Traumatic Brain Injury
A traumatic brain injury (TBI) is the most common cause of death and disability in people. It is a severe and debilitating loss that occurs when the brain is struck or jolted from outside forces.
The Centers for Disease Control and Prevention estimates that 2.6 million emergency room visits, 235,000 hospitalizations and 50,000 deaths occur each year as a result of a traumatic brain injury. The actual incidences of TBI may be even higher because may mild TBIs are never seen in the emergency room. As such, TBI represents a substantial source for neuropsychiatric death and disability. Greater than 30% of all injury and related deaths car accidents result in TBI. Millions of dollars are necessary to care for these victims over their lifetime.
Traumatic brain injuries are graded as mild, moderate, or severe on the basis of the level of consciousness or Glasgow coma scale (GCS) score. Mild traumatic brain injury is in most cases a concussion and there is normally full neurological recovery, although many of these patients have short-term memory and concentration difficulties. A concussion is caused when the brain receives trauma from an impact or a sudden momentum or movement change. The blood vessels in the brain may stretch and cranial nerves may be damaged. A person may or may not experience a brief loss of consciousness (not exceeding 20 minutes). A person may remain conscious, but feel “dazed” or “punch drunk”.
In moderate traumatic brain injuries the victim can be lethargic and disorganized. In severe injury the patient is comatose, unable to open his or her eyes or follow commands. Patients with severe traumatic brain injury have a significant risk of oxygen loss to their brain and swelling. If these sequelae are not prevented or treated properly, they can exacerbate brain damage and increase the risk of death. Long term effects of a traumatic brain injury can include impaired amnesia, loss of consciousness, depression, confusion, memory loss, headache, dizziness, blurry vision, nausea and vomiting, sensory loss, difficulty, speaking, insomnia, and personality changes. The severity of symptoms depends on the extent of the injury. Mild traumatic brain injuries generally present at the time of the injury and are usually temporary. Moderate traumatic brain injuries are similar to those of mild traumatic brain injury but more serious and last longer periods of time. Severe traumatic brain injuries globally affect the person on a permanent basis as a true loss of quality of life.
Given the complexity of the brain and its function, there are a variety of types of injuries that can occur. For example:
- Diffuse Axonal Injury occurs when the brain is shaken or rotated strongly by rotational forces, such as with a car accident. Injury occurs because the unmoving brain lags behind the movement of the skull, causing brain structures to tear. There is extensive tearing of nerve tissue throughout the brain. This can cause brain chemicals to be released, causing additional injury. The tearing of the nerve tissue disrupts the brain’s regular communication and chemical processes. This disturbance in the brain can produce temporary or permanent widespread brain damage, coma, or death.
- Coup-Contrecoup Injury exists when the force impacting the head is not only great enough to cause a contusion at the site of impact, but also is able to move the brain and cause it to slam into the opposite side of the skull, which causes the additional contusion.
- Closed Head Injury happens when a person receives an impact to the head from an outside force, but the skull does not fracture or displace. With a closed head injury, the brain swells and has no place to expand. This can cause an increase in intracranial pressure, which is the pressure within the skull. If the brain swells and has no place to expand, this can cause brain tissues to compress, causing further injury. As the brain swells, it may expand through any available opening in the skull, including the eye sockets. When the brain expands through the eye sockets, it can compress and impair the functions of the eye nerves.
In addition to the type of injuries, the area of the brain that is affected also demonstrates the outcome of lasting symptoms. Since our brain defines who we are, the consequences of a brain injury can affect all aspects of our lives, including our personality. Brain injuries do not heal like other injuries. Recovery is a functional recovery, based on mechanisms that remain uncertain. No two brain injuries are alike and the consequence of two similar injuries may be very different. Symptoms may appear right away or may not be present for days or weeks after the injury. One of the consequences of brain injury is that the person often does not realize that a brain injury has occurred. For example, injury to the frontal lobe of the victims brain, the emotional control center and home to one’s personality, can have a grave impact on that person’s motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior. By comparison, injury to the brain stem can caused difficulty with breathing, control of blood pressure and temperature, balance, swallowing, insomnia, dizziness, and organizational perception of the environment. Therefore, depending on the local of the injury in the brain will also impact the prognosis for recovery and length of ongoing care that will be needed.
Much of what can be learned from the brain following a traumatic brain injury can be viewed digitally. Some of the more frequently used tests include:
- 3T Brain Magnetic Resonance Imaging (MRI) with Susceptibility weighted imaging (SWI) and diffusion tensor imaging (DTI) provides the microstructure of the organ by quantifying water diffusion over the brain’s surface.
- Computed tomography (CT) produces multiple pictures of the inside of the body through cross-sectional imaging CT scanning of the head is typically used to detect bleeding, brain injury and skull fractures.
- Positron emission tomography (PET) scan is an imaging test that helps reveal how your tissues and organs are functioning using a radioactive drug. On a PET scan, these areas show up as bright spots revealing or evaluating several conditions, including some cancers, heart disease and brain disorders.
- Single-photon emission computerized tomography (SPECT) scan lets your doctor analyze the function of your brain through nuclear imaging that creates a 3-D image. A SPECT scan produces images that show how your organs work. For instance, a SPECT scan can show what areas of your brain are more active or less active.
- Functional magnetic resonance imaging (fMRI) measures the metabolic changes that occur within the brain. It may be used to examine the brain’s anatomy, determine which parts of the brain are handling critical functions, evaluate the effects of stroke or trauma that cannot be found with other imaging techniques.
- Magnetic Resonance (MR) spectroscopy measures biochemical changes in the brain by comparing the chemical composition of normal brain tissue with abnormal tumor tissue. MR spectroscopy analyzes molecules such as hydrogen ions or protons to look for issues.
Following a traumatic brain injury, treatment options are, unfortunately typically only short-term professional assistance leaving family members to care for the long-term needs of the person with brain injury. Without adequate training and professional support for this caregiver role, a variety of problems are commonly reported by family members, including social isolation, changes in family roles, depression, anxiety, and increased somatic difficulties.
Victims of traumatic brain injuries often require long term cognitive rehabilitation, physical therapy, counseling, adaptive modifications, case coordination and attendant care. Expert consultants need to carefully work with the victim to establish a base line condition, develop a treatment protocol including the needs and duration, and establish the costs associated with implementing a life care plan.
The attorneys at Abir Cohen Treyzon Salo, LLP, are experts in the cause, treatment and prognosis of traumatic brain injuries. If you or your loved one have suffered a TBI, please call us to see how we can help. Abir Cohen Treyzon Salo, LLP is a skilled legal team that is dedicated to working meticulously to ensure that you are compensated for your loss. Call us today to speak to one of our personal injury lawyers to schedule a free initial consultation to discuss what we can do for you.