Brain trauma is a catastrophic injury. It affects victims physically, mentally and emotionally. Approximately 85 percent of brain-injured people recover. However, the remaining 15 percent do not. Even with recovery, the path may be slow and interfere with social and work-related events along the way. The cost of traumatic brain injury can be high due to the type of prolonged treatment that is often involved. In short, brain injury takes a toll on the person as well as his or her family.
What Is Traumatic Brain Injury?
Traumatic brain injury (TBI) is most often caused by a blow to the head. It can also be caused by a penetrating injury, although this is not as common with car accidents. The injury caused by the initial impact can fracture the skull or cause the brain to hit the inside of the skull as it responds to the momentum of impact. The skull itself protects the brain but also acts as a restrictive entity when trauma occurs.
The trauma to the brain inside the skull may cause bruising of brain tissue as well as bleeding and swelling. The initial symptoms might be mild and deal with visual problems, headache or brief periods of lost consciousness. However, as the brain swells, it puts pressure on the tissue and impacts on nerve connections within the brain. The swelling also causes a loss of oxygen, which can be life-threatening.
Classification of Brain Injury
Brain injuries are further classified according to their severity:
- Mild brain injury: In this level of brain injury, the individual is awake but may have passed out for a brief period. They may be slightly disoriented, confused or have a loss of memory.
- Moderate brain injury: In this case, the individual may seem lethargic. He or she is sleepy and may have been unconscious for 20 minutes to five or six hours. Their eyes are open, and they can be aroused from their slumber.
- Severe: At this level, the person is unconscious with their eyes closed. Even direct stimulation will not arouse them. They were unconscious for six hours or longer.
Types of Brain Injury
There are types of brain injuries that rank according to the type of damage the brain suffers. Some of the most common types of brain injuries include:
- Concussion: Concussions are the mildest type of brain injury the person could experience. It is caused when the brain impacts the surface of the skull secondary to a blow or a fast back and forth movement of the head. It can be mild or more severe. Mild concussions usually heal within a few months with rest. More severe concussions can affect the person’s memory and cognitive abilities and cause other deficits. For some, the effects of a concussion do not resolve even with appropriate therapy.
- Coup contrecoup injury: When the brain is injured at the site of the impact, it is referred to as a coup injury. It is also called a contusion of the brain. However, in some cases, the impact is strong enough to force the other side of the brain to strike the skull. This is called a contrecoup injury. The brain in both the coup and contrecoup injuries is bruised and often bleeding. The contrecoup injury can actually be more severe than that of the initial injury. This sort of trauma is considered a double injury that is focal rather than diffuse.
- Subdural hematoma: This is an injury that causes blood to leak from blood vessels outside the brain and accumulate between the dura, or first layer of protective membranes surrounding the brain and the arachnoid layer. The pooling of blood can put pressure on the brain. It is worse in those who are older and on blood anticoagulants. Within hours to weeks, the person may experience confusion, slurred speech, vomiting and headache. With larger collections of blood, surgery may be necessary to drain the blood and relieve the pressure.
- Subarachnoid hemorrhage: Traumatic subarachnoid hemorrhage is caused by a blow to the brain. It causes blood to collect below the arachnoid layer, and pressure is applied to the brain. The most common symptom is a severe headache. It can be diagnosed by a CT or MRI scan, cerebral angiography or a lumbar puncture. Surgery is required with this injury.
- Diffuse axonal injury: This is one of the most damaging injuries to the brain. It is caused as the brain moves rapidly back and forth after impact, causing the nerve cell axons to be sheared or torn. The axons are that portion of nerve cells where they connect one to the other. If this connection is disrupted, it is difficult for nerve transmissions to move from one part of the brain to another. This, in turn, can cause considerable damage to the person’s brain function.
Immune System Response
After the initial injury occurs, the body mounts an immune system response, causing inflammation. As fluid accumulates, it places more pressure on the brain. This can occur up to five days after the injury, and the built-up inflammation increases the potential for brain damage. Medical steps are taken to relieve the inflammation.
Symptoms of Brain Injury
The area of the brain and the type of injury dictates the sort of symptoms that might result. Frequently seen symptoms are:
- Visual difficulties
- Inability to concentrate
- Balance problems
- Sleep disturbances
- Memory loss
- Unusual fatigue
- Emotional lability
- Various levels of consciousness, usually seen with diffuse injuries
Incidence of Brain Injuries
Close to 2 million Americans suffer a brain injury every year. Of these, 1.1 million will suffer a mild injury. About 235,000 people will have a moderate or severe head injury. Fifty thousand will die.
