TRAUMATIC BRAIN INJURY
As we as a society are becoming painfully aware with the return of our military personnel who have suffered blast or other traumatic injuries while serving our country in Iraq and Afghanistan, concussion injuries to the brain can have not only serious short term consequences, but also, potentially life altering, career changing, disabling permanent, life long effects.
However, concussion injuries, commonly referred to as traumatic brain injuries or TBI , are not limited to war injuries. Often concussions result from motor vehicle collisions, falls, and other life events resulting in concussive forces to the head and brain—often without realization by the person concussed beyond knowing at the time of the event or over time thereafter that the “just do not feel right.”
It is a known medical fact that a concussion to the brain can occur without a direct blow to the head from an object, such as in acceleration and deceleration injuries in a motor vehicle crash and certain blast injuries.
As your doctor will explain to you, the signs and symptoms of a concussion are many, vary from person to person, and overlap in many instances with signs and symptoms of other medical conditions.
Therefore, after an accident or other traumatic event, even if there has been a trip to the local ER, it is important to follow up with your personal doctor to hopefully rule out a concussion if you “just do not feel right,”which may include one or more of a myriad of symptoms.
Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. Some symptoms are evident immediately, while others do not surface until several days or weeks after the injury.
A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. The person may also feel dazed or not like himself for several days or weeks after the initial injury. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.
A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and/or increased confusion, restlessness, or agitation.
Small children with moderate to severe TBI may show some of these signs as well as signs specific to young children, such as persistent crying, inability to be consoled, and/or refusal to nurse or eat. Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible.”
Most People With A Concussion Recover Quickly and Fully
But for some people, symptoms can last for days, weeks, or longer. In general, recovery may be slower among older adults, young children and teens. Those who have had a concussion in the past are also at risk of having another one and may find that it takes longer to recover if they have another concussion.
Some of these symptoms may appear right away, while others may not be noticed for days or months after the injury, or until the person starts resuming their everyday life and more demands are placed upon them. Sometimes, people do not recognize or admit that they are having problems. Others may not understand why they are having problems and what their problems really are, which can make them nervous and upset.
The signs and symptoms of a concussion can be difficult to sort out. Early on, problems may be missed by the person with the concussion, family members, or doctors. People may look fine even though they are acting or feeling differently.
Danger Signs in Adults
In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. Contact your health care professional or emergency department right away if you have any of the following danger signs after a bump, blow, or jolt to the head or body:
- Headache that gets worse and does not go away.
- Weakness, numbness or decreased coordination.
- Repeated vomiting or nausea.
- Slurred speech.
The people checking on you should take you to an emergency department right away if you:
- Look very drowsy or cannot be awakened.
- Have one pupil (the black part in the middle of the eye) larger than the other.
- Have convulsions or seizures.
- Cannot recognize people or places.
- Are getting more and more confused, restless, or agitated.
- Have unusual behavior.
- Lose consciousness (a brief loss of consciousness should be taken seriously and the person should be carefully monitored).
Danger Signs in Children
Take your child to the emergency department right away if they received a bump, blow, or jolt to the head or body, and:
- Have any of the danger signs for adults listed above.
- Will not stop crying and cannot be consoled.
- Will not nurse or eat”
Therefore, it is clear from the NIH and CDC information that prompt and proper medical evaluation, care and treatment by your doctor is critical if you “just do not feel right” because of one or more of the noted symptoms, including those which are subtle and do not seem serious but result in you being at a different health and/or functional level physically, behaviorally and/or emotionally after a traumatic event.
It is important to always remember that the term “Mild TBI” refers only to the initial presenting signs and symptoms and does not mean the long term consequences of a “Mild TBI” will be “Mild.” Even though you may have gone to the ER after a traumatic event, it is important that you follow up with your personal doctor because the role of the ER doctor on the day of the event and the role of your personal doctor after the ER visit are different in terms of evaluating the nature, degree and extent of your traumatic injuries, their effect on you over time and whether or not you need ongoing medical care.
Hopefully, your doctor can rule out a traumatic brain injury. If not, early evaluation and treatment by your doctor can ensure a proper treatment protocol. The recent tragic death of actress Natasha Richardson due to a concussion injury with resulting brain bleed after a seemingly minor fall on a ski slope emphasizes the importance of prompt medical care at an ER and thereafter from your personal doctor after a concussion event.
Effects of Concussion Injuries Subtle and Cumulative
As we see with football players and other athletes, the effects of concussion injuries to the brain are often subtle but cumulative. The athlete may play a physical sport for years without apparent problems, but all of a sudden there is a routine “hit” on or fall by the athlete, such as a tackle in football, that does not appear out of the ordinary and the athlete’s career is over.
