SERIOUS INJURIES – Closed Head Injuries/Brain Injuries

If you have sustained an injury to your head, a complete neurologic exam should be performed.

Closed Head Injuries/Brain Injuries – The number one cause of head injuries is road accidents. Drivers, passengers, pedestrians, and cyclists are the victims. Other causes include assaults; injuries incurred in sporting events, and falls resulting in a blow to the head.

1.5 million people each year incur a closed head injury, 75% of which are classified as mild. However, each year approximately 50,000 individuals die from head injuries and more than 100,000 suffer permanent disability. The severity of the injury is initially judged by assessing the so-called Glasgow Coma Scale (GCS) which assesses eye, motor, and verbal abilities. A score of 13-15 indicates a mild injury, a score of 9-12 indicates moderate injury, and a score of 8 or less indicates severe injury. Concussion, where there is no loss of consciousness, is considered a mild injury.

There have been great advances recently in the understanding of the pathologic process that results from a closed head injury. Depending on the severity of the blow the following structural findings may be present as noted clinically or by imaging: linear or depressed skull fractures, subgaleal hematomas (“goose eggs”), intracranial hemorrhage, cerebral edema, diffuse axonal injury (DAI), or no findings at all. Intracranial hemorrhages may include Sudbury hematoma, epidermal hematomas, intracerebral hemorrhage, or subarachnoid hemorrhage. The recent use of amyloid precursor protein staining has enabled clinicians to identify axonal injury which is often responsible for memory and cognitive impairment, and sometimes vegetative states associated with coma. Neurochemical changes occur after traumatic brain injury.

It is most important to ascertain whether or not you have lost consciousness during a traumatic incident. Generally, the prognosis is worse if you lost consciousness since there is a greater risk that the mediators of brain inflammation are produced in this setting. It is also important to elicit the type and mechanism of injury, as these also have some prognostic importance. Someone who is injured by assault or from a falling object has a much greater risk than patients sustaining acceleration/deceleration injuries that occur in motor vehicle accidents, because the former mechanism is associated with greater axonal damage. Also, if you are taking anticoagulant medication, you must immediately advise your physician, because you are at much greater risk for internal bleeding.

If you have sustained an injury to your head, a complete neurologic exam should be performed.

All head injured patients are potential litigants because of the persistent and disabling nature of the condition. Make sure your physicians document your case meticulously and substantiate the mechanism of your injury, the extent of your injury, the physical, emotional and cognitive consequences of your injury, delineate the treatment, and discuss your prognosis.

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