Brain Injury Awareness: Facts and Guidelines for Dealing with Brain Injury Cases

Brain injuries have been classified and re-classifed over the years with several different names. What was once an open head injury is now called a traumatic brain injury. Traumatic brain injuries are then classifed as severe, moderate or mild based upon how long the person was unconscious.

We agree with a group of lawyers who are advocating that brain injuries should be classified with two simple categories: those involving coma and those that don’t. And though brain injuries are the signature wound of military personnel returning from Iraq and Afghanistan, the military calls it mild traumatic brain injury.

Think about this. Beth Jameson suffered an anoxic brain injury due to a stroke; Alan Forman suffered diffuse axonal brain injury after being run over by a boat; Claudia Osborn was riding a bicycle and was hit by a car resulting in traumatic brain injury; Donna Jones suffered TBI during a snowmobile accident; Courtney Larson was in an automobile accident; David Fierce was driving a car that hit a patch of black ice and slid off the road right into his brain injury. Angela Ronson’s brain injury came as a result of an Arterio-Venous Malformation (AVM) rupture.

Rebekah Vandergriff lay in a coma for six weeks after her car accident. Beth Jameson and Alan Crimmins were put into morphine-induced comas to prevent their brains from receiving more damage.

Each person mentioned above suffered memory problems, cognitive problems and behavioral problems. Beth and Courtney did not remember they were married; Beth didn’t remember she had two children. David Fierce did not remember that he was trying to get away from a former girlfriend … and married her!

Different Types of Brain Injuries – Common Problems

Anoxic and Hypoxic brain injuries are differentiated by oxygen amounts. A person suffering from anoxia is not getting any oxygen to the brain. Hypoxia, on the other hand, happens when a person does not receive an adequate amount of oxygen going to the brain.

It is not possible to use the word all when talking about brain injuries. No two brains are exactly alike before being injured; therefore no two injured brains are exactly alike afterward. There are common problems, and those common problems usually involved loss of skills involving memory, cognition and behavior.

1. Traumatic Brain Injury

Traumatic brain injury occurs when an external force causes injury to the brain. That external force could be from an automobile accident, a fall, a gun shot, a sports concussion or a roadside bomb (IED as they’re called in Iraq). TBI is normally classified as mild or severe, depending upon numerous factors.

Traumatic brain injuries may not be diagnosed during early treatment. Each year, thousands of persons suffering from brain injury are sent home from hospital emergency rooms because of a lack of symptoms or, quite possibly, a lack of brain injury knowledge among ER personnel.

Dr. Antoinette R. Appel has stated: “Left to fend for themselves, the victims of traumatic brain injury, already confused by their inability to be the people they were prior to the injury, now face the daunting task of demonstrating that an injury they do not understand and cannot comprehend is producing the confusion they cannot communicate.”

Dr. Appel has a PhD in psychology from the City University of New York and has devoted herself to the understanding of types of brain injury and the role of the neuropyschologist when it comes to identifying, proving and treating brain injury. Her statement in the previous paragraph is one of the best summations of traumatic brain injury we’ve seen.

Inability to be the People They were Prior to the Injury

People who are familiar with Brain Injury Survivor’s Guide will identify this confusion as part of the Cycle of Response discussed in chapter six. Brain injury affects memory. Beth Jameson, co-author of Brain Injury Survivor’s Guide, could not remember how to cook or how to put on her makeup.

Courtney Cox, co-author of I Can’t Remember Me, could not remember her husband or family members. Claudia Osborn, author of Over My Head, had a terrible time when shopping. She said she would either forget her list, or take the list and forget to take money, or forget how to get to the grocery store.

These are just three examples out of millions of people who were confused by their inability to be the people they were prior to their brain injuries.

Demonstrating that an Injury they do not Understand and Cannot Comprehend is Producing the Confusion they Cannot Communicate

How do you explain to someone something you don’t understand and cannot comprehend? Beth mentioned in her book that there were many occasions when she stood silent in the middle of a sentence, trying to remember the words she wanted to say.

Has that happened to you? Did the other person say to you like they would say to Beth, “That happens to me all the time”? Beth said she simply wanted to scream, “NO, that doesn’t happen to you ALL the time; it happens to ME ALL THE TIME.”

Difficulty finding the correct words at the correct time is a very common problem among people who have suffered brain injury. Just because it’s a common problem does not make it any easier to live with. Not only is it confusing, it leads to frustration which leads to guilt which leads to depression (also from Cycle of Response in Brain Injury Survivor’s Guide).

Earlier you read that traumatic brain injury is classified as mild or severe. Please understand that any injury to the brain is traumatic for both the injured person and family members, whether it’s caused by an external force or not.

