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Mild Traumatic Brain Injury Mild Traumatic Brain Injury

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[Mild Traumatic Brain Injuries (TBIs)] [male narrator] Traumatic brain injuries, also referred to as TBIs, occur across the United States at an estimated rate of 1 every 16 seconds. Symptoms of these so-called mild TBIs typically involve problems with memory, mood changes and personality changes. Most of these injuries go undiagnosed because the symptoms are only detectable by those who knew the person well before the injury occurred. Frequently, diagnosis of a mild TBI is dependent upon history and clinical presentation because physical evidence of injury often does not exist. There may be no evidence of a direct blow to the head or any other type of direct head trauma immediately following an incident that results in a mild TBI. Such evidence may be absent because the injury can occur with little or no impact to the head. The TBI itself results from the soft, friable brain impacting on the hard, sharp ridges on the inside of the skull during a sudden acceleration or deceleration event. There may be absolutely no head impact involved, or the head impact may be against a cushioned surface such as an airbag or headrest, leaving little or no evidence of impact on the face or head. Traditional imaging studies like CT and MRI most often show no evidence of mild TBIs because they are not sensitive enough to detect the widespread microscopic axonal injuries that can collectively result in devastating neuropsychological and cognitive deficits. [Sudden Deceleration] TBIs can occur as the result of impacts at varying speeds and from multiple directions. The severity of the TBI does not necessarily correlate with the speed of a vehicle during a collision but with the unique combination of deceleration and rotational forces that affect the brain during the collision. The car crash animation sequences show how a sudden deceleration injury typically occurs. For purposes of demonstration, an impact at a speed of 15 to 35 miles per hour into a sturdy barrier was used. A frontal impact was selected because frontal impacts are one of the most commonly occurring causes of TBIs. The crash depicted in the animation was based on video studies of crashes performed by a number of crash test engineers. The first animation sequence shows the impact and sudden deceleration at a speed that is slightly slower than real time to help demonstrate the violence of the motion. The collision is then repeated in slow motion to highlight the detailed movements of the upper body and head. Prior to the impact of the vehicle, the body and head are traveling forward at the same rate of speed. At the moment of impact, the vehicle suddenly stops, but the body and head continue to travel forward. Next, the body's forward motion is halted by the seat belt, but the head continues to travel forward. The left shoulder's forward motion is halted by the shoulder harness before the rest of the body, so rotation is added to the upper body and head in addition to the continuing forward motion. The head then comes to a sudden halt as it impacts with the airbag. At the moment of impact, the head violently rotates and begins an immediate reversal of movement. This back and forth motion is sometimes referred to as the contrecoup effect. The head then rebounds into the headrest, experiencing yet another immediate and violent impact and change of direction. [Relevant Anatomy] In order to understand how TBIs occur, one must have a detailed understanding of some areas of the brain as well as a basic understanding of the relationships of various significant structures of the brain to the head and skull. In this animation sequence, the head and brain are sectioned through the left eye. The brain is surrounded in the skull by cerebrospinal fluid. This fluid helps protect the soft, friable brain from impacts with the hard, jagged edges of the inner skull. The brain is composed of gray matter and white matter. Gray matter consists of cell bodies. White matter consists of myelinated extensions of the cell bodies that communicate with other cell bodies. These extensions are called axons. The arteries that supply the brain penetrate the external surface of the brain and divide into smaller and smaller branches. Upon microscopic examination of the brain, one can appreciate the relationship between the fragile axons as compared to the much larger and more resilient blood vessels. Axons typically measure from one-fourth of one micron to ten microns in diameter while the blood vessels in this area typically measure from 30 to 240 microns in diameter. [Brain Impact During Sudden Deceleration] During a sudden deceleration, as shown in the beginning of the animation sequences, the brain violently impacts against the inner surface of the skull at two times: first, when the head impacts with the airbag or otherwise stops its forward motion and begins its immediate, rapid, violent reversal of motion; and second, when the head