Whiplash, Concussions and Mild Traumatic Brain Injuries
Car accident victims who leave the emergency room with a diagnosis of whiplash or soft tissue injuries are often thrilled to learn that there were no broken bones. However, after they suffer for many months or years with soft tissue injuries, these accident victims would gladly trade in their whiplash injury for a simple broken bone. Having practiced personal injury law for more than thirty years I can tell you that a soft tissue injury is usually more severe than a simple fracture. The word “soft” refers to the “tissue” not to the injury. It is important to recognize that the brain is a soft tissue and a brain injury is not “soft” or insignificant. A wrist fracture can be casted and heals within four weeks. An ankle fracture can heal in eight weeks. Soft tissue injuries such as a tear or rupture of a muscle, ligament or tendon can take months to heal and these injuries often result in chronic pain and a permanent restricted range of motion. The healing or repair process involves the creation of scar tissue which is not as pliable as our muscles, tendons and ligaments. Furthermore, an injury to a muscle, ligament or tendon often disrupts the nerves within and around the soft tissues which can then lead to pain, numbness, tingling and in some cases permanent disability.
In some people’s minds the term “whiplash” conjures up stereotypes of ambulance chasing lawyers slapping collars around their newly minted clients. However, the reality of a whiplash injury is often a lifetime condition of headaches and chronic pain.
It is reported that more than 3,000,000 Americans sustain whiplash injuries every year. About half of these people will end up with some degree of chronic pain. About 10% of these people will become permanently disabled.
Since the 1950’s the medical community has conducted more than eighty studies to determine the percentage of patients with serious complications following whiplash injuries. The actual percentage of those persons who will go on to develop chronic pain is between 45% and 83%. The typical symptoms involve neck pain and headache.
It has been determined that there are a number of risk factors which point towards a poor outcome. These risk factors include the following:
- Head turned at time of crash;, Prior neck injury;, Prior headaches;, Prior neck pain;, Inadequate headrest;, Poor position in car;, Arthritis or degenerative disc disease;, Advanced age;, Rear impact;, Female gender; and, Non-awareness of impending crash.,
What all this means is that every year about 3,000,000 people will sustain whiplash injuries and about half of those individuals will have chronic pain. More troubling is the fact that about 10% of the injured individuals will become permanently disabled as a result of their whiplash injuries.
For decades the medical community discounted the seriousness of headaches and cognitive problems following whiplash injuries. However, the medical community now recognizes that the typical whiplash injury involving a rapid acceleration and deceleration (rear-end collision) is one of the leading causes of concussions or mild traumatic brain injury. The inside of the skull contains many bony ridges. The brain is somewhat like a bowl of Jello. With a sudden acceleration/deceleration, the brain is slammed back and forth into the rigid, bony contours of the skull. The resulting stretch and shear of the brain tissues causes microscopic damage to the pathways in the brain that may or may not ever fully recover. The result can be diffuse axonal injuries causing cognitive deficits, memory problems, concentration problems and personality changes. The diffuse axonal injury is the hallmark of a mild traumatic brain injury and it cannot be seen by the naked eye. Furthermore, diffuse axonal injury cannot be seen on standard MRI or CT scans. However, the mere fact that nothing shows up on an MRI or CT scan does not mean that a diffuse axonal injury is not a serious brain injury.
The medical literature explains that any alteration in consciousness (dazed, startled or confused), even if brief, suggests widespread neuronal dysfunction. Structural neuronal damage can accompany even very mild brain injury. Even in patients with what appeared to be minor or trivial injuries there are reported findings of destruction of myelin (the white matter around axons of nerve cells), axonal retraction bulbs (bead-like structures at the end of a ruptured axon) and aggregates of small reactive glial cells (indicating recent tissue injury in a variety of brain regions). Jonathan M. Silver, M.D. et al., Neuropsychiatry of Traumatic Brain Injury, American Psychiatric Press Inc. 1994.
A concussion is by definition a mild traumatic brain injury. In addition, it is important to note that in order to be diagnosed with a concussion you do not need to be knocked unconscious. In fact, the modern definition of concussion includes any change in mentation as a result of a blow to the head or an acceleration/deceleration injury (whiplash). For years professional football players were taken out of games only when they were knocked unconscious. The medical community now recognizes that a concussion has occurred whenever the person is dazed, confused or startled. Multiple concussions (even without any periods of unconsciousness) are now known to lead to serious and life-threatening brain injuries.