Diagnosis of Traumatic Brain Injury
A slew of tests are available to diagnose brain injury. These range from X-rays to MRIs. In addition, a procedure called the Glasgow Coma Score, which rates the person’s condition using a 15 point test is commonly used. There are three categories within the test:
- The first grades the person’s ability to open their eyes.
- The second involves questions and the person’s ability to answer correctly, such as what is your name and who is president.
- The third involves testing to see if the patient can follow commands. If they are unconscious, the ability to respond to stimulation is tested. After the test is completed, a number is extracted from each category, and a final score is obtained. The scores range from 3 to 15. A score of 8 or below signals severe damage while a score of 13 to 15 is indicative of mild damage. A score of 9 to 12 reveals moderate damage.
Treatment of Brain Injury
Treatment is related to the degree of damage. A mild concussion is usually able to heal in time with rest. All TBIs that fall in the moderate to severe range require hospitalization usually within the intensive care unit. Some patients with swelling and bleeding in the brain require surgical intervention. Every effort is made to decrease swelling, and move the patient to a head injury recovery unit.
Some severely injured patients require neurocritical care. The patients may be comatose or paralyzed and they require specialized, intensive care. This person, a neurointensivist, oversees the patient’s care while in the unit. All patients are carefully monitored and have hourly neuro checks. Some monitors include:
- Monitor to measure brain oxygen: This measures the oxygen in the brain tissue by virtue of a small catheter placed into the tissue through a hole in the skull. It allows doctors to be sure that the amount of oxygen given to the patient is sufficient to keep the brain oxygenated.
- Intracranial pressure monitor: A small tube is placed within a ventricle in the brain to measure the pressure of the intracranial fluid. The ICP is usually less than 20 mmHg. After a brain injury, the pressure may increase. When it does, this monitor will recognize the increase and assure that proper medical intervention is done to relieve the pressure.
- Ventilator: Some patients require a ventilator to help them breathe.
- EEG monitor: Around 25 percent of all TBI patients have seizures. The seizure can be small and virtually undetectable to the naked eye. By using an electroencephalogram, even small seizures that do not cause convulsions are picked up. Seizures are dangerous for a TBI patient, so most patients are monitored for 72 hours after the injury occured.
Brain Injury Treatment
There are several ways that patients are treated in the unit:
- Pain meds and sedatives are administered to keep them comfortable.
- Medication to prevent damaging seizures is given for a week.
- Hypertonic saline is used to keep the pressure down. Since it is sodium heavy, it draws the fluid out of the brain and lets the body remove it.
- The patient is carefully monitored for infection. If an infection is detected, tests are run to identify the organism and determine which antibiotics are successful in killing it.
Surgery for Brain Injuries
Surgery is often used to repair broken blood vessels, remove blood clots (hematomas) and treat a skull fracture. A craniotomy (making a small flap in the skull so the surgeon can access the brain) is done. Once the task has been completed, the flap is closed and held in place with screws and plates.
In some cases, a decompressive craniectomy is done. This happens when the brain has swollen so much that the patient is in mortal danger. A large portion of the bone is removed and placed in a freezer. The brain is covered by a protective film, and the skin is sutured shut. Once the patient is stable, a cranioplasty is done, and the bone is replaced.
Brain Injury Recovery
All patients recover at a different rate. At first, their eyes are shut, and they don’t respond to stimuli. As recovery begins, the patient will have their eyes open more than before. However, their response to all stimuli is equivocal. As more time passes, responses will be more appropriate for the stimuli, and they may begin to follow and perform in response to commands. The patient’s recovery can take as long as several years.
Compensation for a Brain Injury
Compensation for this type of injury is complex. Since recovery is patient and damage specific, there is no way of adequately predicting it at the start. An experienced injury lawyer will help his clients by making sure that the most accurate prediction is made while balancing that against the time limits placed on a injury case. The use of medical experts is a viable way to accomplish this.
Hiring a Brain Injury Attorney
If you or a loved one has suffered a traumatic brain injury or other injuries to the brain as a result of a car accident, the Law Offices of David Azizi will review your claim for free and direct you toward you strongest move toward justice and fair compensation. Contact a brain injury lawyer online or call (800) 991-5292 to get started.