Mild Traumatic Brain Injury is a classic oxymoron, a very unfortunate conjunction of contradictory terms.
It is important to understand that a brain injury, even a mild brain injury, is truly life changing.
The designation of “mild” brain injury is a holdover from WWII when neurologists employed a simple classification system: mild, moderate or severe. Mild was a catchall term for those who had substantially recovered from a closed head injury or concussion and appeared to have regained their previous levels of thinking and learning.
The first effort to better define mild TBI was made by the American Congress of Rehabilitation Medicine in the Journal of Head Trauma Rehabilitation (1993): “A mild TBI is a a traumatically induced physiologic disruption of brain function,” as manifested by any one of the following:
- Any period of loss of consciousness (LOC);
- Any loss of memory for events immediately before or after the accident;
- Any alteration in mental state at the time of the accident;
- Focal neurologic deficits, which may or may not be transient;
- Glassgow Coma Scale score greater than 12 out of 15;
- No abnormalities on computed tomography (CT) scan;
- No operative lesions;
- Length of hospital stay less than 48 hours.
The brain is extremely soft and pliable matter suspended and protected by a bath of cerebral spinal fluid. Rotational forces, especially rapid decelerations are extremely harmful, can result in traumatic injury.
In addition to the structural changes to the brain, such as bleeding, when an individual’s head is struck a high rate of speed, the brain experiences rapid acceleration and deceleration that cause it to strike the skull repetitively, which is known as a coup-contrecoup, or simply bouncing of the brain within the skull.
This causes damage to the brain at the neuronal level, specifically tearing or stretching of axons, which is referred to as “diffuse axonal injury” or DAI. In boxing when a blow connects to the chin, causing severe rotational acceleration that results in a knockout that is the result of a major rotational force, disrupting the brain’s internal communication. This injury can be permanent as brain cells cannot regenerate. As such, more than one area of the brain can be impacted, and more diffuse damage occurs.
Damage can be identified on a 3T MRI with deep tensor imagery evaluated by a skilled neuroradiologist. Although the nature of a survivor’s deficits may seem mild, the actual injury may be greater pending on radiological findings.
From a recovery standpoint, hemorrhages, contusions, or hematomas eventually dissipate and resolve so that from a structural standpoint, some examining physicians may deem the brain to be healed. However, this does not translate to recovery from a functional standpoint, especially when there is damage to the frontal lobes.
The frontal lobes play an important role in higher mental thinking skills, working memory, planning, sequencing, mental shifting as well as emotionality and personality.
The frontal lobes also contain most of the dopamine-sensitive neurons in the cerebral cortex. The dopamine system is associated with reward, attention, short-term memory, motivation and depression. Both behavioral and emotional changes are related to frontal lobe dysfunction which can impact personality, causing increasing irritability as well as depression. This adversely impacts the ability to cope with daily stressors.
It is not uncommon that individuals with mild brain injury may not be able to recognize a decrease in their sense of self and suffer depression beyond the capacity to appreciate it, other than decreased sleep and energy.
Many individuals, due to the change in biochemical composition as well as diffuse axonal injury, experience changes in personality and mood. These individuals are in essence living with an “invisible disability” and often are not capable to possessing the insight or awareness to make healthy behavioral or emotional changes.
Individuals with mild brain injuries often appear to other around them as free from deficits because there are no obvious physical handicaps. But there is nothing “mild” about a mild TBI.
Many people with these injuries have periods of depression and while this could be considered a normal reaction to any traumatic event, the ongoing nature of the actual and perceived changes cause depression to increase, become more serious or prolonged.
Depression is not purely psychological in nature and should not be the sole focus of recovery. For survivors of brain injury, depression has an organic basis, namely it is neurologically induced as a result of the injury.
Contact Our San Jose, CA Brain Injury Lawyers for Immediate Help
Alexander Law Group, LLP attorneys are available to answer questions and share our knowledge of the law and the results of our research and experience. Our goal as personal injury lawyers is to make a difference for our clients. Every day we deal with a range of health and safety issues that most people do not encounter until after an injury occurs. As safety lawyers we are committed to providing our clients and the public with information for safer and healthier living. Call 888-777-1776 or contact us online to schedule a consultation to see how we can help you.
