Types of Brain Injury: All You Should Know
There are two basic types of brain injuries. A brain injury may be a traumatic brain injury (TBI) or an acquired brain injury (ABI). Because of recent news stories relating to athletic injuries, traumatic brain injuries are probably more familiar to most of us. Here’s a closer look at the two types of injuries.
Traumatic Brain Injury
A traumatic brain injury results from a significant blow to the head, such as may be received in a car accident or a fall. TBIs can also occur when the head violently jerks back and forth, causing the brain to strike the interior walls of the skull. Finally, an object penetrating the skull may also cause a TBI.
The sudden or violent movement in a brain injury can cause the brain to move around in the skull. It can also lead to chemical changes in the brain and the stretching or damaging of brain cells.
Acquired Brain Injury
An acquired brain injury is any injury to the brain resulting from any cause at any time after birth. ABIs can include injuries from illness such as strokes and those from lack of oxygen flow to the brain. In effect, ABIs result from activity inside the body rather than outside. The brain cells that die in these injuries cannot regenerate, resulting in long-term deficits in brain function.
Severity of the Brain Injury
Doctors diagnose brain injuries as mild, moderate, and severe depending on the initial symptoms that present. Despite the specific diagnosis, symptoms and healing times can vary significantly. Even seemingly mild brain trauma can result in serious or potentially fatal complications, as the mild TBI designation relates only to the initial presentation of symptoms and not to the overall prognosis.
TBIs that medical professionals deem mild can still be severe injuries resulting in serious and lasting effects and complications. If you are diagnosed with any type of TBI, you should remain on watch for any brain injury symptoms of complications or lingering effects.
A mild brain injury is usually not life-threatening, though it can be in some cases. Nevertheless, even a so-called “mild” brain injury can create long-term symptoms and complications that are highly disruptive to daily life.
Moderate and Severe TBI
Blows or jolts usually cause moderate and severe TBIs to the head or by a penetrating injury, such as sustained from a gunshot. In the United States, severe TBIs result in thousands of deaths annually. For survivors, a severe TBI can lead to life-long health issues that can affect all aspects of the victim’s life. The impact is similar to that of chronic severe disease.
Moderate and severe TBIs are serious and can be extremely costly. These injuries may require ongoing care over a years-long recovery. Such injuries also impact the family of the victim, but also society and the economy. The five-year outcomes of TBIs that needed inpatient rehabilitation show that 22 percent of the victims die, 30 percent worsen, 22 percent stay the same, and only 26 percent actually improve.
How Do Brain Injuries Happen?
Although brain injuries are probably most well-known from motor vehicle accidents and sports injuries, the most common cause is falling. Car accidents are the second most common cause, followed by non-vehicle-related blows to the head.
Falls – Falls in the home and slip-and-fall injuries in public are the most common cause of traumatic brain injury. Fall-related TBIs are particularly common in older adults and young children. A fall, essentially, is an event where a person unwillingly and accidentally comes to rest on a lower level than that at which the person started. These can include falls from a bed, falling downstairs or from ladders, or unknown or unrecognized hazards in industrial or commercial settings.
The common risk factors for falls include:
- Age – those 65 and over and children under 15 have the highest risk of head injury in a fall. Older persons are especially susceptible to severe consequences from a fall-related TBI because of pre-existing changes to the brain.
- Prior history of falling – half of those who fall today will fall again within the next twelve months
- Balance problems – impaired balance from whatever cause greatly increases the risk of falls
- Use of multiple drugs – as people age, they take more and more drugs in combination. Sometimes, these can affect equilibrium and balance or cause dizziness, leading to an increased risk of falling.
Firearms – whether used in assault or suicide—are a major factor in severe TBIs. While only 12 percent of TBIs result from firearms, in those aged 25-34, firearms are a leading cause of TBI, with 35 percent of all TBI deaths coming from gunshots. In fact, a gunshot wound to the head is fatal in 90 percent of cases, with many victims dying before receiving any medical care. Even if the victim survives the initial gunshot wound to the head, many will suffer from seizures and require long-term medication or rehabilitation to treat them. Often, a return to the pre-TBI lifestyle is impossible.
Motor Vehicle Accidents – Traumatic brain injury is a frequent consequence of a motor vehicle accident. Several different kinds of TBIs can occur in a vehicle accident. The results can be catastrophic when the vehicles are of significantly different size and weight—as when an 18-wheeler hits a compact car or a pedestrian—the injuries can be catastrophic.
Among the common auto accident injuries are:
- Concussion, the most common TBI in accidents.
- Diffuse axonal injury, the technical name for the movement that results in soft tissue injuries like whiplash. When the diffuse axonal injury is severe, coma is often the result.
- Contusions or bruises to the brain can be mild or severe, depending on the location in the brain where the injury occurs. Major brain bruises can cause the brain to herniate or start to squeeze out of the skull. If significant swelling occurs, surgery may be necessary.