impacts against the headrest and repeats the immediate, rapid, violent reversal of motion. [Brain Impact During Sudden Deceleration] By observing the collision from a view that follows the motion of the head, one can appreciate the deformation of the brain as it violently impacts against the front and back of the skull. When the impacts of the brain against the skull are viewed in slow motion, the shock waves that travel through the brain during the impacts can be observed. [Brain Impact Against Inside of Skull] Close inspection of an area of the outer surface of the brain and inner surface of the skull during the initial impact shows the soft, fragile brain scraping against the hard, jagged inner surfaces of the skull to create shearing forces. [Axonal Shearing Without Blood Vessel Injury] As the gray matter, comprised of cell bodies, and the white matter, comprised of axons, are of two different densities, the shearing forces create a plane of cleavage where many axonal injuries occur. The axons may be completely torn, partially torn or separated from their connections with other cells. Thousands or even millions of scattered axons may be torn. But unless some of the larger and more resilient arteries are also torn, no bleeding occurs. Traditional imaging studies such as CT or MRI are not nearly sensitive enough to detect individual axonal injuries or even relatively large groups of axonal injuries. CT and MRI are designed to detect areas of bleeding. Unless a blood vessel or multiple vessels are torn, creating a relatively large bleed, these studies fail to demonstrate any findings that would indicate the presence of multiple, widespread and microscopic axonal injuries that can result in devastating neuropsychological deficits. [Axonal Shearing With Blood Vessel Injury and Resulting Hemorrhage] In situations when the forces involved are severe enough to result in injury to the blood vessels, the injuries to the axons are even more severe. An injury to one or more blood vessels results in the release of red blood cells into the surrounding brain tissue. CT and MRI are designed to detect blood or, after a period of time, the remnants of blood called hemosiderin. Large quantities of red blood cells must hemorrhage from a blood vessel or blood vessels to be detectable on CT or MRI. If even one small hemorrhage occurs that is detectable, it is an indicator that there are likely vast numbers of associated axonal injuries that are not depicted in the scans. [Top View of Sudden Deceleration] In addition to the deceleration forces, rotational forces are typically involved in most collisions. The combination of rotational and deceleration forces results in traumatic forces on the brain that may be far greater than the force of the collision may imply. This combination of forces is very similar to combining cold temperatures with high winds. Either alone may be tolerable, but when temperatures of 30 degrees are combined with winds of 30 miles per hour, the net effect can be quite chilling. [Relevant Anatomy] When the skull and brain are viewed in section from above, it can be seen that the brain consists of two halves that are connected by only a few central structures. One of these structures is called the corpus callosum. The corpus callosum consists of axons that allow for communication between the opposite sides of the brain. The front of the corpus callosum is called the genu. The two halves of the brain are separated by a tough ligamentous structure called the falx. The falx is rigidly fixed to the skull in the front, back, top and bottom of the skull. [Corpus Callosum Injury During Sudden Deceleration and Rotation] During the violence of an impact involving the combined sudden deceleration and rotational forces, similar to the one shown in earlier animation sequences, the corpus callosum can often become injured. The injuries occur because the soft, friable brain reacts in a very fluid-like way as a result of the violent forces. The left side of the brain impacts against the falx, and the right side of the brain pulls away from the falx. Because the falx is rigid, the axons that comprise the corpus callosum are torn and broken. Again, thousands of axons may be torn without being evident on imaging studies. Unfortunately, the majority of mild traumatic brain injuries go undiagnosed. The difficulty in diagnosing these injuries is likely due to the combination of two factors: one, the absence of injuries on traditional imaging studies; and two, the casual clinician's perception of a normal appearing and behaving individual. Careful interviews of friends, family and coworkers regarding the changes in an individual before and after a traumatic event may be the most reliable way to recognize those who have suffered these injuries. Those close to a brain injured individual will often describe a completely different person before and after the incident. Only after the presence of a traumatic brain injury is diagnosed can one then proceed with measures to improve, or at least help cope with, the resulting problems.

