Traumatic Brain Injuries - Direct Hit to the Head Not Required

Apr 17, 2015

From the NFL all the way down to Little League, sports authorities have recently taken steps to better protect players from traumatic brain injuries (TBI’s). While most of us are not suiting up for physical sports, we are all routinely riding around in vehicles. In essence, all of our brains are regularly cruising around at 30, or 45, or 70, miles an hour.

The brain is a free floating mass inside the skull. While brain matter is soft, the skull is hard. An injury occurs when the brain hits one side of the skull and bounces backwards to the other side of the skull. Think of putting an egg inside a glass Mason jar and filling it with water. Do you think you could shake the jar hard enough to crack the egg? Not surprisingly, TBI’s frequently occur in motor vehicle crashes. Side impacts snap a person’s head sideways impacting the door pillar or window. TBI’s can also occur in a rear end collision or in a front impact collision or when the head does not impact anything. If the skull is thrown in one direction and snapped back in the other direction, an injury is likely. Simply put: all that is required is the rapid acceleration and deceleration of the head. The inside of the skull is not smooth, but has rough and jagged edges. These abrasive edges can cut and sheer on brain tissue as it is forcefully thrown backwards and forwards in the skull. 

Symptoms of injury can range from mild to profound. If the skull is not broken, the injury is classified as a closed head injury. Closed head injuries often do not show up in CT scans or MRIs. 

A concussion is classified as a mild TBI and by its very diagnosis cannot be seen in any CT scan or MRI. For too long, the effects of TBIs or concussions have been downplayed. Even the very existence of a concussion is often dismissed in particular patients.

If there is visible damage in a CT scan or MRI it is not a mild TBI, but a moderate or greater TBI. “Mild TBI” however should not be confused with minor. Symptoms from a TBI can manifest in many forms: headaches; dizziness/vertigo; nausea/vomiting; double vision; inability to pay attention; loss of concentration; forgetfulness; sensitivity to light; seizures; difficulty with reasoning, problem solving  or judgment; irritability; or depression. Symptoms can be short-lived or indefinite.

Research is now showing that a second concussion while still recovering from a first concussion can cause exponentially more damage than two single events spaced far enough apart the brain has had an opportunity to recover from the initial TBI. Once you have a concussion, you are at a far greater risk for significant brain damage if you suffer a second concussion while recovering from the first concussion. This finding has led to the implementation of concussion protocols in the sporting world.

The head and the neck are extremely vulnerable in a motor vehicle collision.  Advances in automotive safety have reduced those risks, but they are far from eliminated. Airbags may keep you from being launched through a windshield, but they hit with such force that they can cause a concussion. If you are traveling at 35 mph and hit another object the car will stop suddenly; your head however continues to travel forward- and more importantly your brain inside your head continues to travel forward- at 35 mph.  An airbag is deployed at 200 mph to meet your head before it crashes into the windshield. The airbag stops your head from the 35 mph forward momentum and takes it backwards at 200 mph. As the skull is stopped and shoved backwards the brain inside impacts the front of the skull as it comes to a stop and then is propelled backwards only to hit the back of the skull when the head abruptly comes to a rest against the headrest.

In any type of a collision the head is going to be thrown in one direction or another only to come to an abrupt stop and to be snapped back in another direction either through reaching the end of the limitations of the physical body or with the aid of some structure in a vehicle (airbag, window, pillar, headrest).  For a long time traumatic brain injuries were ignored and the symptoms chalked up to symptoms associated with the neck injuries (whiplash) that occur in these collisions.  Because medical imaging was negative it was assumed no damage to the brain had occurred.  

Research however now shows that the brain does truly suffer significant damage at a microscopic level undetectable in modern imagery and it is those injuries that account for the symptoms that once were so often dismissed. 

If you or someone close to you is in a collision and are exhibiting symptoms of a traumatic brain injury it is important that you note those symptoms to EMS and/or emergency room personnel so that adequate testing can be ordered to determine if it is a mild closed head injury or if there is something more profound going on that needs more attention. 

Since the skull is an enclosed space, when the brain is injured to the point that swelling occurs, the force of the swelling can actually cause more damage as the pressure builds inside the skull. Sometimes in these situations holes are drilled through the skull by neurosurgeons which allow the pressure in the brain to dissipate. While that treatment is certainly not a pleasant one it is far more desirable than allowing increased pressure to cause damage to brain tissue resulting in permanent brain damage.

At Willis and Willis Co., L.P.A., we have handled hundreds of cases involving some form of a TBI. These cases pose unique challenges not just to you and your medical providers, but to your attorneys as well. Experience matters, and building these cases correctly from the ground up is the only way to obtain a full recovery for these injuries.

Willis & Willis Co., L.P.A.
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Akron, OH 44303

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