Recognizing Traumatic Brain Injury: Not Limited to NFL Players
By John Leighton
These days we hear a lot about traumatic brain injuries. The coverage of the NFL concussion claims – and the league’s long-standing denials – combined with the acclaimed film “Concussion”, has brought brain injury into everyone’s consciousness (pun intended). But brain injuries don’t just happen to NFL players.
In fact, traumatic brain injuries (TBIs) are very common. More than 2 million Americans sustain some form of brain injury every year. Most of these are minor TBIs, but all can have lasting and serious effects. Because most of these injuries do not involve skull fractures, they are often overlooked or misdiagnosed. Often patients with other injuries suffer TBIs that are not recognized until much later. By then it is frequently seen as unrelated to the initial trauma or attributed to “aging” or another condition.
While x-rays, MRI and CT scans are often normal, the TBI victim may experience cognitive problems, headaches, sleep disorders, memory issues, attention deficits, mood swings and frustration. Although we often refer to these traumatic brain injuries as “mild,” the resulting changes can be devastating to the individual and their family.
Organizations such as the Brain Injury Association of America (BIAA) have been long-time advocates for brain injury research of this silent epidemic facing America. The Centers for Disease Control and Prevention (CDC) recognizes TBI as a “preventable public health hazard.” This is because most TBIs are from falls, being struck by some object, motor vehicle crashes, and assaults. Once considered a benign injury, concussions are symptoms of a trauma to the brain. Post concussive disorders can result in cognitive problems, motor dysfunction, and sensory and emotional changes.
Even a “minor” TBI can affect all aspects of someone’s life. This is why early recognition of a brain injury is critical to assisting in rehabilitation. Most people who have fallen or been in a car crash don’t realize that they have suffered a brain injury. They may be “stunned” or “dazed,” but later feel fine. In reality, the brain may be bruised. The microscopic structures inside the brain are easily damaged. A condition known as Diffuse Axonal Injury can occur, where the axons are sheared by the sudden movement of the brain in the skull.
Educating the public about traumatic brain injuries is critical. Today most bicycle riders wear helmets, as do most skiers. The reason is simple: protecting the brain from trauma is essential. After all, one doesn’t have to split open the skull in order to sustain a life-altering brain injury. Sometimes just the force of being struck from behind in a car can cause a violent shift in the brain within the skull. Picture the brain as large pieces of gelatin connected by microscopic wires between each lobe sitting in a closed coconut shell. If the shell moves forward or backward fast and suddenly stops, the gelatin is thrust against the inside of the coconut. The gelatin may end up looking fine but the microscopic axons may be sheared or torn. If an axonal shearing takes place, brain connections are lost and a TBI has occurred. Sometimes that injury is imperceptible, and sometimes it changes a victim’s life. In either case, there a permanent loss of cognition or function.
Keep in mind that unlike NFL players, we don’t walk around with helmets and pads when trauma strikes. When you consider that NFL players are sustaining TBIs even with that protection, the enormity of the problem comes into focus. The skilled trial lawyer who represents TBI patients must understand the medicine and symptoms, and must be aware of the latest technologies available to accurately diagnose and treat TBI. They then must be able to teach that to a lay jury.
Because most traditional diagnostic testing is not sensitive enough to identify microscopic brain damage on a cellular level, newer technologies have emerged to assist neurologists, neuropsychologists and neuroradiologists in recognizing these conditions. The newer technologies that are sensitive to TBI are still emerging, like DTI (diffusion tensor imaging), which uses a form of MRI (magnetic resonance imaging), and qEEG (quantitative electroencephalography, often called “brain mapping”) to determine whether a patient has sustained a TBI. Neuropsychological testing is also an essential element in recognizing and treating brain injuries.
As diagnostic medicine progresses, we are better able to recognize and diagnose brain injuries from traumas of all kinds. It is important to be aware that someone who has just taken a fall, or been in a car crash, may have suffered a TBI. “Shake it off” used to be a widely-accepted treatment; today that is not so. With our increasing awareness of how serious even seemingly “minor” head trauma may be, it is critical to have trauma patients seen by qualified medical experts in the appropriate fields. Although we now know that head trauma – singularly or cumulatively — can produce long-term brain damage, if undiagnosed it ends up being attributed to other factors and falls through the cracks. The victim does not receive essential, early treatment nor are they compensated for their damages.
So the next time you wince at that 275 lb. linebacker striking that 225 lb. running back, think also of that two-ton car striking the back of that other car carrying an unhelmeted 150 lb. driver. They may have a lot more in common than you think.