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This animation gives an overview of the frequency of TBI — from causes and symptoms to available diagnostic imaging techniques and basic information on brain anatomy.

© Medivisuals. For display on BrainLine.org website ONLY. Permission to use in litigation may be obtained by contacting Medivisuals.com

Comments [24]

Thank you so much. Injury june this year, and in 08 on job. played the tough girl back then and kept on working (x2). this time much less force or so I think, has sent me for a loop. workcomp has refused to cover me; and all I want is to heal and get back my life. the video is powerful, informative and easy to watch. thank you again.

Sep 16th, 2013 9:11am

So glad to find this, I have been living a silent hell, i fell March 6th 2013 on ice, landed smack on my head, went to the ER, had a CAT SCAN, nothing, went home and now over about the last 6 weeks, i have had the strangest sensations in my head, some pain but mostly heat sensations that can become overwhelming at times. I just get so worn out and want to sit down and cry. I am a very happy person til lately, going to make an appointment with a neurologist today, hope all will be ok and it just goes away.

Aug 13th, 2013 11:33am

I had a bad car accident on April 26, 2013 resulting in a few roll over where I received a head injury. I was rushed to the hospital because after people were able to get me out of the car after I awoke I was in a panic and was kicking windows trying to escape I was incoherent and and kept falling because I said it was too bright. My sister in law insisted I leave that hospital and go to another one because of difficulty with a nurse. I just wanted to go home an remained in that way for about 2 weeks (somewhat appearing drunk when I tried to walk). But I have a question. I cannon find on the Internet. Would a concussion (this would be my 4-5th in 4 years) cause me to start reversing things I say or remember? As if I was talking and wanted to say something was blue and something was orange at the end start there with the completely wrong sentence? This is very frustrating and embarrassing and sometimes causes me to become extremely angry with myself, which is very out of character. People are commenting on this and how how it is unlike me to not get things right and be angry. I have finally gotten over the nurse gotten an MRI and have an appt. with a neurologist in 3 weeks. Is it normal to reverse things? Even direction you are going?

Aug 9th, 2013 1:40pm

I suffered a TBI after being bucked off a horse into a steel wall. After a CT scan I was told I was fine. 4 months later I started experiencing seizures. I now am diagnosed with Epilepsy. I wish I would have listened to my gut instinct because I knew I was not "fine."

Aug 9th, 2013 12:20pm

In 1973 I had blunt force trauma to the head as a child of 6 years of age. From that time through grade 1-12, I struggled with academics but no one around me seemed to be able to pick up the signs of what today we call TBI. In 1985-1989 I severed in the Army as a paratrooper in the 82nd Airborne division and who really knows what damage I sustained during 3 straight years on jump status. Today and since 2005 I've been fighting for disability benefits with the VA for things as TBI and PTSD but in my situation I never was involved in combat. So the burden of proof is so much higher including not having treatment records dating back to the time when I was 6 and next to nothing in service medical records all because I was considered functional and healthy. I think we are just in our infancy in our understanding of the impact of this condition and how it will affect future generations. Even the VA has granted presumptive status for 5 conditions in late 2012 which it estimates are likely to occur in ones life time to include seizures, Alzheimer's and Parkinson.

Jul 21st, 2013 11:02pm

cerebral abnormalities in the temporal region. picked up by an eeg and an electrophyisiology exam.the other machines could find nothing. as a result of these injuries i am suffering from blurred vision and even worse, alice in wonderland syndrome. mostly macropsia and sa bit of micropsia.i cant see people stood in front of me for more than a split second, yet i know they are there and interreact with them as though everything is normal. i cant remember the last time i actually saw anybody, i see a feature of their or face or body and the rest of them blends in with the background. and yet i have 20/20 vision........as long as i am sat still. as soon as i stand i can look but i cannot see. anybody else have a similar sort of problem? im bill and my email address is wilimilicuri@kotmail.com

Jul 21st, 2013 6:14pm

I am so glad I am not alone. I was in a car accident 2 years ago where I was hit from behind and then from the left side. I have had to change jobs because I couldn't do what I used to do in a normal 8 hour workday for less than 12-13 hours. It has robbed me of my life and happiness and my husband, since he doesn't understand and thinks I'm putting my job in front of him but doesn't think I should quit my job. I would give anything to have my life back that the idiot driving with a suspended license took from me.

