Have you hit your head so hard that you felt dizzy or lost consciousness? Are you having trouble remembering things or recalling events after an accident? Then you may be suffering from a traumatic brain injury (TBI) or mild traumatic brain injury (mTBI).
With the new research that is being discovered for CTE, Chronic Traumatic Encephalopathy, from NFL football players, we are beginning to learn a lot more about head trauma and the aftereffects on individuals. In fact, an individual can suffer a traumatic brain injury without his/her skull actually making contact with another object. This is known as coup and contrecoup brain injury. The brain is suspended in a fluid called cerebrospinal fluid. Although the brain is anchored at certain points, it is relatively free to move within the skull.
When a railroad engineer is in a front-impact train crash, the force of the impact can cause sudden hyperflexion of the head and neck that forces the brain forward against the skull. Meaning, when the train has a front impact, the engineer’s head slings forward, causing significant pressure to his/her head and neck.
Following the impact, the recoil results in hyperextension of the head and neck that forces the brain forward against the front of the skull. Throughout the inside of the skull, there are sharp ridges and edges. When the brain hits the inside of the skull during a coup contrecoup closed head injury, the brain scrapes against the sharp ridges inside the skull. The brain’s impact with the skull can cause injury to the brain.
When a person is hit from the side, rather than front to back, it can result in rotational forces on the brain, which are 10 times stronger than linear forces. When moved from side to side, the rotational force in recoil action causes the brain to impact the inside of the skull resulting in tearing and shearing of axons resulting in further injury to the brain. When a traumatic brain injury occurs, it is important to understand there may also be damage to the brain on a cellular level.
Neurons within the brain are individual brain cells. Neurons are the basic communicating units that produce the functions in the other parts of the body. The axons are the structures through which neurons communicate with one another. The axons are like the extension cords that connect neurons with other neurons. During trauma, the brain rotates and twists within the skull. When this happens, the axons twist and shear apart. This is called a rotational or inertial force.
This rotational force also causes damage to the myelin. The myelin covers axons, much like an insulating protection on an electrical cable. When the axon shear, the brain experiences cytotoxic release. Specifically, calcium that is normally contained within the brain cells is released into the brain. This release of calcium is toxic to the neurons. Essentially, this is a release of calcium in the brain which causes the brain cells to start to destroy themselves. That cytotoxic release prevents the signals from being sent normally throughout the neural pathways.
Because the connections between neurons are damaged, injury to one part of the brain will prevent other parts of the brain from functioning correctly. Unlike other cells in the body, the neurons and axons have minimal potential to regenerate. This is why traumatic brain injuries result in permanent neurobiological damage that produces lifelong deficits.
After the axons and myelin sheath are damaged, they will scar. The scarring further disrupts the transmission of signals through the pathways. If the sheath can repair itself, normal nerve function may return. However, the underlying nerve fiber can die if the sheath is severely damaged. Nerve fiber in the central nervous system (brain and spinal cord) cannot fully regenerate itself. Thus, these nerve cells are permanently damaged.
FREQUENTLY ASKED QUESTIONS
How do I know if I have a mild or traumatic brain injury?
There are several different ways to diagnose a traumatic brain injury. Generally, any of the following is sufficient to diagnose a traumatic brain injury.
1. Loss of consciousness
2. Memory loss or amnesia
3. Confusion or disorientation
4. Glasgow Coma Score (GCS) of 13 or higher
What are the signs and symptoms of a traumatic brain injury?
Physical symptoms may include:
1. Headaches
2. Blurred vision
3. Loss of smell
4. Dizziness
Cognitive symptoms may include:
1. Short-term memory loss
2. Disorientation
Amnesia
3. Poor concentration
4. Poor coordination
Emotional symptoms may include:
1. Personality changes
2. Changes in appetite
3. Depression
4. Confusion
5. Irritability
6. Agitation
MYTHS ABOUT TRAUMATIC BRAIN INJURY
1. If you did not hit your head or had no physical sign of injury, you do not have a traumatic brain injury.
This is simply incorrect. Modern science and medicine have shown that a person can suffer a TBI without hitting her head against another object. The brain itself is suspended in fluid and moves around the skull. When enough force is exerted on the body and head to cause the brain to shift quickly, the brain can make contact with the inside of the skull, which has very sharp edges, resulting in the brain.
