Brain Injury Information

An overview of Brain Injury accidents, including an examination of Traumantic Brain Injury, the levels of Brain Injuries, disabilities that can result from Brain Injury, and Brain Injury prevention.

Understanding Brain Injury · Traumatic Brain Injury · Degrees of Brain Injury · Resulting Disabilities · Brain Injury Tests · Brain Injury Prevention

Understanding Brain Injury

A brain injury is a life altering event that can affect virtually every area of a person’s life. It is a complex type of injury with a broad spectrum of symptoms and disabilites. Every brain injury is unique, and each brain injury victim has his or her own set of problems as a result, depending upon the person’s health before the injury, the location of the brain injury, and the severity of the injury. In addition, the consequences of two similar brain injuries may be very different.

Brain injuries can be caused by open head injuries, closed head injuries, deceleration injuries, harmful chemcials or toxins, hypoxia (lack of oxygen), tumors, infections, and stroke. When an outside force strikes the head, there may be damage to the brain and to the skull that protects it. The strength and direction of the outside force is important in determining how serious the injury to the skull and brain is. Specific parts of the brain control specific functions, and the outcome of a brain injury is also partially determined by the location of the injury. Brain injuries do not heal like other injuries, and the effects of a brain injury are oftentimes long-lasting and recovery may be incomplete.

If you can prove that the brain injury suffered by you or a loved one is directly related to another party's negligence or wrongdoing, you may be entitled to compensation for your losses, including pain and sufferings, medical bills, and more.

Traumatic Brain Injury

Traumatic Brain Injury (TBI) occurs when a sudden, outside trauma impacts the head or penetrates the skull, causing damage to the brain. It is also known as acquired brain injury. Traumatic brain injury differs from degenerative and congenital brain problems because it is caused by an external force. The symptoms of traumatic brain injury can range from mild to severe, but every case of TBI is serious. Little can be done to reverse the initial brain damage caused by trauma, but medical personnel can work to stabilize an individual with TBI and focus on preventing further injury. The effects of a TBI depend upon the severity of the injury, the location of the injury, and the age and general health of the individual. TBI can cause damage to cognitive and physical abilities, sensory processing, communication skills, and can cause changes in behavior and mental health. Motor vehicle accidents, falls, sports accidents, physical violence, and firearms are among the most common causes of traumatic brain injuries.

Degrees of Brain Injury

1. MILD BRAIN INJURY
A mild brain injury is diagnosed only when there is a change in the mental status of the personat the time of injury, such as confusion or loss of consciousness. The change in mental status indicates that the person’s brain functioning has been altered and that he or she has suffered a concussion.

Characteristics:

No loss of consciousness (person is confused or dazed) or brief loss of consciousness (usually only a few seconds or minutes) Testing or scans of the brain appear normal

Symptoms:

Headache Fatigue Sleep disturbance Irritability Sensitivity to noise or light Balance problems Decreased concentration and attention span Decreased speed of thinking Memory problems Nausea Depression and anxiety Emotional mood swings

2. MODERATE BRAIN INJURY
Moderate brain injury can occur any time there’s a sudden, violent movement of the head or a blow to the head. Moderate brain injury may not be diagnosed until well after the injury, as other apparent injuries can mask the symptoms.

Characteristics:

Loss of consciousness lasting from a few minutes to a few hours Confusion lasting for days or weeks Physical, cognitive, and/or behavioral impairments lasting for months or permanent

Symptoms:

Headache Memory issues Dizziness Nausea Tiredness Problems concentrating Mood and personality changes

3. SEVERE BRAIN INJURY:
The rate of recovery for severe brain injury victims is highly dependent upon individual circumstances. The amount of time spent unconscious or in a coma, as well as how much is recovered within the first month, are good indicators of long-term recovery. However, most patients with severe brain injury who recover consciousness suffer from disabilities, including the loss of many higher level mental skills.

