Brain Injury From Car Accidents
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As a doctor who treats many patients with neck and concussion injuries due to car accidents, I am always astounded when I hear that an ER doctor or family medical physician refutes my diagnosis of concussion or mild traumatic brain injury. It is common for a patient to report to me that their doctor says they don't have a concussion or brain injury, further they will often question how a mere "Chiropractor" can make such a diagnosis. I try my best to smile and explain to the patient, that there are indeed standardized methods to medically diagnose a concussion or MTBI as long as the doctor knows how to perform them.
Truth About Concussion, Mild Traumatic Brain Injury Due to Car Accidents
The first thing to understand is the fact that approximately half of all victims in a motor vehicle collision suffers a brain injury. It can be extremely mild and resolve in days, but often they can be more problematic and last weeks, months and in some case indefinitely. The symptoms may be mild like a headache or severe with vomiting, dizziness and inability to think, speak or walk.
Second, realize that you do not need to hit your head to suffer a brain injury. The quickness with which an accident occurs causes your head to jerk very hard very fast. The brain is suspended inside the skull and there is room between the brain and skull. When the head is propelled back very quickly, the brain tends to slosh backwards and strike the interior of the skull bone causing a bruise like injury. This is a simplistic but valid concept of how injuries occur and is well documented in medical literature. A graphic example of a brain injury without an actual head trauma is 'shaken baby syndrome" in which a child suffers brain damage from being shaken too vigorously.
How a Competent Doctor Diagnoses a Brain Injury:
Glasgow Coma Scale
Glasgow Coma Scale (GCS) is a tool to determine level of consciousness of a victim of a traumatic brain injury. The scoring is between 3-15. Subjects with scores of 3-8 are in coma state. Scores of 13-15 are considered mild traumatic brain injury. Some authors describe a score of 15 as a very mild traumatic brain injury. A score of 15 does not mean there is no injury, it merely means the injury is mild. The GCS is a broad tool for screening, it is not very sensitive.
When a patient shows symptoms of brain malfunction after a trauma, a thorough neurological examination must be performed to find subtle clues that a brain injury exists. Checking for pupil response, watching if the eyes stay coordinated with each other during movement, asking the patient to remember and recite common words, asking them to do simple tasks with eyes closed, checking their blood pressure from one side to the other and many other exam procedures are used to "clinically" make a diagnosis.
Additionally, other tools such as standardized questionnaires accepted by the scientific and medical community as valid, are used to determine the impact of the symptoms on the patient's daily activities. Questionnaires regarding sleepiness, dizziness, headache, stress related to the accident, etc are all designed to assess the impact your brain injury has on your life and are repeated later after treatment to judge improvement.
A knowledgeable doctor can make the diagnosis through these methods fairly easily, but again they must first understand what tools are available and how to administer and interpret them. Most general doctors do not.
An MTBI is a neurological insult that occurs at the time of the injury and develops over time, usually hours to days. This causes many ER and family practitioners to miss a MTBI. The victim is conscious and to the outside world responsive and "normal," but on closer inspection neuropsychiatric malfunction can be observed. Tests such as x-ray and CT scan are negative for MTBI. MRI's are often not sensitive enough to show the fine neurologic injury, although newer techniques can, but are expensive and few imaging centers have the capability. EEG's are often not sensitive enough to show abnormalities.
Mild traumatic brain injuries should not be regarded as "nuisances" or self-limiting conditions. A MTBI can evolve into Post-Concussion Syndrome (PCS) where symptoms and impairment can last indefinitely.
The medical journal, Brain Injury reports patients with "very mild traumatic brain injuries, (Glasgow coma score 15) "There was a significant impairment in neuropsychological performance (verbal memory, arithmetic abilities and psychomotor reaction time) at onset and after 6 weeks..." "In MRI scans, three patients showed traumatic lesions (slight epidural haematoma, haemorrhagic contusions and white matter lesions indicating diffuse axonal injury)." They concluded "Structural and functional impairment can be identified using neuroimaging and neuropsychological examination, even in very MTBI patients."
If you've suffered a trauma like a car accident and you have a headache, dizziness, fuzzy feeling in your head or find you cannot concentrate well, you may have a concussion. You would be wise to have it evaluated by a doctor specializing in this field to ensure you do not have an injury that will plague you months or years down the road.
For more information about Dr Barry Marks Car Accident Chiropractor go to www.drbarrymarks.com or call 714 938-0575
B. Vollera*, T. Benkeb, K. Benedettoc, P. Schnidera, E. Auffa & F. Aichnerd,
"Neuropsychological, MRI and EEG findings after very mild traumatic brain injury" Brain Injury Volume 13, Issue 10, pp 821-827 1999