Strokes can also cause brain injury. So can lack of oxygen. So can drug use. And so can many other things. While these are not officially called traumatic brain injuries, the results are the same.

Some physical symptoms include nausea, vomiting, headache, dizziness, blurred vision, some loss of vision, difficulty sleeping, getting tired easily, lethargy and other sensory losses such as smell or taste.

Some cognitive symptoms include inability to concentrate, short attention span, difficulty finding words and memory problems.

Some behavioral problems include disinhibition, becoming easily irritated, being very quick to anger, etc.

Beth Jameson insisted that a message she desperately wanted to convey in Brain Injury Survivor’s Guide is this: Knowledge is Power to a Brain Injured Person. Victims and family members must learn more about brain injury. They should attend support groups if possible. They should find Internet support groups and share information with others…and learn from others.

A brain injury, in many instances, can be overcome. But, it will not go away.

2. Acquired Brain Injury- What is it?

Acquired brain injury, simply stated, includes any brain injury that is acquired at or after birth. Cerebral palsy, for instance, can be acquired prior to birth, during the birthing process or shortly after birth.

Since there is evidence that cerebral palsy can be linked to the mother or child’s medical history, it is not really considered to be what are commonly known as acquired brain injuries.

Multiple sclerosis certainly affects the brain but it is considered to be a nervous system disease caused in part by heredity but triggered by any of multiple viruses.

Common Causes of Acquired Brain Injury

Trauma to the head is the most common cause of brain injury and can result in mild, moderate or severe traumatic brain injuries. Although rare, this trauma can occur in the birth canal during the birthing process. Head trauma, however, is most often caused by accidents, falls, and sports injuries.

Traumatic brain injuries, due to Improvised Explosive Devices (IED) became the signature wound sustained by troops in Iraq and Afghanistan.

Brain tumors can also cause brain injury. The severity, of course, depends on the location and size of the tumor.

Strokes are another common cause. A stroke is caused by oxygenated blood not properly reaching brain cells, resulting in those cells dying. The severity of brain injuries caused by strokes, then, depends on the location of the dead cells and how many cells died during the stroke event.

Readers of Brain Injury Survivor’s Guide are familiar with the fact that Beth’s brain injury was caused by an anoxic stroke after suffering Adult Respiratory Distress Syndrome (ARDS).

Cerebral hemorrhage is another cause of acquired brain injury. One such event of cerebral hemorrhage is known as Arterio-Venous Malformation. Even though a person is born with AVM, it is usually a number of years before it shows its ugly self.

Hydrocephalus gets its name from the Greek words hydro (meaning water) and cephalus (meaning head). It is a condition caused by too much fluid in the brain causing pressure on it. The brain and spinal cord float in a fluid called cerebrospinal fluid (CSF). The amount of CSF surrounding the brain is a delicate balance, and too much causes the unwanted pressure. Hydrocephalus can be present at birth, or it can be caused by head trauma or stroke.

Brain Aneurysms are another cause of brain injury. An aneurysm is an abnormal bulging inside a blood vessel. Brain aneuryms, also called intracranial or cerebral aneuryms, are often not noticed until they rupture. This rupture, in turn, becomes a cerebral hemorrage (mentioned above). It has been estimated that as many as 1 in 15 people in the United States will develop a brain aneurym during their lifetime.

Acquired brain injuries are about the last thing any person would want to acquire but they are more common than most people believe. People would like to see world peace; they would like to acquire fame and fortune. Acquiring a brain injury is not on anyone’s list.

Once acquired, though, there are many strategies available on a self-help level and many therapies available from speech therapists, occupational therapists, psysiatrists and neuromedical personnel that can benefit both those who have suffered an ABI and those that love them.

3. Anoxic Brain Injury

Anoxic brain injury is caused by a lack of oxygen going to the brain. The brain begins losing brain cells after only four minutes without oxygen. There are very few things in life that you can do in that short amount of time. Please understand that when a brain loses brain cells, it’s not like you losing your car keys. Lost, in this context, means dead!

Readers of Brain Injury Survivor’s Guide are familiar with the fact that Beth’s anoxic brain injury was caused by a stroke after suffering Adult Respiratory Distress Syndrome (ARDS) in the hospital while recovering from surgery. And you’re also familiar with the fact that the stroke and subsequent brain injury went undiagnosed for months.

Anoxic brain injury differs from hypoxic brain injury simply as a matter of amounts. Anoxia results from a lack of oxygen; hypoxia results from the lack of an adequate supply of oxygen. In fact, the two are so closely related that the medical community uses HAI which stands for hypoxic-anoxic brain injury.

However, even though the two are kissing cousins, a total lack of oxygen can cause more widespread and more significant brain damage. Then again, is a total lack of oxygen for five minutes worse than an inadequate supply of oxygen for an hour?

