Car Accident Induced Mild Traumatic Brain Injury (MTBI) or Concussion
MTBI the Forgotten Injury
Approximately half of all car accidents that involve injuries involve concussions or MTBI. These injuries are often overlooked in Emergency Departments and family doctors and chiropractors. Concussions remain undiagnosed even when patients report frank head trauma and positive symptoms for MTBI.
The American Academy of Neurology defines MTBI or Concussion as “a trauma-induced alteration in mental status (emphasis mine) that may or may not involve loss of consciousness. This is an injury to the brain due to acceleration of the brain within the skull vault which causes cell damage and an altered mental state. The injury often occurs without frank head trauma and may take hours to days for symptoms to fully evolve. Patients who experience sensations of altered consciousness such as being dazed, stunned, or confused immediately after a collision are highly suspect of having a MTBI and require monitoring.
MTBI Concussion Symptoms
The typical symptoms are altered mental state: loss of consciousness is a severe alteration, other signs of altered state are: disorientation, stare, delayed verbal response, confusion, slurred speech, observable lack of coordination, memory deficits, and emotions out of proportion with circumstances. Surprisingly to some, is that symptoms may be slow to evolve over a period of weeks and even months.
Severity Grading of Concussion
The severity of MTBI is graded by several factors based on history, questionnaires and physical examination.
Glasgow Coma Scale
A common form for doctors to complete in cases of head trauma, will usually be negative in Mild Traumatic Brain Injury. Clearly, this is because the form is to grade Traumatic Brain Injury not the mild form.
Acute Concussion Evaluation (ACE)
This questionnaire is to be completed by the physician with input from the patient or a close relative. Specifically, it can detect subtle problems found in MTBI and also more severe signs of MTBI and TBI.
Aggravating Factors Predisposing to MTBI or Concussion
- Previous History of Concussion
Damage to the brain is cumulative. In other words, once someone is subjected to a trauma that causes MTBI, each successive concussion adds a layer of damage and dysfunction. - Head trauma
Both indirect (sudden shaking or acceleration) and direct (head strike) trauma causes damage. An accident victim that holds the back of their head in a rear-impact collision or the side of the head following a side-impact, should be carefully examined for concussion. Undoubtedly, the injured may not recall striking the head because the event is so quick it does not register in their consciousness or they were in an altered state. Unquestionably, if an accident victim is holding their head or complain of head tenderness soon after a collision, it means they struck their head. - Loss of consciousness
An actual total loss of consciousness, no matter how brief, is an indicator of severe brain stress that causes the body to shut down to preserve itself. - Airbag deployment
Air bags travel at approximately 200 mph and deliver a tremendous amount of force upon impact. Therefore, the likelihood of head trauma with an airbag is great. - Head Restraint Position
Studies have concluded that head restraint offset (the distance between the back of the head and the head restraint) of 4 inches or more predisposes the occupant to whiplash injuries. Additionally, this distance allows the head to slap back into the restraint causing concussion.
MTBI or Concussion After a Car Accident is Common and Often Commonly Undiagnosed.
After a car collision it is imperative to discuss all of your symptoms with a car accident injury medical expert. Specifically, they will be able to perform the proper examination and follow up care to help heal your brain.
Dr. Barry Marks Chiropractor in Orange has been a leading car accident whiplash and concussion expert in Orange County since 1986.
If You Think You May Have a Concussion and Need Help,
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References
American Academy of Neurology (1997). Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee. Neurology, 48, 581-85.
Moss NEG, Wade DT. Admission after head injury: how many occur and how many are recorded? Injury 1996;27(3):159-161.
Parker RS, Rosenblum A. IQ loss and emotional dysfunctions after mild head injury incurred in a motor vehicle accident. Journal of Clinical Psychology 1996;52(1):32-43.
Hohl, 1974 volume 56 Journal of Bone and Joint surgery pages 1675-1682
John R Brault, MS, Jeffrey B Wheeler, MS, Gunter P Siegmund, BASc, Elaine J Brault, MS, PT Clinical Response of Human Subjects to Rear-End Automobile Collisions. Arch Phys Med Rehabil Vol 79, January 1998