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
Does Your Doctor Understand Concussions?
Every day I consult with patients suffering from automobile accident injuries. Approximately half of these patients suffer from concussions. Most of these patients have been to a physician prior to consulting me. Only a small fraction of these patients had been previously diagnosed with a concussion and are surprised when I inform them. More times than not, a concussion will go undetected and undiagnosed in an emergency room and/or a private primary medical physician's or general chiropractor's office after a car accident.
A Concussion otherwise known as a Mild Traumatic Brain Injury (MTBI) is...
A traumatic injury to the brain due to a blow or a sudden jolt that causes the brain to malfunction. It may or may not involve loss of consciousness and it can be very mild or become prolonged.
Dangerous Lack of Brain Injury Education
Probably the most common reason for this lack of understanding is poor education. Medical and Chiropractic schools do not spend much time specifically on the topic of brain injury. The study of brain injuries constantly evolves with advances in technology. Common brain knowledge now far surpasses what was known just a few years ago. Only doctors who have an interest or specialization within this field bother to endeavor to take post-doctorate courses or even read medical or scientific literature on the topic.
Dangerous Myths About Concussions Propagated by Doctors:
“You Can't Have a Concussion—You Did Not Hit Your Head or Lose Consciousness”
“There Is No Treatment for Concussions—It Will Just Take Time”
All too Often, Patients Will Tell Me "My Doctor Said I couldn't Have a Concussion" and Repeat the Above Statements.
Further proving lack of general knowledge on this topic, some patients will report that their doctor is actually miffed that I have made such a diagnosis. When they learn I am a chiropractor it only intensifies their scrutiny. Never mind that I have spent years studying whiplash and brain injuries at the post-doctoral level alongside other chiropractors and medical doctors, but there are criteria and tests published by academic, medical and scientific journals to document, classify and follow up on brain injuries. This is information your average primary care MD or generalist DC have no knowledge of.
2 Problems Caused by Lack of Brain Injury Knowledge
First, brain injuries go undiagnosed leading to long-term health issues, needless suffering, improper treatments, psychological damage to victims and poorer outcomes in personal injury cases. If the concussion is undiagnosed then proper treatment is delayed. Patients continue to suffer from sometimes bizarre and confusing symptoms. Observed by an untrained physician, many people are told they just need to get over it and that it is a psychological problem. It is not uncommon to see a chronic concussion patient to be on anti-depressants and anti-anxiety drugs because they have been told they are just suffering from a psychological disorder. In the longer term, concussions have been linked to more likely onset of Fibromyalgia, Parkinson's and Alzheimer’s diseases.
Second, even if a primary care physician or even a neurologist does recognize a concussion, the most common treatment is rest. Most medical physicians will tell you with all earnest that there are no treatments for mild brain injuries. The problem with that notion is that it is wrong. And since most patients accept the advice of their doctors, particularly specialists like neurologists, they tend to give up on finding further care and then as mentioned earlier end up with long-term suffering. The truth is, treatments DO exist to help accelerate the healing of brain injuries, they just don't happen to be pharmacologically based. In fact, research dating back to the 1960's showed that low light laser therapy can help heal concussions. This research has been ignored by the mainstream medical establishment.
Simple Truths About Car Accident Concussions
Concussions caused by car accidents are common and do not require direct contact with the head. A sudden jolt particularly from behind or the side may jerk the head so violently that the brain is injured. It's the same principle as “shaken baby syndrome.”
It does not take a severe collision to cause a brain injury. In fact, slower speed collision with less vehicle damage are more likely to concuss your brain than higher speed massive vehicle damage collisions. That's because in slow speed collisions there is no bleed off of energy from deforming car parts to slow down the impact so more energy is transferred to the body. A quick pop from behind that jerks your head is a typical mechanism for concussion.
You do not need to lose consciousness to have a concussion. Most concussions do not involve loss of consciousness, but symptoms soon after an injury are usually present.
Tell tale signs of concussion: headache, dizziness, foggy or out of sorts sensation, confusion, disorientation, ringing in ears, difficulty speaking, nausea, vomiting, amnesia, lack of memory or concentration, crying, lack of coordination, blurry vision, face numbness, anger, and more. One or more of these symptoms within moments of the collision is enough to suggest a brain injury and requires an evaluation by a medical specialist trained in concussion detection.
Your symptoms may slowly evolve over a period of days to weeks. This delay in onset of symptoms is not uncommon in mild traumatic brain injury.
There is a lack of knowledge in the medical field about concussions after a car accident.
This leads to misinformation and needless and prolonged suffering. If you've had a car accident, even a minor one and you have the symptoms described in this article and your doctor has told you you’re fine or just give it time, then you owe it to yourself to get checked by an expert in this field. If you do have a concussion there are treatments available to help you.
Transcranial Cold Laser Therapy for Concussion
Studies have shown that the use of "cold laser" so called because the beam causes no heat, has wide ranging applications for health.
Since lasers were first discovered in 1960, researchers have postulated that focused beams of energy may have an effect on human cells. In 1967, a Hungarian researcher proved just that. Endre Mester showed that hair growth could be stimulated and wounding healing was accelerated in lab mice. Today, Low Level Laser Therapy or LLLT is widely accepted as an effective therapy for pain relief and tissue repair.
