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Concussion and mild traumatic brain injuries

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  • Troy
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  • April 11, 2011

Concussion and mild traumatic brain injuries

Motor vehicle collisions inflict violent forces on the body and often result in an occupant’s head striking the interior of the vehicle.  Sharp blows to the head can cause the brain to jostle around inside the skull, ripping and tearing brain and connective tissue and can lead to short or long term cognitive impairment.  Often, diagnostic exams will not show visible damage, yet the victim experiences difficulty thinking clearly, nausea or vomiting, irritability, sadness, and disruption of normal sleeping patterns.  http://www.cdc.gov/concussion/signs_symptoms.html Some of these symptoms may appear right away, while others may not be noticed for days or months after the injury, or until the person starts resuming their everyday life and more demands are placed upon them.  Sometimes, people do not recognize or admit that they are having problems.  Others may not understand why they are having problems and what their problems really are, which can make them nervous and upset.  Id.

According to the Centers for Disease Control, a concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works.  http://www.cdc.gov/concussion/  Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.  The CDC’s web site, particularly the page located at http://www.cdc.gov/concussion/get_help.html, contains a wealth of useful information about the causes, symptoms, and treatment of concussion and other traumatic brain injuries.  The fact sheet and brochure downloads found on that web page are especially helpful.

In a recent statement developed for use by physicians, health professionals, and other people involved in the care of injured athletes, the authors defined “concussion” as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. “Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008,” P. McCrory, et al., Journal of Clinical Neuroscience, 16 (2009) 755-763,.”  Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:

1. Concussion may be caused either by a direct blow to the head, face or neck or a blow elsewhere on the body with an ‘‘impulsive’’ force transmitted to the head.

2. Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously.

3. Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.

4. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. In a small percentage of cases, however, post-concussive symptoms may be prolonged.

5. No abnormality on standard structural neuroimaging studies is seen in concussion.  Id.

Whether caused by a traumatic blow to the head during a sporting event or during a violent car wreck, concussion and other traumatic brain injuries cause untold anxiety and grief to the victims, their friends, and their families.  The CDC estimates that direct medical costs and indirect costs such as lost productivity from mild traumatic brain injuries totaled an estimated $12 billion in the United States in 2000.  http://www.cdc.gov/concussion/headsup/pdf/Facts_for_Physicians_booklet-a.pdf

Motor vehicle trauma remains one of the leading causes of MTBI (seen in emergency departments) and among the most difficult to prove.  Insurers have consistently relied upon the absence of gross anatomic damage to deny claims of MTBI and concussion arising from motor vehicle collisions.  Insurance companies have argued that because “the CT scan is negative and the MRI is negative, there is no injury; therefore, the alleged victim is faking the symptoms.”  Recently, however, with advancements in technology and more extensive studies involving the brains of professional athletes, health care providers are beginning to shift the focus from “anatomic damage to an emphasis on neuronal dysfunction involving a complex cascade of ionic, metabolic and physiologic events. Clinical signs and symp­toms of MTBI such as poor memory, speed of processing, fatigue, and dizziness result from this underlying neurometabolic cascade.”  Id.  These and other scientific developments should afford the victims of concussion and other MTBI a better chance of being fairly compensated for their injuries and suffering.