If you have been involved in an automobile accident in which you sustained a whiplash injury, it is important to treat the physical aspect of the injury with physical therapy, chiropractic treatment and/or anti-inflammatories. More importantly, you need to pay attention to any cognitive deficits that you or a loved one experience after a car accident. Keep an eye out for headaches, fatigue, light sensitivity, changes in personality, changes in mood, impaired memory, word-finding problems and problems with simple math. These are classic signs of a concussion and post-concussion syndrome. If these symptoms go untreated, they can escalate into serious problems.
In addition to the phenomena known as diffuse axonal injuries (structural damage to the brain tissue, neurons and blood vessels), it has now been established that a blow to the head or the rapid acceleration/deceleration which causes whiplash injuries can also set into motion a complex cascade of molecular events known to create secondary damage to the brain. One of the chemical events that occurs after trauma to the brain is oxidative stress. After trauma the body produces excess “reactive oxygen species” (ROS). Excess ROS is also known to be present in the diagnosis of Parkinson’s and Alzheimer’s. See Glial Cells: The Dark Matter of the Brain, BrainInjury.com (Nov. 15, 2011). With the release of certain chemicals within the brain, a whiplash victim can go on to develop cognitive, memory, and emotional issues. This chemical cascade cannot be seen on standard films any better than the diffuse axonal injury. However, these are very real injuries. As a result of chronic headaches, fatigue, memory problems, cognitive problems and emotional issues following a concussion, patients with concussions often experience depression. The insurance company will later claim that the car accident victim is a malingerer, a faker, and he/she suffers from depression, not from post-concussion syndrome. However, depression and anxiety are caused by the brain injury, they did not appear spontaneously.
A whiplash injury or a mild traumatic brain injury is not a soft, mild or insignificant injury. Reliance solely on primary care physicians for the treatment of these disorders may delay recovery. Oftentimes these whiplash injuries and brain injuries require the care of a neurologist, physiatrist and neuropsychologist with special training and experience in these types of cases. Make sure that you and your family obtain referrals to the best medical team.
The outcome for accident victims with concussions and a mild traumatic brain injury is somewhat unpredictable. Common symptoms include headache, dizziness, poor concentration, poor memory, irritability, fatigue, anxiety, depression and alcohol intolerance. The most common cognitive problems after mild TBI involve disorders of attention, concentration and memory reportedly present in up to 59% of people three months after the injury 1 . Headaches and dizziness sometimes benefit from pharmacological treatment. People with more than three or four recurrent post-traumatic headaches per month or constant headache may benefit from medication including antidepressants such as Amitriptyline, Nortriptyline and selective Serotonin reuptake inhibitors.
Although a traumatic brain injury will probably not be detected by an MRI or CT scan, a brain injured person can undergo a battery of neuropsychological tests which can pinpoint the area of the brain that has been damaged. Although these tests are expensive and time consuming, they are usually necessary to convince a skeptical insurance company that the injury is real.
A single head injury doubles the risk of a second head injury which increases the risk of another head injury eight fold. Repeated head injuries have a cumulative effect on cognitive symptoms. This has been investigated and documented among athletes with mild TBI.
Patients seeking compensation for post-concussion syndrome or a mild traumatic brain injury do not present more symptoms or deficits on neuropsychological testing than similar patients who do not have compensation claims. It appears that litigation does not play a major role in perpetrating symptoms of post-concussion syndrome in the majority of cases.
The lawyers at Mirick O’Connell have handled many serious cases involving whiplash, concussions, post-concussion syndrome and mild traumatic injuries. If you have sustained neck or head injuries, make sure to treat with doctors who specialize in these injuries and make sure you work with lawyers who understand these injuries.
1 Cognitive Issues: Memory impairment, Difficulty in attention and concentration, Deficits in language skills, Deficits in visual perception, Deficits in executive functioning, Deficits in problem solving, Deficits in abstract reasoning, Deficits in judgment, Deficits in planning, Deficits in organizational skills.
Behavioral Issues: Verbal and physical aggression, Agitation, Sexual dysfunction, Impulsivity, Mood disorders, Personality changes, Altered emotional control, Anxiety, Depression.