Traumatic Brain Injury

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Mild Traumatic Brain Injury – Do you know if you have a Mild TBI and what to do?

A helmet may not protect your head from a mild Traumatic Brain Injury (MTBI) and motorcyclists often sustain a mild traumatic brain injury in a motorcycle accident.  According to the Centers for Disease Control and Prevention, 1.7 million people sustain a Traumatic Brain Injury (TBI) each year and 75% of TBIs are concussions, also known as Post-Traumatic Concussion Syndrome or mild TBI.  (Watch the video below.)

What is a mild TBI?

Medical professionals describe a concussion as a “mild” traumatic brain injury or mild TBI because concussions are usually not life-threatening.  The effects of a concussion can be serious and lifelong which is why a concussion is a “mild” traumatic brain injury.  A traumatic brain injury which is not mild is profound or life-threatening.

Definitions:

  • Concussion is an injury to the brain which results in loss of normal brain function. Its effects can be temporary or permanent and is usually caused when a rider’s helmet strikes the ground, a car or another object.  Many times, there are no signs of trauma and no loss of consciousness.  It is the most common type of traumatic brain injury.
  • Traumatic means trauma or injury caused by an accident rather than from disease.
  • Post-Traumatic means after the trauma or accident.
  • A syndrome is the association or grouping of several clinically recognizable symptoms.
  • Post-Traumatic Concussion Syndrome is where some of the symptoms below are experienced, having been caused by a concussion which occurred in an accident.  This is a mild traumatic brain injury.

What can cause a mild TBI?

A concussion may be caused by a fall, bump, blow, or jolt to the head such as from whiplash which causes the head and brain to move quickly back and forth. Obviously, this happens in most motorcycle accidents. The resulting concussion can change the way your brain normally works.  This can last a short time or even be permanent.

Inflammation caused by the trauma occurs during the first 48 hours after the accident and can cause damage to the brain, so mild permanent brain damage may not even have been caused at the moment of the accident.  Additionally, it can take a long time before symptoms are recognized, as discussed below.

Acceleration / Deceleration (coup-contrecoup) injury — A relatively simple and easy to understand video explains diffuse axonal injury (DAI) and how it is caused in low speed and high speed injuries.

This animation by Medivisuals explains diffuse axonal injury and neuron “suicide and murder.” See how a TBI can go undetected because symptoms may not be immediately observable and areas of injury and cell death can be too small for traditional CT & MRI to detect. These symptoms may progressively worsen as cell death continues, resulting in devastating brain injuries that do not fully develop until weeks or months after the initial incident.

Diffuse Axonal Injury (DAI) caused by rotational brain motion

When to diagnose MTBI

MTBI diagnosis should be obtained when one or more of the following indicators occur at the time of accident:

  • Confusion, disorientation, or impaired consciousness;
  • Dysfunction of memory around the time of injury;
  • Glascow Coma Scale (GCS) of less than 15 (reported either by EMS or in the hospital) (see also What Is the Glasgow Coma Scale? and video);
  • Loss of consciousness lasting less than 30 minutes;
  • Nausea or vomiting; or
  • Bleeding on or in the brain, usually diagnosed by CT scan in the hospital, is an indicator of significant head trauma.

Symptoms of mild TBI

One or more of the following symptoms occurring more frequently than usual or after your accident may indicate you have a mild TBI.  Note that you will not experience all of these symptoms and see below why symptoms may show up long after an accident:

  • Difficulty thinking clearly
  • Attention problems
  • Difficulty concentrating
  • Poor judgment
  • Impulsiveness
  • Fatigue, feeling tired, slow or lacking energy
  • Occasional or slight confusion
  • Difficulty remembering new information (mild loss of short term memory)
  • Difficulty recalling words and names
  • Chronic headaches
  • Severe headaches
  • Fuzzy or blurry vision
  • Hearing loss
  • Tinnitus (ringing in your ear)
  • Dizziness
  • Altered taste and smell
  • Sensitivity to noise or light
  • Balance problems
  • Irritability
  • Being argumentative
  • Sadness or depression
  • Being more emotional
  • Emotional swings
  • Anxiety or nervousness
  • Panic attacks
  • Sudden outbursts of uncontrollable crying or laughing
  • Loss of appetite or increase in appetite
  • Sexual dysfunction
  • Weight change
  • Insomnia or sleeping more than usual
  • Sleeping less than usual
  • Trouble falling asleep; or waking up from a deep sleep
  • If a student in school, a change in grades after the accident
  • If employed, a change in employment records such as noting difficulties performing tasks or ability to get along with other employees

How soon are symptoms of Mild TBI noticeable?