Characteristics:

Prolonged period of unconsciousness state Permanent physical, cognitive, and/or behavioral impairments

Symptoms:

Vomiting Lethargy Headache Confusion Dilated pupils Vision issues Cerebrospinal fluid leaking out of the ears or nose Respiratory problems Cognitive issues Emotional and behavioral changes Speech and language problems Difficulty Swallowing

There are several different categories of severe brain injury:

Coma: State of unconsciousness from which an individual cannot be awakened, in which the individual responds minimally or not at all to stimuli, and initiates no voluntary activities. Vegetative State (VS): Severe brain injury in which arousal is present, but the ability to interact with the environment is not; eye opening can be spontaneous or in response to stimulation; general responses to pain exist, such as increased heart rate, increased respiration, posturing, or sweating; sleep-wake cycles, respiratory functions, and digestive functions return Minimally Responsive State (MRS): Severe traumatic brain injury in which a person is no longer in a Coma or a Vegetative State. People in this state display primitive reflexes, inconsistent ability to follow simple commands, and an awareness of environmental stimulation. Akinetic Mutism: Neurobehavioral condition that is characterized by minimal body movement, little or no spontaneous speech, speech which can be elicited, eye opening and visual tracking, infrequent and incomplete ability to follow commands, and vigilance and agitation Locked In Syndrome: Rare neurological condition in which a person cannot physically move any part of the body except the eyes. The person is conscious and able to think. Vertical eye movements and eye blinking can be used to communicate with others and operate environmental controls. Brain Death: Results from a very severe injury to the brain. When brain death occurs, the brain shows no sign of functioning.

Resulting Disabilities

The degree and type of disabilities that can result from a Traumatic Brain Injury depend upon on number of factors, including the severity of the injury, the location of the injury, and the age and general health of the patient. Some common disabilities include problems with:

Cognition: attention, calculation, memory, judgment, insight, and reasoning Communication: language expression and understanding Sensory Processing: sight, hearing, touch, taste, and smell Social Skills: empathy, capacity for compassion, social awareness Mental Health: depression, anxiety, personality changes, aggression, acting out Physical: spasticity, seizures, balance, paralysis

TBI is sometimes referred to as "the silent epidemic," because many people have no visible impairments after a head injury. However, impairments in one or more areas listed above are common and may be temporary or permanent in nature, causing partial or total functional disability.