Jul 20th, 2013 1:13pm

I had a fall at work on March 11, 2011. I trippd over a wagon in a stockroom that was not supposed to be there. I cut my face to the tune of 17 stitches. I kept telling them that I had pain shooting through my eyes, ears, temples and the back of my head. The doctor that stitched up my face said that I do not have a concussion because I did not hit my head. !!WRONG!! I hired a lawyer but he is a "dud" and I had to fight for everything myself. The worse thing is that I had to go back to work after the fall because they would not take me out.I continued going back to the doctor and complaining about headaches and dizziness Then about a month later I woke up at about 4 am and felt like my brain was shaking violently. This happened 4 times and it was then that I went to the ER and they did a CT scn and found the concussion. They diagnosed it as Post Concussive Distress. I am pulling things out of my had through my ears,eyes and nose. I still going through the feeling that my brain is shaking and it is trickling down through my body.I am hearing and seeing things and I lost my job. Worker Comp is doing nothin so Iam going to my own doctors.

Jul 19th, 2013 2:24pm

I\'m also TBI due to motorcycle accident 9 months ago. I have many ideas to move forward, but don\'t know after reading this website. You make it sound so permanent and non-correctible that I have to re-evaluate. Thnk you for it though, Jack

Jul 17th, 2013 3:49pm

i am also a person with undiagnosed brain injury. it is so frustrating. i have come to the realization that we have to find things out for ourselves about any help in recovery. i am trying to search out ways to help speed up repair and recovery of continued issues such as cognitive,balance, memory, personality changes. there must be something out there that will help repair the damages. we cant give up

Jul 17th, 2013 1:35pm

I dropped a 750ml bottle of Vinegar on my head, and I've been suffering since March 31, 2013. I have finally been diagnosed, but struggle to regain my cognitive skills, so I can return to work, and a normal life.

Jul 16th, 2013 12:19pm

I have TBI.On May 15,2009.my husband pick me up on his motorcycle,also he gave me his helmet to put on,as we left my job just an ave away it was a impact.the lady took a chance at the last min.she thought she could beat the motorcycle.i really don't remember to much.but her license was giving back to her a month ago.as we found out in court a year later,i didn't know how she look,or nothing.but i sense in got emotional when that lady came in with 2mans.now you already have people in the court room sitting down.i had no idea until those came in .from to many accidents in her fault.she is an older lady in her 60s.i had to be air lifted.i was in a coma for 3weeks & 1day.the hit was so hard i went up in the air in flew 100ft away in the middle off the road.my husband flew in hit the pole.family was told i might not make it because of my condition i had massive bleeding,but i did,they told them i not able to walk,my whole left side.i couldn't feel it or move my arm & leg.it took 6 1/2months.i only have problems with my left hand,i cant smell,hear to well in my right ear,also my right eye it weak.but i'm truly bless

Jun 10th, 2013 8:44pm

worst part about docs is it is called practicing medicine for a reason. no one seemed to have the answers just lots of guesses and no real treatment plan.

May 21st, 2013 9:36am

I have had a traumatic brain injury since my 16th birthday. I was diagnosed with double pneumonia and flown on a jet to a hospital and put on a life support system for 25 days and in a hospital for 7 months. The doctors told my parents that i wasn\'t going to make it.But towards the end, my eyes were opened on the day of my dads birthday and i was a miracle!! The doctors had never seen anyone like me! I eventually came home and i am still recovering but with a lot of issues, no friends, no college, i could go on and on and on... but hey you\'ve gotta think positive and be thankful that you are alive!!!! God bless you all!!!

May 11th, 2013 9:49pm

Thank you so much for this video on mild TBI. After battling with my doctor and insurance company for over a year, following a car accident where my head took the most impact, I now know that it is all in my head (physically not literally). It is so hard when there are no physical scars, breaks etc and scans are clear. This video sheds so much light on a very invisible, silent disability.

Apr 20th, 2013 10:09pm

I'm going to *make* my doctor view this before he even says hello to me the next time I see him. His assumption is that, because the MRI is clear, there's no TBI--even though three other doctors have said otherwise and even though I had two car accidents a year apart at freeway speeds (drunk drivers involved in both--I was sober both times) and haven't been the same since. Some days, it astounds me that, as well-publicized as TBI is within the medical community (especially within the military and VA community where I receive my healthcare), the doctors can still be so incredibly ignorant.