- Open-Head Injury, an injury involving a blow to the head resulting in a cracked or fractured skull in addition to the TBI. The most serious type of open-head injury is a penetrating wound injury. High-velocity penetrating brain injuries, such as those caused by guns, have the worst prognosis of any brain injury.
- Coup-contrecoup is an injury that damages the brain in two locations: the impact site and the opposite side of the brain forced against the skull. These injuries are, in effect, two-sided or doubled cerebral contusions.
Common Types of Brain Injury
As you can see from the above discussion, there are several common types of brain injuries, with more detail below.
Concussions are one of the most common types of traumatic brain injury. They happen because of a sudden blow or impact to the head or body, or a rapid change in movement. As many as 3 million sports and recreation-related concussions occur annually in the United States. Of these, approximately 300,000 happen in football. Most people think if the victim was not unconscious, there was no concussion. This belief is a myth.
Concussions can impact memory, cognitive function, balance, coordination, executive function, judgment, speech, and reflexes. Most, however, do not cause lasting damage to the brain, though repeated concussions, even if mild, can cause cumulative damage creating long-term issues. This risk is especially high when the second concussion follows closely on the first.
The prognosis for a concussion depends upon its severity. Victims of mild concussions can recover within a few weeks, while more severe concussions may take months to heal. Both can lead to long-term lingering symptoms that may materially harm the victim’s lifestyle.
Diffuse Axonal Injury
Diffuse Axonal Injury happens when the brain shifts rapidly inside the skull as the injury occurs. The axons, or long connecting fibers in the brain, are torn as the brain moves rapidly against and away from the hard bone of the skull. Although the changes caused by DAI are difficult to detect on CT or MRI scans, their effects are profound, with most victims ending up in a coma. The most common symptom of a DAI is the loss of consciousness, lasting for six or more hours.
Victims who do not remain unconscious may exhibit other typical brain injury symptoms such as
- Nausea or vomiting
- Drowsiness or fatigue
- Vertigo and dizziness
The most frequent causes of DAI are:
- Car accidents
- Sports accidents
- Child abuse (e.g., shaken baby syndrome)
The prognosis for DAI is not good in that most people do not survive severe head injuries. Those who do may remain forever in a coma or, if conscious, require life-long rehabilitative and assistive care.
Brain Bruises and Contusions
A contusion is a bruise to the brain. It can cause bleeding and swelling inside the brain around the location of the injury.
An intracranial hematoma is a blot clot in or around the brain. There are different types of hematomas, classified by their location in the brain. They can range from rather mild head injuries to severe and life-threatening injuries.
The different types include:
- Epidural hematoma – an injury where a blood clot forms under the skull but above the membrane that surrounds the brain (the dura). These injuries usually come from an arterial tear and are associated with skull fractures.
- Subdural hematoma – an injury where a blood clot forms under the dura but not within the brain. These hematomas generally result from tears in veins that go from the brain to the dura or a cut in the brain itself. They are occasionally associated with skull fractures.
- Contusion or intracerebral hematoma – a bruise to the brain itself. It causes bleeding and swelling in the area of the injury. Contusions may occur with a fracture or with other blood clots.
A subarachnoid hemorrhage occurs when there is bleeding into the cerebrospinal fluid that flows in the space surrounding the brain. These injuries are frequently fatal, with approximately one in four victims dying within 24 hours of the injury and half within the first six months. They often come with subdural hemorrhage or contusion.
Long-Term Consequences of Traumatic Brain Injury
TBIs can be mild, with only several weeks of rest needed for recovery. Many TBIs, however, present more serious long-term consequences, many of which can be life-altering or catastrophic. Difficulties in learning, planning, and judgment (the so-called executive function) can make a return to gainful employment difficult or impossible. Victims may experience paralysis, chronic headaches, chronic pain, balance, and mobility difficulties, and even mood and emotional disorders.
Living with TBI is not cheap. Often victims will require medical, rehabilitative, and assistive care and equipment for the rest of their lives, meaning that a life with reduced income potential also faces vastly increased expenses. Physical therapy necessary to regain lost skills can cost hundreds of dollars per hour, while assistive devices and equipment can cost thousands per piece of equipment. Modifications to the home and auto of victims can add more to the expenses caused by TBI, as can the costs of home care if needed.
Consult a Bronx Brain Injury Lawyer
Whether mild, moderate, or severe, most brain injuries result from the negligence or intentional misconduct of another party or parties. As you have seen, they usually result in devastating and life-changing consequences for the victims, who may be unable to support themselves or even manage their day-to-day living after a traumatic brain injury.
If you or a loved one has experienced a brain injury in the Bronx, you should contact an experienced and knowledgeable brain injury attorney. Symptoms do not all show immediately and can linger and worsen, far beyond your doctor’s initial expectations. Settlement of any brain injury damages claim requires skills and expertise to understand the complexities of the injury and, equally importantly, the complexities of the long-term expenses victims will face.
One of your first steps after suffering a traumatic brain injury should be to contact a Bronx brain injury lawyer. Your first consultation and case evaluation are free, and you will pay no legal fees unless we handle your case successfully.