Delayed Injuries To The Brain
Unfortunately, once the accident has taken place, the immediate injuries have already occurred and cannot be modified. Fortunately, the secondary or “delayed” injuries are yet to occur. This makes it vital to try to prevent or minimize secondary injury to the brain, as well as optimize health after the accident victim is first hospitalized.
There are several types of secondary or delayed brain injuries which can occur, including bleeding (hemorrhage), herniation, edema, and damage to the neurotoxic cascade. Let’s look at what these sort of injuries are:
BLEEDING OR HEMMORRHAGE This can occur anywhere inside the head as a result of blood vessels being torn or disrupted. This bleeding can occur:
- Within the brain itself (called an intraparenchymal or intracerebral hemorrhage)
- Into the ventricles (intraventricular hemorrhage) or;
- Into the spaces surrounding the brain, like between the skull and dura (epidural hematoma); under the dura (subdural hematoma) or under the arachnoid layer of the meninges, into the cerebrospinal fluid (subarachnoid hemorrhage)
The consequences of this bleeding depends on the amount of blood, how fast it accumulates, and the location of the bleeding. Wherever the blood is located, it will take up space. This can be a problem, since the brain is within a closed, rigid space. Because this space is usually filled with the brain, the cerebrospinal fluid, and the blood within the blood vessels, any additional blood that occupies space in the brain will mean one of two things:
- Something else has to give, or
- There will be increased pressure in that space
Neither of these results is good for the brain injured accident victim.
If a hemorrhage or other space occupying lesion occurs very slowly, then the brain will have time to adjust. It can squeeze some fluid out of the brain or the cerebrospinal fluid space, or decrease the amount of blood in the blood vessels, and thus make room for the extra blood from the injury. However, if a hemorrhage occurs very rapidly and occupies a significant amount of space, it will place the brain under significant pressure. If there is increased pressure to the brain, the circulation will have to adjust to ensure there is still enough blood flow to the brain to keep it nourished. If the blood flow is insufficient, this can result in further injury to the brain due to lack of oxygen and blood flow (hypoxic ischemic brain injury).
HERNIATION SYNDROME is a localized mass or area of swelling which pushes on or deforms the brain. The brain will try to squeeze itself into another space within the intracranial space, resulting in high pressure on the focal areas of the brain and its blood vessels. This can lead to further localized injury or stroke.
EDEMA or swelling of the brain can also occur after head trauma (such as a car or motorcycle accident) and can result in increased intracranial pressure (ICP). The swelling can be localized in an area of the contusion, or it can be diffuse. For the most severe injuries, doctors will place an intracranial pressure monitor into the brain temporarily. This can be surgically implanted into the head, and sends information about the pressure in the brain/head to a monitor so that doctors know what’s going on. This technology has come a long way towards better understanding TBI for doctors and personal injury lawyers alike. It allows medical and surgical staff to recognize problems to the brain early on before they get too difficult to manage. It allows doctors to prescribe the right medication, at the right time following a serious motor vehicle accident involving brain injury. It also helps doctors to know when surgery is, or isn’t appropriate.
In the context of a personal injury case, this technology allows lawyers to keep a proper timeline/track on what happened to the accident victim at exactly what time; and allows the lawyer to better understand the mechanism and severity of the brain injury.