The Man Who Slept for 19 Years

Dr Martin Brookes

January 2005

Terry Wallis' 19-year journey back to consciousness is a remarkable story. But in June 1984, the time of his car crash, he was just another statistic; one more name on the list of 1.5 million Americans who sustain a brain injury each year. Perhaps it's going too far to say that Wallis was one of the fortunate ones, but he did at least survive his brain injury. Each year in America, 50,000 people are not so lucky.

Brain injury is the great silent epidemic. In the US alone there are estimated to be 5.3 million people (more than 2% of the entire population) living with disabilities brought on as a direct result of brain injury. It is the leading cause of death among children and young adults, and it kills 1.5 times more people annually than AIDS.

The UK has its own unnerving statistics. Each year, almost 12,000 people will suffer a head injury so severe that they will remain unconscious for six hours or more. After five years, only 15% of these people will have returned to work. Most head injuries are less severe of course. Of the one million people who visit a UK hospital with head injuries each year, the majority will arrive with only small bumps and knocks.

But even relatively minor head injuries can have serious consequences for the brain. The common symptoms of dizziness, nausea, headaches and memory loss can be complicated by depression, anxiety and mood swings. Most people will make a full recovery after three to four months, but in some cases the changes can be permanent.

The fragile organ

The brain can be damaged in a number of ways: through a stroke, tumour, infection, or a degenerative disease like Alzheimer's, for example. But probably the most common forms of brain injury stem from a physical trauma to the head.

The brain is an extremely delicate organ, with the consistency of firm blancmange. Any sudden jolt causes it to slide around, compressing and expanding as it goes. For the billions of neurons that make up the brain, this is bad news. If the jolt is serious enough, these long fragile nerve cells will be stretched, twisted and sheared.

The extent of internal damage can confound expectations. A gunshot wound to the head, for example, might seem catastrophic, and often is, but when an external object penetrates the skull, the impact is often localised. Contrast this with the kind of serious jolt to the head that might occur in a car crash. Though the skin might remain unbroken, the impact on the brain can be more diffuse, and more devastating as a consequence. The brain will be thrown backwards and forwards against the walls of the skull, causing extensive damage at the points of impact. A bad situation is made worse by the fact that the bones at the front of the skull have a rough, irregular texture that can literally shred the frontal cortex.

The initial impact is often only the start of the brain's problems. With nowhere else to go, blood escaping from burst arteries in the brain will gather in pressurized pools (called haemotomas) and squeeze the life out of neurons. The nerve cells come under further pressure from the swelling that occurs at the site of the injury (known as a cerebral oedema). If the swelling is serious enough, it can kill more neurons by cutting off their supply of blood and oxygen.

Next: Part 2 >

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