Mild Traumatic Brain Injury
Posted on November 5, 2013
By Dr. Bill Gallagher
If you have watched a football game in the last year you know that if a player’s helmet comes off on the field then they are out of the game for the next play. If they show any signs of a concussion they are out of the game until a doctor clears them to play again. The NFL has finally admitted that mild traumatic brain injuries, concussions, are a serious problem and not something that should be brushed off .
The CDC also knows that traumatic brain injuries are involved in one-third of accidental deaths so why then do doctors and lawyers fail to identify them in personal injury cases? We all know that an object in motion tends to stay in motion and when a head accelerates in a collision the brain inside of it does the same. When the head reaches the limit of its motion and bounces back in the opposite direction the brain, acting as a separate entity continues its motion until it crashes into the inside of the skull. A soft tissue brain crashing into a bony surface means the brain will lose every time.
Statistically 50 percent of people who are rear ended with minimal damage to the vehicle will suffer cerebral contusions and 80 percent will suffer a concussion. So what should you look for? The list of symptoms is long but some of the most common findings include;
• Short term memory loss
• Visual disturbance
• Loss of smell
Headaches are so common after an accident that it is rare for a victim to not list it as a complaint. Between the impact that the brain has taken and the muscle and ligament damage in the neck, headaches are to be expected. Their intensity, location and how long they persist are all factors that determine the value for the case.
Disorientation may be more obvious at the scene but can also be tested by the doctor using ACE, acute concussion evaluation or the Rivermead Post Concussion Symptom Questionnaire. Either will provide measurable ratings to document the concussion.
Short term memory loss can easily be tested by having the patient repeat a list of four or five unrelated words such as; red, clock, seven, horse, left . Most will be able to tell you the details of every accident they have been in over the years but when suffering a short term memory loss will not be able to repeat the list again a minute later.
Visual disturbances are often overlooked and can also be measured. Diminished visual acuity and difficulty focusing on the printed word are common findings. With the visual cortex at the posterior part of the brain, along with the eyes and optic nerves being involved it is easy to see how vision can be affected.
Loss of the sense of smell is probably the most commonly overlooked symptom and for that matter most doctors do not even check for it. Th e olfactory nerves drop down from the forebrain to the nose and when that brain is thrust into violent motion these are especially susceptible to damage. Testing is as simple as having the patient smell vials of common household odors one nostril at a time with their eyes closed. To rule out the possibility that they are reporting a loss of smell that does not actually exist a particularly noxious odor will elicit a physical reaction if the nerve is fully functioning.