tcome after head trauma. The Glasgow coma scale (GCS) evaluates the eyes, verbal skills and motor skills of the patient. A score of 15 is normal. The lowest possible score is 3 which suggests deep coma or death. A 15 represents a fully awake person. A low GCS score also may predict poor outcome. Hemorrhage and fracture are important predictive factors for an unfavorable outcome as are CT scan irregularities, abnormal pupillary responses. Patients older than age 60 may also have a poor prognosis.
Even a small amount of brain damage can profoundly change and damage someone’s life. The issues involved in the medical care can be complex and the legal issues challenging.
Oftentimes a neuropsychologist will become involved in examining a traumatic brain injury patient to address the extent to which the traumatic brain injury affects the ability of the individual to function. A neuropsychological examination may include evaluation of attention, memory, executive functioning, speech and language, intelligence and motor skills. Neuropsychological testing can assist in the evaluation of mild, moderate and severe traumatic brain injuries and the increased risk of the onset of psychiatric illness.
Traumatic brain injury and the elderly
Although motor vehicle accidents are the most common cause of a traumatic brain injury in a younger individual, falls account for the highest proportion of traumatic brain injury in older individuals. Motor vehicle accidents remain the second most common cause of traumatic brain injury in people over the age of 65. Older patients tend to have more cognitive impairment after a traumatic brain injury then do younger patients. Elderly patients who sustain traumatic brain injuries are generally at risk for a higher mortality as well as poor cognitive and functional outcomes.
Age related cerebral atrophy leads to a decrease in brain volume per year after the age of 60. The aging brain may be less able to mount an effective regenerative response to brain trauma. Age related changes also lead to a reduction in the flow of blood to the brain. The cerebral atrophy leads to brain shrinkage. Shrinkage increases the distance between the brain and skull. Changing velocities within the skull when involved in a car accident may stretch and tear small bridging veins which run to the surface of the brain. This type of injury is more common in the elderly given the shrinkage of the brain.
Types of Traumatic Brain Injury
A closed head injury results from a blow to the head for example when the head strikes the windshield or dashboard. This can result in a skull fracture, bruising of the brain, bleeding of the brain, laceration or tearing of the brain as well as nerve damage.
In addition to the primary brain damage associated with a closed head injury, secondary damage may occur. This includes swelling of the brain which may result in movement of the brain from the mid-line. A shift from the mid-line found on a CT scan may indicate a poor prognosis. The displacement of the brain from the mid-line can cause compression and inadequate flow of blood and oxygen to the brain. Brain compression may also cause sugar depletion to brain cells and may impair brain cell function and cause permanent neuronal damage.
Traumatic brain injury can also give rise to neuro-chemical changes in the brain including increased excitary amino acids which can cause swelling and neuronal death as well as an influx of calcium which can cause further brain damage. Secondary brain damage can also include increased intra-cranial pressure, infection, low or high blood pressure and cardiac changes.
Cases involving traumatic brain injury are often complex and will typically involve issues which should be discussed with a personal injury attorney.
A concussion is the most common and least serious type of traumatic brain injury. Concussion typically involves temporary impairment of neurological function. Imaging of the brain such as a CT scan normally shows no structural change to the brain as a result of a concussion.
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