Article: Traumatic Brain Injury 1996 - Medical Litigation News

TRAUMATIC BRAIN INJURY 1996

Traumatic brain cell destruction is more complex than previously realised. After Traumatic Brain Injury, nerve cells are hypersensitive to secondary insult for about 24 hours. In particular, mildly diminished blood-supply to the brain may be unusually destructive[1].

PRACTICE POINT

During the day after Traumatic Brain Injury, other insured events or substandard care may adversely affect recovery.

A team of Israel radiologists[2] again underlined the greater sensitivity of Single Photon Emission Computed Tomography (SPECT) scanning compared with conventional Computed Tomography (C-T), Magnetic Resonance Imaging (MRI) and ElectroEncephaloGraphy (EEG), this time in pediatric TBI (see Medical Litigation News Volume 1, Issue 3). The diagnostic imaging technique was particularly superior in lesions of the basal ganglia and cerebellum.

PRACTICE POINT

Positron Emission Tomography (PET) or SPECT scanning are usually the most sensitive
modes of diagnostic imaging for detection of Mild Traumatic Brain Injury.

As in Late Whiplash (see Medical Litigation News Volume 2, Issue 2), balancing mechanism deficits can be demonstrated after MTBI even in the absence of clinical neurological abnormalities[3]. A Dual-Plate Force Platform measures the amplitude and velocity of sway during quiet standing, and ability to compensate for unexpected unbalancing with and without visual cues.

PRACTICE POINT

Force Plate recording should be considered for clients complaining of gross motor deficits
after TBI, irrespective of neurological abnormalities.

More than half the patients in an Australian TBI study[4] also suffered headaches or other chronic pain. Inadequate pain management prejudiced recovery from brain injury.

An unrelated American paper[5] reported similar chronic pain prevalence, and found associated sleep problems probably contribute significantly to persisting cognitive deficits. In the absence of chronic pain, insomnia was unexpectedly more common among Mild than Moderate or Severe TBI patients.

PRACTICE POINT

Damages resulting from TBI may be compounded by inadequate control of the accompanying chronic pain and insomnia.

Perhaps surprisingly, Chronic Pain was more common among Late Whiplash patients than among Moderate to Severe TBI victims[6].

This Canadian study, undertaken at least 4 years after injury or onset, found no difference in cognitive deficits between the two groups or in comparison with a group of patients with Chronic Pain Syndrome but no head or neck injury. The authors challenged the supposedly specific neuropsychological profile of Mild TBI.

As previously reported (Medical Litigation News Volume 2, Issue 8), recovery in cognitive deficits is being observed considerably later than previously taught. Reaction Time tasks of increasing complexity showed significant improvement at ten years as compared with five years after TBI[7].