. There are four primary sutures of the cranial vault – the coronal, sagittal, lambdoid, and squamous. At birth, the sutures are not quite joined, thus the “soft spot” atop of a newborn’s head. Over time, the sutures fuse and are eventually obliterated, if the individual lives long enough. Bioarchaeologists use this “degree of suture closure” to get a rough age estimate at the time of death.

Fourteen bones make up the face. These bones are also joined via sutures, so, in reality, your head and face are a conglomeration of many flat and oddly shaped bones, all joined together to give you a distinct outward appearance.
But back to the head…

Although the skull provides a protective shell for our fragile brains, simple injuries can have devastating effects. A fall from a moderate height, a minor car crash, even a love tap with a baseball bat can do severe damage to those delicate tissues. And unlike other tissues in the body, nerves are unable to mend. Once they are damaged, they’re done.

Luckily, our noggins contain about eighty-six billion neurons and, because the brain is wired with redundant circuits, sometimes even a serious head injury can be mitigated by the brain’s ability to rewire existing connections. This is why physical therapy is so vital to head-injured patients. They must teach their brains new ways of accomplishing old tasks, like walking, talking, and using their limbs.

My patient was one of the lucky ones. Although the surgeons excised a large part of his frontal lobe, he suffered only minor memory loss and was otherwise normal. I got to know him during his long stay in recovery and it was amazing to sit and play cards with an individual whose brain I had come to know intimately.

So take care with your cranium. A simple blow can have frightening results. My brother fell off his bike years ago and suffered a subarachnoid bleed. He was restless and angry following the injury and, to this day, can be extremely temperamental.
Although some of that may be genetic…


Stay safe and enjoy this awesome video of skull anatomy!
http://www.youtube.com/watch?v=Nc5IRj3OJhE