Symptoms of a mild traumatic brain injury can occur immediately with nausea or vomiting but the lack of nausea or vomiting doesn’t mean that you did not sustain a mild TBI.  Onset of symptoms may occur days, weeks, or months after a motorcycle accident injury.  However, symptoms are often noticed weeks or months after onset and may be diagnosed long after that, even years later.

Why can it take so long to become aware of or diagnose the symptoms?

  1. Accident victims are acutely aware of the most painful injuries first and later become aware of other less painful injuries after the most painful ones dissipate.  Since symptoms of a mild TBI are not painful (except for headaches) and by definition are mild, mild TBI symptoms are often overlooked.
  2. When an accident victim becomes aware of his/her symptoms, the person thinks the symptoms will go away and waits and hopes until a long time passes.  Eventually after many months of continuing symptoms, medical advice may finally be sought.
  3. Some accident victims are too embarrassed to admit or tell anyone about their symptoms.
  4. Motorcycle accident victims may be aware of experiencing some of the symptoms but do not realize why they are experiencing the symptoms or that it is because of a mild traumatic brain injury.  When we represent a client injured in a motorcycle accident, we look for these symptoms and refer our client to a neuropsychologist for diagnosis when we suspect the possibility of a mild traumatic brain injury.

What can you do if you believe you may have suffered a mild traumatic brain injury?

First, a mild TBI must be diagnosed; and then the injury should be treated

1) Detecting or Diagnosing Mild TBI

A CT Scan of the brain or an MRI of the brain can conclusively show the brain damage but is not necessary to show the existence of mild traumatic brain injury.  Most MRI machines of 1.5 T (Tesla), which are low resolution, will miss 40-50% of traumatic brain damage.  A  much higher resolution 3.0 T (Tesla) MRI should be used to detect brain damage.

A neuropsychologist or neurologist can also determine if you have suffered a mild TBI even if not showing on a scan.  Sometimes when the patient describes the symptoms to a neurologist, the neurologist will diagnose MTBI and refer the patient to a neurologist who specializes in MTBI or to a neuropsychologist for further testing and treatment.

When we believe that our client may have a mild traumatic brain injury, we will obtain a 3.0 T (Tesla) MRI of the brain when appropriate and refer our client to a neuropsychologist for testing to determine if you have suffered a mild TBI.  We work with neuropsychologists on Long Island who can conduct testing to determine if a mild traumatic brain injury exists.

2) Treating Mild TBI

There is no known cure for MTBI but patients can be taught how to cope with the disability and there may be a natural supplement which can substantially help.
When diagnosed with a mild TBI, a neuropsychologist will determine in what ways the brain was injured.  A neuropsychologist or psychologist can then provide treatment consisting of mental exercises to re-train your brain to use different pathways to perform brain functions.

A neurologist or a psychiatrist can also prescribe short term medications for mild traumatic brain injury but for moderate to severe TBI, medications can cost as much much as hundreds of thousands of dollars over a lifetime and can be recovered in a lawsuit.  See a chart showing how different drugs are used and work to treat moderate to severe TBI.

Coping with Behavior Problems after Head Injury for patients, family members and friends.

A natural supplement believed to be highly beneficial for some recovery is high doses of fish oil with omega-3 fatty acids (see the video below).

Sending your brain to the gym — learn what vets and service members are doing at Walter Reed’s Brain Fitness Center.

Smartphone apps — The National Center for Telehealth & Technology has a list of Android & iPhone smartphone apps for mood tracking, treatment exercises and more.
48 Life-Changing Mobile Apps for People with Brain Injury

Concussions on TV

On FOX TV News, “The science behind concussions”, Marc Siegel, M.D., NYU Langone Medical Center and David Samadi, M.D., Lenox Hill Hospital said — “One smack and you can end up not the same for the rest of your life.” Dr. Siegel wrote on FOX News, about Pro Football Hall of Famer and sports broadcaster Harry Carson, “Carson says he has met athletes who suffer a single bad blow to the head during a game in high school and are never the same again.”

This mother said her son made a miraculous partial recovery from a coma

60 Minutes “Invisible Wounds” shows what a concussion looks like and how it affects you

How much money can I get if I suffered a mild TBI?  