Therefore, it is critically important that people with a history of one or more prior concussions see their doctor for a careful evaluation and that the patient gives their doctor an accurate history of their prior concussion and other traumatic injuries. It is especially important that young people playing sports be carefully monitored during and after a sporting activity for concussion signs and symptoms, particularly if the athlete loses consciousness, is dazed or otherwise has an altered state of consciousness during or after a sporting game, practice or other activity.
The CDC has stated the following regarding a “blow” or “jolt” to the head in high school and youth sports:
The CDC has also created a “Heads Up Tool Kit For High School Sports” and a “Heads Up Tool Kit For Youth Sports” for coaches to reduce head injuries in high school and youth sports.
The CDC has developed excellent resources for coaches, administrators and parents relating to traumatic brain injury in high school and youth sports, including http://www.cdc.gov/concussion/HeadsUp/high_school.html and http://www.cdc.gov/concussion/HeadsUp/youth.html.
Each kit is a tremendous resource for both coaches and parents who must be ever vigilant regarding concussion injuries. The kit contains easy to use information which every youth coach (and parent) should have at her or his disposal.
This is particularly important at the youth sport level where the coach may simply be a volunteer with little or no formal education in coaching and sporting injuries. Be sure that your child’s high school or youth coach is aware of this online resource and follows proper protocols for identifying concussion signs and symptoms.
There is no glory your child or her/his school or other team can earn in staying in a game after being concussed worth the potential long term consequences of further, repetitive concussive forces to the already injured brain, a fact your doctor, who is your and your child’s best ally in protecting your child after a concussion, can explain to you in great detail.
Finally, the following are some important facts to keep in mind about concussion/TBI, whether mild, moderate or severe, which your family doctor can explain to you in greater detail based upon her or his medical education, training and experience:
1. You can sustain a concussion without having a loss of consciousness.
2. Concussion signs and symptoms should never be ignored by you. You should go to your doctor right away when you experience signs or symptoms of concussion. (See NIH and CDC resources above for signs and symptoms of concussion.) Other online resources are also available to you.
3. While certain types of traumatic brain injury can be detected by a MRI or Cat Scan of the brain, the fact you or a loved one have had a brain MRI or Cat Scan read as normal after a concussion does not mean there is not a traumatic brain injury at a microscopic level that cannot be detected by the MRI or Cat Scan.
4. To determine whether or not you have sustained a concussion, in addition to your doctors’ clinical evaluation, your doctor may need to order additional testing and/or refer you to various medical or psychological specialists to arrive at a final diagnosis and prognosis for you.
5. If you have a concussion, that fact may affect the types of medication your doctor will prescribe to you for other injuries.
6. Certain medications which might normally be given by a doctor for other injuries sustained in an accident or other traumatic event may be contraindicated if you have a concussion. Therefore, it is important to get into your doctor early if you have any concussion symptoms.
7. Early intervention and management of your care by your doctor after a traumatic event, whether your injuries do or do not include a concussion, is the most prudent course you can follow to give you your best opportunity for optimum medical recovery from your injuries.
8. MAKE SURE YOUR CHILD WEARS A HELMET WHEN BICYCLING; AND IF YOUR CHILD PARTICIPATES IN SPORTS, MAKE SURE YOU ARE VIGILANT IN PROTECTING YOUR CHILD REGARDING A HEAD INJURY BY INSISTING THAT THE HIGH SCHOOL OR YOUTH COACH HAS THE CDC “HEADS UP” KIT FOR YOUTH SPORTS OR HIGH SCHOOL SPORTS AND BY TAKING YOUR CHILD TO YOUR DOCTOR AT THE FIRST SIGN OR SYMPTOM OF A CONCUSSION.
HELPFUL LINKS
- Traumatic brain injury (TBI) in the military: www.TraumaticBrainInjuryAtoZ
- http://www.emergency.cdc.gov/masscasualties/blastessentials.asp
- The National Institutes of Health: http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm#153863218
- U.S. Center For Disease Control and Prevention: http://www.cdc.gov/concussion/signs_symptoms.htm
- Tips to help aid recovery after a concussion. http://www.cdc.gov/concussion/feel_better.html
ABOUT THE AUTHOR
James I. Knudson, JD, of Knudson Brain Spine Injury Law Office P.A., is located in Rockledge, Florida. You may reach Mr. Knudson at 321-632-2722.
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