We often represent adults and children who have sustained severe head trauma — in motor vehicle accidents, falls, and other scenarios — resulting in a traumatic brain injury (TBI). Simply put, TBI is an injury to the brain that occurs after some form of trauma.
Classifications of Traumatic Brain Injuries
Traumatic brain injuries are often classified as mild, moderate or severe. Mild TBI or concussion is the most common. The name “mild” is misleading — mild TBIs can result in permanent and debilitating injury. The classifications are typically based on the Glasgow Coma Scale, which is a quick assessment of a patient’s level of consciousness and neurological functioning. Severe TBI typically involves bleeding in the brain and fractures of the skull.
Traumatic brain injuries are further defined as closed or penetrating. Penetration of the brain tissue may be by a fragment of skull that has been fractured and is depressed into the brain tissue or actually penetrates the brain tissue. When the injury is closed (without skull fracture) the injury can still be quite devastating.
The intact skull is rather unforgiving to the injured and swelling brain tissue. There is simply no place for the swollen brain tissue to expand and therefore brain damage occurs. The individual may require surgery to relieve the pressure.
These injuries can result in coma, a state in which the person is totally unconscious and unaware and unarousable. Coma results from diffuse trauma to the brain. Coma is usually of short duration, lasting a few days to a few weeks. After a period of time, patients generally gradually come out or a coma, some may progress to vegetative state, while others will not survive. The spectrum of TBI is wide and varies from the extremes of coma to concussion, with various stages in between.
Surgical Treatment for TBI
If injuries are quite severe and there is bleeding in the brain, the blood will require evacuation of the blood clot or hematoma surgically, usually by drilling a hole to relieve the pressure. They occur as a result of an injury that has occurred as a result of an automobile injury, a fall or an act of negligence in the workplace or other areas. Sometimes the injury is devastating and disabling for the individual preventing them from caring for even their basic needs. Sometimes it causes more subtle changes in cognitive ability, the way they think and reason, communicate and relate to the world. They may be plagued by seizures that come on without warning and forced to take medication and restricted from driving.
With concussions, there may be a loss of consciousness after the accident, but this is not always the case. A concussion is a clinical syndrome and imaging studies such as a CT scan will not diagnose a concussion but are made by medical professionals on the basis of injury and symptoms. These imaging scans are important to rule out other serious head injuries such as we mentioned above, intracranial hemorrhage and skull fractures. A concussion occurs after the initial head injury, and the diagnosis is marked by symptoms of a change in mental statuses, such as disorientation, often times after a brief period of unconsciousness. The injured individual may arouse unsure of their surroundings, the date, or other relevant information. Amnesia for the events just prior to the injury, as well as a headache, dizziness, and vomiting, may be present. A loss of consciousness is often present, but not required, for the diagnosis of concussion.
Damage to the brain may occur that is confined to just one region of the brain, and result in discreet symptoms which can mimic a stroke. This may cause paralysis, speech difficulties or a very discrete impairment. Alternately, damage may be more “global” with widespread damage. Damage to the brain from an accident or fall, for example, cause swelling of the brain tissue due to injury. Fluids accumulate within the injured brain and the skull does not permit expansion, therefore brain damage occurs.
TBI may result in a syndrome of mental status changes, for example, a very mild-mannered person becoming subject to violent or antisocial behavior. Experts are only now beginning to understand and acknowledge the full potential for long-term consequences in TBI.
Recognizing and Diagnosing TBI
Traumatic brain injury should be suspected and raise concern to the individual when symptoms do not resolve after an injury to the head in an accident.
Symptoms may be marked by worsening impairment, occasionally seizures, and a post-concussive syndrome in which symptoms may persist for months and are less well delineated in nature. Studies conclude symptoms of the post-concussive syndrome to include those of mental impairment, disorientation, exertional headache and mental “fogginess” to personality changes, poor concentration, insomnia and irritability.
When symptoms are sub-acute or more subtle in nature, a post-concussive syndrome may be considered and neuropsychiatric testing may shed additional light onto the exact nature of the problem. Certainly, a CT or MRI would be included in this evaluation as well as a neurology consultation.
Victims of TBI may require a lifetime of care of suffer chronic symptoms that impair their earning ability to earn a living and impact their quality of life. If you have suffered a traumatic brain injury as a result of the negligence of others, either on the in an automobile accident, on the job or during the course of other events, consult the experts at Passen Law Group for a free consultation. Call us at 312-527-4500.