Causes of Anoxic Brain Injury

Cardiac arrest normally receives the prize as being the leading cause of anoxic brain injury. Or, does it? A 1989 study showed cardiovascular disease and anesthesia accidents caused one-third of all anoxic brain injuries.

Asphyxia, caused by suicide attempts and near-drownings, is another cause. The study also found that anoxia was commonly caused by chest trauma, barbituate poisoning (drug use), electrocution and severe bronchial asthma.

4. Hypoxic Brain Injury

Hypoxic brain injury is caused by a decrease in the supply of oxygen going to the brain. It differs from anoxic brain injury because anoxia means there is no oxygen going to the brain. That does not mean that a hypoxic brain injury is any less severe.

Patients must still be ventilated and other life-saving measures must be taken. Hypoxia can cause coma, seizures and, even, brain death. A major consideration with hypoxia will be how long the brain did not receive an adequate supply of oxygen, and that is, in many cases, unknown.

Causes of Hypoxic Brain Injury

Carbon monoxide poisoning complicates medical treatment because it can continue to cause additional damage to the brain for days or weeks after the event.

Near drowning, strangling, choking on food, suffocation, cardiac arrest and head trauma can all cause hypoxia.

Prospects for Recovery

Like most everything else related to head trauma and brain injury, it depends. First, of course, it depends upon the severity of the hypoxia. How much time passed while the brain was not receiving enough oxygen.

The longer a person is unconscious, the more potential damage is being done to the brain. A second “depends” is the cause of the hypoxia. As has already been mentioned, carbon monoxide poisoning can continue to produce problems, and that complicates recovery.

5. Diffuse Head Injury

Diffuse brain injury, more often than not, is misdiagnosed or NOT diagnosed because it is not revealed by a CT scan or magnetic resonance imaging (MRI). The diffuse damage on the cellular level can be seen only under a microscope which means it can only be seen during an autopsy.

Diffuse axonal brain injury is one of four types of diffuse brain injury and has begun to receive more attention in the medical community. Concussions and whiplash injuries are major contributors to a person having diffuse axonal brain injury.

Diffuse Axonal Brain Injury – How it Happens

This photo shows a brain cell, and it looks a lot like an octupus, doesn’t it? The arms protruding outward are axons. At the lower left of the photo you can see two of the arms almost touching with a bright flash of orange between them. The space between the two arms is called a synapse and that bright flash of light represents the electrical charge that passes information from one axon to the other.

The photo shows a normal, healthy brain cell performing correctly. In other words, this is what a non-injured cell would look like when everything is performing like clockwork.

Now, let’s throw in a whiplash or some other high-speed velocity change that throws the brain forward and back or side-to-side or a combination of the two. The “arms” of the octupus became stretched or, possibly, torn during the event.

If you really like big words, the medical folks would refer to this as coup (forward), contracoup (backward) and centrifuglar (all around) movement of the brain.

Isotropic stress is another big word for you, and it refers to the shockwave that flows through the brain at the time of the injury.

Imagine having in front of you a nice J-ello dessert that was molded to look like the top half of a ball. As long as you’re imaging, be sure to get your favorite flavor like strawberry or cherry. If you lift up the plate and shake it, what happens?

The J-ello shakes back and forth, doesn’t it. If you shook it back and forth harder and harder, something else would happen. It would begin to stretch out of shape and tear. You supplied the coup, contracoup and centrifuglar movement; the waving of the J-ello as it rocked back and forth supplied a stronger and stronger shockwave inside the dessert (the isotropic stress).

The mess you now have in front of you represents the brain cells. But it may not be a mess. The tears and deformity inside the dessert may not be noticeable. They may be so tiny that they cannot be seen. Actually, you could run a sharp knife through that J-ello about half-way down, withdraw the knife and not see the cut you just made.

The deformed, stretched or torn axons can no longer transmit electrical impulses correctly. In other words, the information that was passing from one brain cell to another is no longer passing along the route.

Depending upon the severity of the event, you may experience a very brief period of unconsciousness or a more, prolonged one. You may not even know you were unconscious. Using a sports metaphor, you may feel like you’ve just had your bell rung and nothing more.

Days, weeks or, perhaps, a month or two passes and you begin to notice things are not like they once were. You’re having frequent headaches. You’re having difficulty remembering things. You’re having trouble sleeping. You may seem to be having problems remembering people’s names…or forget what you were talking about in the middle of a sentence.

Concussions and whiplash injuries can be much more severe than they appear. If you are planning to seek advice from a personal injury attorney following such an event, you should think seriously about consulting one who has experience with brain injury cases.

You certainly would not want to receive a settlement for neck and back pain, only to discover later that you now have a brain injury that will be with you for the rest of your life.