Brain Injury Tests

Magentic Resonance Imaging (MRI):
    The MRI slices the brain radiographically into slabs using magnetic fields, and brain damage seen on an MRI  can be as small as 1 to 2mm in size. The MRI is also very helpful in detecting the remnants of old hemorrhaged blood.
    Magnetic Resonance Spectroscopy (MRS):
    This tool is used in conjunction with MRI and uses a strong circular magnet to detect the intra-cellular relationship of brain metabolites. Studies show that in an injured brain, the relationship between the amount of certain compounds in the brain changes in predictable ways, which can be picked up, non-invasively, by MRS. While MRS is in its early stages, it holds great promise in the objectivication of brain injury.
    Computerized Axial Tomography (CAT) Scans:
    The CAT scan slices the brain radiographically using x-rays. Although a CAT scan does not provide as much detail as the MRI, it is more effective in detecting fresh blood in and around the brain. CAT scans are often repeated to insure that a brain injury is not becoming more extensive, usually in the early stages of ER treatment.
    Positron Emission Tomography (PET) Scan:
    PET scans are based on the fact that the brain uses glucose for energy. By labeling a glucose molecule with a radioactive "tag," and then inhaling radioactive glucose and placing the patient's head under a large geiger counter, one can identify abnormal areas of the brain that are underutilizing glucose. However, because cyclotrons are needed to generate the radioactive gas, PET scanning is not widely available.
    Single Photon Emission Computed Tomography (SPECT) Scan :
    SPECT scanning is similar to PET scanning in that a radioactive chemical is administered intravenously to the patient, but in this test the radioactive chemical remains in the bloodstream and does not enter the brain. The SPECT scan maps the brain's vascular supply. Because damaged brain tissue normally shuts down its own blood supply, focal vascular defects on a SPECT scan are circumstantial evidence of brain damage. The advantages of a SPECT scan over a PET scan are its availability and lower cost. Recent studies have demonstrated abnormal SPECT scans after head trauma when the CAT and MRI were normal, suggesting that the SPECT scan is more sensitive to brain injury then either CT or MRI scans. Because the radioactive chemicals used in SPECT and PET scans are carried to all parts of the body by vascular tree, SPECT scans and PET scans should be used judiciously in patients of reproductive age.
    MRA (Magnetic Resonance Angiography):
    MRA is a way of visualizing the carotid and vertebral arterial systems in the neck and brain without having to inject contrast into the bloodstream. The resolution is not as good as with conventional arteriography, but the patient is spared the risks of catheterization and allergic reactions to the dye. In conventional arteriography, a catheter is threaded from the femoral artery in the groin backward up the aorta into a carotid or vertebral artery in the neck, and then dye is injected up the catheter. As the dye flows into the brain, x-rays are taken of the cerebral vasculature.
    EEG (Electroencephalogram):
    The EEG test monitors the brain's electrical activity by way of wires attached to the patient's scalp. These wires record the brain's electrical activity. Normally, the resting brain emits signals at a frequency of 8 to 13 cycles per second (cps), called alpha activity, which is best seen in the occipital regions. Anything faster than 8-13cps is called beta activity. Slower rhythms include theta activity (6-7 cps) and delta activity (3-5 cps).
    Theta and delta activity occur in the normal brain as the patient descends into sleep. If the patient is awake, any slowing of electrical activity in a focal area of the brain may indicate a lesion. Widespread slowing indicates a widespread disturbance of brain function, often due to problems such as low blood sugar, drug intoxication, or liver failure. Spiking discharges indicate an irritable area of cerebral cortex, and the spikes may produce a seizure.
    Quantitative EEG (QEEG, BEAM, Brain Mapping):
    This test is is similar to the EEG. Brain wave activity varies throughout the day depending on the state of alertness. Each area of the brain normally spends a characteristic amount of time in alpha, beta, theta, and delta activity. Brain mapping computers are capable of creating a map of the brain's electrical activity depicting how long each area of the brain spends in each of the basic rhythms. By comparing the patient's map with that of a control population, it is possible to localize areas of focal slowing of electrical activity. Alone, a QEEG is insufficient to diagnose brain damage but in combination with other neurologic tests, it can help confirm brain inujury.
    Evoked Potentials:
    Evoked studies take advantage of the fact that each time a sensory system of the body - vision, hearing, touch - is stimulated, an electrical signal is generated in the brain. These electrical signals can be detected with electrical wires on the scalp. Visual evoked recordings (VER) are recorded over the occipital lobes, brainstem auditory evoked recordings (BAER) over the temporal lobes, and somatosensory potentials (SSEP) over the parietal lobes.
    Lumbar Puncture:
    A lumbar puncture, also known as a spinal tap, is used to analyze cerebrospinal fluid. An analysis of the fluid helps doctors determine if there is any bleeding in the brain and spinal cord areas.

Brain Injury Prevention

Many cases of Traumatic brain injury (TBI) can are preventable. In order to reduce your risk of suffering a TBI, follow the guidelines listed below:

Always wear a seatbelt when you are in a car When driving with children, make sure to buckle them into a child safety seat, booster seat or seatbelt (depending on their age) Wear a properly fitted helmet when taking part in the following activities: riding a bicycle, riding a motorcycle, riding a scooter, playing sports, using in-line skates or a skateboard, riding a horse, rock climbing, sledding, skiing or snowboarding Keep all firearms and bullets locked up Reduce the risk of falls by using a step-stool with a grab bar to reach objects on high shelves, installing handrails on stairways, installing window guards to keep young children from falling out of open windows, using safety gates at the top and bottom of stairs when young children are around, and using non slip mats in bathtubs and showers Only allow your children to use playgrounds with surfaces made of shock-absorbing material, such as mulch or sand Exercises that improve balance and coordination can reduce older adults’ chances of falling and suffering a brain injury

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