We settled a case with a concussion for $1.25 million for a 46 year old woman who did not report headaches until a month after accident.  She did not have any lost income.  Her first neurologist stated (misdiagnosed) in her medical records that her headaches were either early Multiple Sclerosis or from prior Lyme Disease. The defense neurologist stated that the plaintiff did not have a concussion and is faking a head injury.

A concussion in a motorcycle accident may be worth much more. The violent trauma of a motorcycle accident is more likely to cause a concussion and evidence of the injury may be more easily proved.  We currently represent a motorcyclist who’s CT scan showed a drop of blood in the brain.  This is absolute proof of the injury.  Now, we are documenting how it has affected his life.

A mild traumatic brain injury can result in a settlement or award for pain and suffering of as much as several million dollars because it is a long-term debilitating injury which can impair your life permanently.  Other factors such as the past and future cost of treatment and medications increase the value.

While NFL football players may sustain more concussions than motorcyclists, even one concussion can cause a lifetime of problems for an injured motorcyclist.  The NFL settled a suit for $765 Million brought on behalf of 4,500 retired players who’s lawyers claimed the NFL hid information from them about the dangers of head trauma.  However, the settlement of $765 million is a paltry sum amounting to only $170,000 per player and is payable over 20 years!

Legal analysts estimated that the lawsuit was worth $2 billion.  The NFL player’s attorneys may say that the settlement was hastily made to get funds to football players quickly but I think the dramatically low settlement was the result of poor negotiating skills on the part of the player’s lawyers and I think I could have done a lot better.  The real issue in the lawsuit is whether the NFL hid information from the players.

Now, The New York Times reports that the National Football League stated in federal court documents that it expects nearly 1/3 of retired NFL players to develop long-term cognitive problems which are likely to begin at “notably younger ages” than in the general population. This newly revised estimate is probably even lower than what the NFL really believes. The number of players suffering from brain injuries due to concussions is staggering, especially considering that not all players have had a concussion.  The report does not say how many have had a concussion.

Frontline: League of Denial the NFL’s Concussion Crisis (promo-the full video will be here when available)

Proving a Brain Injury

There are many ways we prove a brain injury such as using medical records and experts like a neuropyschologist.

The video below was made to show to an insurance company so they can see what happened to our client’s brain instead of just reading medical records.  If needed, it will be shown to the jury at trial but we think the insurance company won’t want a jury to see it and will offer to pay their $million+ dollar policy. If the case does go to trial, we’re sure we will get a verdict above the policy and we will seek recovery of the entire verdict.

Our client hit his head in a motorcycle accident and he didn’t even know he had a brain injury.  He complained of memory issues and when we received his hospital records, we found a CT scan report which showed he had a small hemorrhage.

Doctors categorize a brain hemorrhage as either small or large. A brain hemorrhage is often described in the medical records as small because a mid-line shift of the brain is needed before it is considered large. Since this encompasses a large range, the video is useful to show that small is still bad.

A mid-line shift of the brain would require 24 hour care for a person injured in an accident or would be deceased.

We created this video from his 2D Black & White CT scan.   This video shows the “small” hemorrhage (bleeding) in his brain in 3D color and also contrasts side by side with the 2D Black & White CT scan.

What should I do if I was injured in a motorcycle accident?

Be sure to keep your helmet as evidence of head trauma.  Call us immediately for a free consultation.  Of course, let us know if your helmet has any damage or if you have any of the above symptoms of a mild traumatic brain injury.

 

MTBI Resources

Traumatic Brain Injury Waiver – 11 Medicaid-funded services assist participants to live in community-based settings, used in combination with existing Medicaid services. Participants may be eligible for rent subsidies and housing supports.
Traumatic Brain Injury Center of North Shore-LIJ
Lumosity – Challenge your brain with scientifically designed training
Brain rewires itself after damage or injury, life scientists discover – UCLA
Smartphone apps for Android & iPhone for mood tracking, treatment exercises and more.
48 Life-Changing Mobile Apps for People with Brain Injury

Look for our skull stress balls at motorcycle runs to help raise awareness of mild Traumatic Brain Injury and your knowledge of the injury.  Many motorcyclists have a concussion which is a mild Traumatic Brain Injury which can be worth millions.

Front of skull stress ball to help raise awareness of mild Traumatic Brain Injury

back of skull stress ball