2. A normal or negative standard brain MRI or CT scan means no TBI.
This is simply incorrect. A person may have a normal CT scan and brain MRI yet still have a brain injury. There are additional types of tests that can be performed to confirm whether a person has a brain injury. Such tests include cortical thickness measurements (CTM), functional MRI (fMRI), and diffusion tensor imaging (DTI).
CTM measures the thickness of the cortex in the brain. The cortex has gray matter, the part of the brain primarily associated with processing and cognition. When there is damage to the cortex, the properties of the cortex change. Specifically, the normally thick cortex becomes thin. CTM is a 3D scanning color. The cortex’s thin properties appear as a color change on the 3D scan. Regular areas appear in red.
Functional MRI measures oxygen connection between parts of the brain that are supposed to communicate with one another. To do this, the doctor electronically directs the MRI to a specific part of the brain. If the brain communicates correctly, an expected corresponding part of the brain will show up as receiving oxygen. However, if the expected areas do not receive oxygen, the brain is not connected correctly and communicating due to damage.
Diffusion tensor imaging or DTI is an MRI method that examines the brain’s white matter by measuring the diffusion properties of water within the brain. The white matter is comprised of neurons and axons. Thus, DTI detects damage to the neurons and axons. DTI works by measuring water movement in the brain. Water moves through damaged tissue at different rates and in different directions than it does in healthy tissue. In healthy tissue, water moves in one direction at a consistent speed.
However, when there is brain damage, water moves in different directions and at different speeds. Water moving through damaged brain tissue is like a hose with holes. If there is no damage, the water all goes in one direction. If there is damage, water leaks out of the hose.
DTI technology measures the direction and speed of water movement to detect damage. The direction and speed of water movement are assigned an FA, fractional anisotropy score. An FA score lower than average indicates rupturing and damage to the axons. When axons are damaged, the neuronal signals are prevented from functioning and communicating properly. Typical diffusion tensor images color-code the preferred directions of tracks, with color intensity indicating FA values. A process known as tractography can be used to reconstruct tracked trajectories based on FA values.
Using these scans and tests is a crucial way to locate specific areas of the brain that have been damaged—identifying parts of the brain that have been damaged assists medical providers in treating patients’ symptoms. For instance, the dorsal medial frontal cortex is involved in creating the human sense of self, called (The theory of Mind) which is the ability to consider the mental states of others. The dorsal medial frontal cortex also involves planning complex cognitive behavior, personality expression, decision-making, and moderating social behavior.
The superior parietal cortex is associated with working memory and spatial orientation and receives a great deal of visual and sensory input from one’s hand. Damage to the superior parietal cortex can cause contralateral astereognosis (meaning that the hand on the side of the body opposite to the damage loses its ability to identify objects by touch) and hemispatial neglect (meaning a loss of awareness of and attention to one side of the field of vision).
It is also associated with deficits in tests involving manipulating and rearranging information in working memory. It would be consistent for someone with symptoms of cognitive deficits, memory loss, visual disturbances, decreased ability to interact with others, and irritability to have findings on the scans showing damage to the dorsal medial frontal cortex and superior parietal cortex.
3. If you do not lose consciousness or get knocked out, you do not have a traumatic brain injury.
This is simply incorrect. Modern medicine and science have confirmed that a person does not need to lose consciousness or be knocked out to suffer a traumatic brain injury. As we have learned, concussion is synonymous with mild traumatic brain injury.
As can be seen on the football field, players suffer concussions often without losing consciousness. Concussions can result from a collision to the head with an object, a pressure relief from a blast (such as a military blast), or simply from sudden acceleration or deceleration of the head without impact. Suppose you or someone you know is suffering from signs and symptoms related to head trauma. In that case, you must seek medical attention immediately to diagnose and treat your symptoms.
For our railroaders, if you are experiencing any of the above symptoms from an on-duty injury, please call our office as soon as possible so we can discuss your medical treatment and potential FELA case.
GET GUIDANCE AFTER A CLOSED HEAD INJURY OR BRAIN INJURY
If you or a loved one has suffered a closed head injury or brain injury, we welcome the opportunity to speak with you and help you and your family through these difficult circumstances. Claims for your loss may be available under FELA (Federal Employers’ Liability Act). Please get in touch with our office or send us a live chat message to contact one of our FELA trial attorneys. Our consultations and case reviews are FREE with no obligation to you or your family, so please give us a ring!
For our railroaders, if you are experiencing any of the above symptoms from an on-duty injury, please call our office as soon as possible so we can discuss your medical treatment and potential FELA case.
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