Mar 21st, 2013 6:38pm

Twenty years after the '92 MVA where I was hit head-on on the driver's side, I am FINALLY getting the help I've been needing for so long. During that accident (yes I had my seat belt on with lap belt in our older vehicle), my forehead hit twice on windshield, my chin hit the steering wheel, and the my roof collapsed on the left side of my head. I was knocked unconcious for a few moments at that time. My TBI's were considered 'mild' from that accident even though it was noticeable to all, not just family, that I was having difficulties not only with the physical injuries I had but also from the head traumas with my speech/language/concentration/short & long term memory with memory loss/and moods - became bi-polar. I also since then have to deal with Complicated (or Comlex) Migraines where I will have stroke-like symptoms complete with right-side weakness. I had the weakness right after the MVA but never fully recovered the strength in that side ... recovered about 80% of the strength. Although my first TBI was at age 4 yrs. in 1960, I recently found out from the TBI specialist associated with a local Rehabilitation Hospital nearby that I was able to recover from that episode because I was so young and my brain was still growing. I had no ill affects after it, retaining straight A's in school up till 9th grade, taking Academic classes until I switched to Secretarial courses. I did not recover from my second TBI, the '92 MVA, though. That's when the problems began. I had my third concussion in 2011. I fell on the left back side of my head with my head hitting the ice first, then my body to follow that. I went back to about 60 - 65% (with the issues I've deal with since the MVA). I've been able to recover up to about 70% but have not gotten to the 80% recovery I had gotten to throughout the years from the MVA. I probably won't now. After that fall, the anomic aphasia worsened, but still I didn't get the help I needed. Fortunately we have a local TBI Support Group I was blessed to find a (very) few years ago. We were not able to attend the meetings each month due to our schedules and how far we lived from them, but through their now-annual Symposiums they put on for the public, I found the TBI specialist I am now going to as well as had gained more information I did not know about before even with their last Symposium. I am so thankful for the one local TBI Support Group leader that I've kept in constant touch with since finding out about them. I am also very thankful for those who, along with Dottie, volunteer their time with that group to help those of us who need support to deal with the changes in our lives after TBI's. They have so much information for us a well as introduced us to the brainline.org page. God bless them!

Mar 21st, 2013 3:18pm

i recently had a head injury i was told everything was fine but i knew better I was seeing double, headaches,dizzines,nausea,vertigo. I was told everything looked ok on ct, and mri know thanks to your vedeo i know more and are more educated.

Dec 20th, 2012 3:13am

Finally, the first thing that makes sense to me with all the varied symptoms I have had progress over the last year after taking a brutal fall on my right cheek bone (I tripped and and fell into a metal chair). I feel like I am slowly losing my mind and losing control over my body functions. I have been waiting to see a neuro Dr. but my primary Dr. thinks it is post TBIS.

Dec 12th, 2012 11:14am

I am so glad to have found this website. I have TBI from a motorcycle crash and I too wish my doctors had been more supportive of my family and myself to explain what was going on with all that I was and still am experiencing. Thank you so much for this information

Sep 22nd, 2012 2:04pm

I finally understand how and why I have felt like I don't fit this person others think I am. I'm not as good, precise, physical, memory and loss of math skills. I had t-bone roll-over accident and the ER said I had concussion. They said I would be okay but, in my mind,brain, everything changed. It's been so frustrating...

Jul 16th, 2012 4:16pm

It's amazing that even the most educated miss out on what's being explained in the beggining of this video and throughout it. "Sheering Injuries" are the most common of T.B.I.'s. Although some like myself will have more severe skull related fractures - it's the 'front to back - left to right' movements that sheer the side of the brain and allows for a violent effect as the brain changes direction in the incident/accident that causes that sheering effect on one or both sides. In mine it was 'left to right, front to back. Thank you very much for sharing this. M. Robinson

Jul 1st, 2012 10:35pm

Thanks so much for this video. 15 yrs post mild TBI and I finally understand. I wish all the docs, especially the neuro ones would see this.It took a year to find help after I was given a mental health diagnosis after I was rear ended at a light at 30mph. I just had surgery and the anesthesiologist saw my medication list and made the comment to her team, "We"ve Got issues" then said "What's TBI?" I knew I was in trouble but too medicated to dare say anything.

Mar 30th, 2012 11:52am

This is a great video, I like the animation and the narrator is easy to hear and understand. I'm also a survivor of a T.B.I. acquired as a toddler.

Dec 12th, 2011 1:58am

 

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