Transcranial laser therapy is the use of cold laser or LLLT to relieve inflammation, stimulate brain cells to regenerate faster and work more efficiently. This treatment is an effective and safe therapy for victims suffering from concussion and mild traumatic brain injury following car accidents, sports, industrial trauma, etc. Standard medical treatment for most concussions involves monitoring and rest leaving it up the body's recuperative powers to heal. This may be alright in very mild cases, but there is growing evidence that if you do not treat a brain injury early, long term prognosis worsens leading to "Post Concussion Syndrome (PCS)." A more active therapy plan for head injuries has been shown to boost healing and get victims back to a more normal lifestyle sooner. An active plan also reduces likelihood of chronic concussion or Post Concussion Syndrome (PCS).
By exposing the body to low level laser light, photo stimulation occurs activating certain cells (mitochondria) to work more efficiently. The mitochondria are responsible for energy within your tissues. With up-regulated (improved) mitochondrial function, comes more energy for healing, repair, energy, etc.
Does Transcranial Cold Laser Therapy Really Work?
In the words of the National Institute of Health,
"Many serious brain diseases and injuries can be successfully treated with noninvasive transcranial laser therapy. " (1)
How Much Laser Therapy Does it Take?
Every case is different, but researchers indicate that from 6 to 30 sessions may be required over a period of days to weeks to repair given tissues. The sessions are short lasting less than 15 minutes and are totally painless. Research has shown that longer exposures are actually less effective than short doses over time. Once the mitochondria have been turned on, more energy will not necessarily make them work any more efficient and if they are bombarded for prolonged periods in one sitting, it may actually slow them down.
Suffering from a Concussion, Mild traumatic Brain Injury or other Nerve Condition? Has your doctor told you, you have a concussion but there is nothing that can be done other than wait?
You should consider transcranial laser therapy because:
- It is effective
- It is safe with no side effects
- It is painless
- It is non-invasive, no shots, no drugs, no surgery
- It is relaxing
- It is affordable
For more information and details on whether cold laser therapy is right for you, call (714) 938-0575 for immediate assistance.
(1) Javad T. Hashmi, MD, Ying-Ying Huang, MD, Bushra Z. Osmani, MD, Sulbha K. Sharma, PhD, Margaret A. Naeser, PhD, LAc, and Michael R. Hamblin, PhD, Role of Low-Level Laser Therapy in Neurorehabilitation, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065857/#R1
Can Brain Damage Occur without a Concussion?
Surprising New Brain Injury Study
A study of 24 high school football players looked at radiological changes in the brain in the absence of frank concussion. The study presented to the Radiological Society of North America has raised concerns. As part of the Wake Forest Kinematics of Impact Data Set or KIDS, players wore accelerometers on their helmets during practice and games. The accelerometers measured number of hits and the force of each impact. Prior to the season commencing, the 16 to 18 year-olds had diffusion tensor imaging or DTI scans, a specialized form of MRI. These scans are able to visualize fine structures within the white matter of the brain. After the season, scans were repeated and results compared.
Players identified as heavy hitters (9 of the 24 subjects) had appreciable white matter abnormalities in a specific portion of the brain known as the corpus callosum and other deep myelinated nerve tracts. Researchers noted that not one of these players had experienced a concussion that season, yet their brains had been physically altered.
These are the same areas identified as injury points for mild traumatic brain injuries. The corpus callosum is a key part of the brain that serves as the bridge of nerves that connects left and right hemispheres. Damage her can lead to many problems with speech, memory, hand eye coordination, vision and more.
This study only looked at physical and physiologic changes in the brains, and did not assess the athlete’s brain function. An earlier study in 2013 however, found that in Division I college football and hockey players, the more the brains changed physically, the more learning and memory problems were encountered.
“Repeated ‘sub-concussion’ blows to the head may be the cause of damage deep within the brain that leads to cognitive problems later”
Other Causes of Brain Injuries
Of course football and hockey are not the only instances of head injuries. Children whose heads are still developing may be susceptible to changes and therefore cognitive dysfunction from other blows to the head that do not present as obvious concussions. Multiple playground falls, bicycle and skateboard spills, etc over a long period of time may result in serious brain problems.
Auto Accident Brain Injuries
Another obvious vector for brain injury that may go undiagnosed is automobile collisions. Auto collisions involve head accelerations that are many times higher than body accelerations. While concussion is fairly common in car crashes, it is estimated that more head injuries are suffered than are diagnosed. I have definitely seen this anecdotally in my practice. It’s not uncommon for patients to suffer an impact and have signs and symptoms such as headache, dizziness, blurry vision, tongue-tied, tiredness and present to en ER, family medical or chiropractic physician and NOT be diagnosed with concussion. And what of the impact victims who do not outwardly present with brain injury, can they too suffer white matter damage that is silent? I would think so since even a “mild” motor vehicle collision often results in head accelerations greater than a hard football hit.
More Work to be Done About Brain Injuries
Obviously, more research needs to be done and more consensuses reached on diagnosing head injuries and protocols for caring for injured brains. In the meantime, it is incumbent on parents and anyone suffering a jarring of the head, even without direct impact, to look out for changes in mood, memory, coordination and speech to detect subtle signs that the brain is indeed damaged.