Sunday, August 22, 2010

Whiplash and Brain Injury, Part 1

Whiplash can cause brain injuries
Part 1 of 2 Part blog

I am proud to be a co-author of an study published in the medical journal, Brain Injury that describes a change in the brain of a significant number of individuals who have suffered a whiplash injury.

Patients who have not suffered demonstrable injury to their spine often, over time, have been considered to have no clear cause of their symptoms. Many have been felt to have unsubstantiated injuries and that their symptoms were either psychological or for secondary/monetary gain.

In 95% of normal individuals, the cerebeller tonsils, a part of the brain that sits in the back of the skull and controls coordination, rests above the opening at the bottom of the skull (where the spinal cord passes from the brain into the spine). In 5% of individuals, these cerebeller tonsils can project through the opening (foramen magnum)--essentially meaning that part of the brain dips into the top part of the neck. This condition is know as cerebeller ectopia or Chiari malformation. This may cause multiple symptoms including headache, neck pain, numbness and weakness in arms and hands, weakness in legs and bladder dysfunction.

20% who have whiplash have Chiari malformation, study says.

This study has demonstrated that over 20% of individuals who experienced a whiplash injury have cerebeller tonsils below the foramen magnum when an MRI is performed with the individuals in the sitting position. Individuals who do not have a whiplash injury do not show a drop of the cerebeller tonsils in the sitting position.

It is uncertain whether this finding is a causative factor for any of the symptoms of the whiplash syndrome or if the same trauma that caused this brain injury can caused other, yet to be defined injuries that lead to the painful symptoms.
Further study is needed before we can say whether surgical intervention is warranted in these cases of cerebeller ectopia.

Speak to your doctor if you've had whiplash, or suffer from persistent headache, neck pain, numbness and weakness in arms and hands, weakness in legs and bladder dysfunction.

Sunday, August 8, 2010



After the craniotomy to remove the enormous
Blood clot in the brain of this octogenarian
The children remained in the waiting room,
Allowing their parents a moment of privacy.
As he remained unresponsive,
His wife approached his side and spoke to him,
“I have been doing the cross-word puzzle without you.
It’s a good thing it’s Monday.”
He awoke on Tuesday.
A blood-clot to his lungs killed him on Friday.
Sunday the cross-word puzzle was no doubt
Excruciatingly difficult
But she certainly completed it
For what else was she to do?

Ezriel Kornel

Sunday, August 1, 2010

What it takes to be an excellent neurosurgeon

I proctor pre-med students during winter and summer breaks and one of the students asked me an interesting question the other day, what does it take to be a good neurosurgeon? Well, first of all, you want, not a good neurosurgeon but an excellent one. So, what does it take to be an excellent neurosurgeon?

The first thing that is crucial and without which the rest would not matter, is judgment. A neurosurgeon needs to be able to establish a diagnosis and then determine when surgery is necessary, when it is not and what other treatment options are available. Once that is established they need to decide what operation is best for each individual patient and their particular condition. It is also of great importance and a matter of judgment that a surgeon be confident in their decision and in their capability in performing a particular procedure. They should be willing to confer with colleagues to help with decision-making and should be able to turn to other colleagues to assist with surgery. Should another colleague have greater expertise in a particular operation, the excellent neurosurgeon should refer the patient to that physician.

Secondly, the neurosurgeon needs to have the surgical skills to be able to perform these operations. Generally, well-trained neurosurgeons who have completed an accredited training program and have become board-certified possess the requisite skills. But, in truth, just as some professional musicians are greater virtuosos then others, the same applies to surgeons. It is a strange gift that skilled surgeons possess, just as certain musicians, artists, mathematicians and writers are more gifted. In fact, I believe everyone has a gift, they just need to recognize where that gift lies, acknowledge it and express it.

Thirdly, an excellent neurosurgeon needs to have great confidence without manifesting a huge ego. They need to know that they can do the job. Anxiety in surgery can interfere with the best results. However, a big ego will prevent anyone from obtaining advice from others and will make them incapable of listening to constructive criticism. They are less likely to learn from their mistakes (and everyone makes mistakes at one time or other, being human after all and not divine.)

Being patient is another skill that neurosurgeons need to possess. If they make a decision too quickly they may perform unnecessary or even dangerous surgery. Sometimes patience allows a problem to manifest or resolve itself in a different manner. With prudent waiting surgery may not be necessary or a different procedure may be deemed appropriate.

Respect and compassion for their patients is another quality that an excellent neurosurgeon should possess. When this is present, a good bed-side manner is always manifest. This needs no further amplification.

Finally, an excellent neurosurgeon must have love and passion for their work. Nobody wants a neurosurgeon who is eager to get you out of the door, or rush to leave their side when lying in a hospital bed or to rush to get through the day. Though neurosurgeons have a life outside of the operating room with families, friends and other interests they should always feel a deep gratification when performing their work. When they are in the operating room all their attention and focus should be on the surgery they are performing.

When all these qualities are evident, you are most likely to experience the best results possible and the quickest and most complete resolution of your illness.