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What is brain injury?

Brain injury is an injury to the brain that generally results from an external trauma such as a blow to the head, but may also occur without any physical contact to the head as in a sudden acceleration/deceleration injury caused by a car crash. Trauma or forces exerted on the brain cause damage which often might be at the microscopic level which as a result can impact speech, cognition, behavior, personality, emotions, and perceptions.

Does a person need to be knocked out to sustain a head injury?

No. Often the person may sustain no loss of consciousness or coma or only a fleeting alteration in consciousness. Nonetheless, there may be injury to the brain, which can cause deficits in a person’s functioning.

Is a brain injury a serious medical problem in America?

Absolutely. The statistics regarding head injury are staggering. Approximately two million head injuries occur each year in the United States and between 75,000 and 100,000 Americans die each year as a result of traumatic brain injuries. For those who survive, 500,000 will require hospitalization and 70,000 to 90,000 will suffer long-term, physical, intellectual, psychological and cognitive deficits. However, the general public is not generally aware of the gravity of the situation. This is why head injury is often referred to as the “silent epidemic”.

What are the most common causes of traumatic brain injury?

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Motor vehicle accidents account for more than half of all head injuries. Other causes are falls, industrial accidents, sporting accidents and acts of violence.

Why is it that a brain injury may not be first diagnosed until long after the accident?

Emergency rooms are generally set up to deal with life threatening and emergent physical injuries and not the more subtle cognitive deficits that may result from a neurological insult to the brain. If there are not “gross” signs of damage, such as hemorrhaging, swelling or contusion of the brain, or signs of skull fracture or other serious trauma to the head, a brain injury may be ignored or not diagnosed in the emergency room. In addition, routine neurological examination is not necessarily capable of picking up subtle, cognitive impairments that can result from a diffuse axonal injury, which is injury to the brain cells themselves on a microscopic level. Similarly, neuroradiological diagnostic tests are not equipped to pick up microscopic damage that results from an acceleration/deceleration injury to the brain.

How is a brain injury diagnosed?

Clearly, if there is evidence of gross damage to the brain, such as hemorrhaging, swelling or contusions, these physical findings will generally be detected on a CT scan or MRI. Further, a neurological exam may detect evidence of neurological insult. However, where the damage is microscopic, such as in the case of diffuse axonal injury, the diagnosis must be made as a result of the history obtained from the patient (for example, a blow to the head or sudden acceleration/deceleration injury), the symptoms reported by the patient (such as alteration of consciousness, headaches, dizziness, confusion, impulsivity, personality changes or cognitive difficulties) and the results of neuropsychological testing, which is sensitive enough to detect impairments in cognitive, perceptual and emotional functioning.

What does the phrase “mild” traumatic brain injury refer to?

This phrase in many respects is a misnomer. There is nothing “mild” about a traumatic brain injury as even a brain injury which does not result in any loss of consciousness can have serious impact on a person’s day-to-day functioning. However, generally, where the person sustains no loss of consciousness or a very brief period of alteration of consciousness, the brain injury is referred to as “mild.” However, the degree or presence of loss of consciousness does not necessarily have a direct correlation with the sequeli resulting from the brain injury. Certain individuals, either as a result of the nature of the injury to the brain or genetic makeup or predisposing physical, cognitive and emotional reasons, may sustain devastating impairments which interfere with the person’s ability to function from even a “minor” traumatic brain injury. The degree of brain injury refers only to the acute phase and the length and presence of any loss of consciousness, and not to the long-term impact that the injury may have on the person’s ability to function.

What are the common indicators and symptoms of traumatic brain injury?

While each person is different and the symptoms associated with a brain injury may differ, generally, one finds a change or loss of consciousness, dizziness, headaches, memory impairments, visual disturbances, speech disorders, disorientation and balance difficulties.

What other symptoms are associated with traumatic brain injury?

Individuals who have suffered a brain injury may experience symptoms and impairments in a number of areas including cognition, memory, problems with arousal, impaired judgment, disorientation, language and learning deficits, fatigue, hearing and vision impairments, emotional liability, anxiety and depression, disinhibition, and other physical, behavioral, personality and emotional changes.