Mild traumatic brain injury and post-concussion syndrome

By Mar 8, 2018 Posted in Blog

One-third of all concussions are missed in emergency room examinations

If you were “dazed” or “confused” following an accident, and are suffering from symptoms such as fatigue, nausea, headaches, trouble sleeping, blurred vision or ringing in your ears, you may have suffered a concussion.  

A mild traumatic brain injury is defined as a brief period of being “dazed or disoriented,” or a brief loss of consciousness.  Statistics show that 33% of concussions are missed in emergency room examinations.  One reason for this is that mild traumatic brain injury does NOT show up on a CT scan or an MRI.  Standard neuroimaging will identify large focal contusions or hemorrhage, but conventional CT and MRI testing does not identify diffuse axonal and vascular injury, both of which are major drivers of poor clinical outcome after traumatic brain injury. Sharp DJ, et al. Practical Neurology 2015;15:172–186. doi:10.1136/practneurol-2015-001087.

Traumatic brain injury has been identified as a health epidemic

Traumatic brain injury has been identified as a health epidemic by the World Health Organization and the United States Centers for Disease Control.

Each year over a million American suffer concussions

Each year in the U.S., 1,000,000 people suffer concussions; 300,000 of these result in serious, long term injuries.  Centers for Disease Control, Report to Congress on Mild Traumatic Brain Injury In the United States: Steps to Prevent a Serious Public Health Problem.

Mild traumatic brain injury can have long-lasting symptoms

A mild traumatic brain injury (TBI) can have serious and long-lasting symptoms, especially in persons who have sustained a previous concussion.  Symptoms include fatigue, headaches, blurred vision, concentration problems, forgetfulness, depression, extreme frustration, and personality changes.  Centers for Disease Control, Report to Congress on Mild Traumatic Brain Injury in the United States: Steps to Prevent a Serious Public Health Problem.

Fatigue is a common symptom of mild traumatic brain injury

Fatigue is one of the most frequently reported symptoms after Mild Traumatic Brain Injury.  In a survey of 299 patients with mild traumatic brain injury, 32% were severely fatigued. Severe fatigue was highly associated with the experience of other symptoms, limitations in physical and social functioning, and fatigue related problems like reduced activity. Of various trauma severity indices, nausea and headache experienced were significantly related to higher levels of fatigue. The researchers concluded that one-third of a large sample of MTBI patients experience severe fatigue six months after injury, and this experience is associated with limitations in daily functioning. Stulemeijer, van der Werf, Bleijenberg, Biert, Brauer and Vos,  J Neurol (2006) 253 : 1041–1047 DOI 10.1007/s00415-006-0156-5

Chronic pain is a complication of mild traumatic brain injury

Chronic pain is a common complication of TBI. It is independent of psychologic disorders such as Post Traumatic Stress Disorder and depression and is common even among patients with apparently minor injuries to the brain.  Post-traumatic headache is a prevalent symptom.  Studies found post-traumatic headache was reported by 44% of patients after 6 months. Post-traumatic headache began at the time of injury in 30% of patients, between 15 days and 1 month in 21%, between 1 and 3 months in 18%, and after 3 months in 32%.  Eleven percent still had headache at 6 months, 54% at 1 year, and 30% after 2 years. Nampiaparampil, Prevalence of Chronic Pain After Traumatic Brain Injury: A Systematic Review. JAMA 2008;300(6):711-719 (doi:10.1001/jama.300.6.711)

Some mild traumatic brain injuries heal quickly; others cause chronic problems

A person with MTBI may manifest brief symptoms or experience persistent and disabling problems (Kushner 1998). The clinical consequences of such an injury can, for example, affect one’s ability to return to work and complete routine, daily activities. In one study, employed persons who were hospitalized for MTBI lost an average of nearly four weeks of work after injury (Binder, Rohling and Larrabee 1997). Other researchers reported unemployment rates among previously employed MTBI victims of 34 percent at 3 months and 9 percent at 12 months after injury (Rimel, Giordani, Barth, et al. 1981; Guthkelch 1980). Also, people with MTBI may return to work despite incomplete recovery (Russell 1971).

People with mild traumatic brain injury are at increased risk for suicide

A study published in 2016 assessed the long-term risk of suicide after a concussion.  The researchers performed a longitudinal cohort analysis of adults with diagnosis of a concussion in Ontario, Canada, from Apr. 1, 1992, to Mar. 31, 2012 (a 20-yr period), excluding severe cases that resulted in hospital admission. They identified 235,110 patients with a concussion. Their mean age was 41 years, 52% were men, and most (86%) lived in an urban location. A total of 667 subsequent suicides occurred over a median follow-up of 9.3 years, equivalent to 31 deaths per 100,000 patients annually, or 3 times the population norm. Weekend concussions were associated with a one-third further increased risk of suicide compared with weekday concussions.  The increased risk applied regardless of patients’ demographic characteristics, was independent of past psychiatric conditions, became accentuated with time, and exceeded the risk among military personnel. Half of these patients had visited a physician in the last week of life. The researchers concluded that adults with a diagnosis of concussion had an increased long-term risk of suicide, particularly after concussions on weekends.  Fralick, Thiruchelvam, Tien, and Redelmeier, Risk of suicide after a concussion, CMAJ 2016. DOI:10.1503/cmaj.15079.

Neuropsychologists can perform tests to determine brain function deficits

A qualified neuropsychologist can perform testing to assess brain function deficits, and can recommend a therapeutic program to help patients cope with this life-changing injury.  Sharp DJ, et al., Practical Neurology 2015;15:172–186. doi:10.1136/practneurol-2015-001087.

The attorneys at Wham & Rogers have extensive experience handling mild traumatic brain injury and post-concussion syndrome cases.

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