CERVICAL SPINE INJURY DURING AUTO COLLISION

The first two articles in this series were about head trauma and in particular concussions. Any car accident has the potential to cause physical damage to your body. Understanding the most common injuries and why they occur can provide you with information that will help you understand what treatment you will need. While the advent off airbags and protective changes in construction of automobiles have helped to prevent many more severe injuries but indirectly force is transferred to the major.....

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CEREBAL CONCUSSION FROM AUTO COLLISION

Over 1.5 million people suffer for a traumatic brain injury due to a motor vehicle collision each year. These injuries are not only from direct trauma, such as your head sticking to steering wheel, head rest, or window. They can also occur from sudden flexion/extension of one’s neck or a sudden twisting motion.

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CONCUSSION - SYMPTOMS AND TREATMENT

Cerebral concussion has become a topic of increased importance, especially with contact sports. Concussion can occur as a result of a blow to the head. It can also occur with a sever jolting of the head, where the brain “bounces around” inside the bony confines of the skull. Concussion is classified as brain dysfunction due to a closed head injury. In severe cases the brain can be irreparably damaged. However, in most cases, after a sports or automobile injury, the brain is only temporarily damaged.


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CONCUSSION - SYMPTOMS AND TREATMENT

Cerebral concussion has become a topic of increased importance, especially with contact sports. Concussion can occur as a result of a blow to the head. It can also occur with a sever jolting of the head, where the brain “bounces around” inside the bony confines of the skull. Concussion is classified as brain dysfunction due to a closed head injury. In severe cases the brain can be irreparably damaged. However, in most cases, after a sports or automobile injury, the brain is only temporarily damaged.


The signs and symptoms of a concussion can be subtle and may not be immediately apparent. These symptoms may last for a few minutes to hours, or even days and weeks. Common symptoms after a concussive traumatic brain injury are headache, loss of short term memory and confusion. There does not have to be a loss of consciousness (getting knocked out) to have a concussion.


Some of the short term signs and symptoms of concussion may include:


•  Headache

•  Temporary loss of consciousness

•  Confusion (foggy sensorium)

•  Temporary amnesia (loss of events around time of injury)

•  Dizziness

•  Ringing in Ears

•  Nausea and vomiting

•  Slurred or difficult speech

•  Delayed response to questions

•  Fatigue


Some symptoms may be delayed by hours or even days after the injury, such as:


•  Concentration and memory complaints

•  Irritability and personality changes

•  Sensitivity to light and noise

•  Sleep disturbances

•  Disturbances to taste and smell

•  Depression


The anatomic injury to the brain is caused by the brain not being adequately cushioned to the external forces applied. Normally, the cerebrospinal fluid, which surrounds the brain, is enough to absorb the impact of most minor head traumas.

More severe impacts or acceleration/deceleration injuries are too much for the body’s normal protective measures. These abnormal forces to the brain may be impact, rotational or a combination of the two. There is no specific threshold of injury that can cause a concussion. Different people in different situations react differently. One should never say that an injury was too small to have caused a concussion.


All parts of the brain are susceptible to concussive injury. The part of the brain affected will determine the specific symptoms the injured person experiences. In each affected area, the cellular activities of the brain cells are temporarily disrupted and causes them to have a reduced metabolic state. This reduced brain cell activity is what causes the persistent post-concussive symptoms. Usually the majority of these affected cells recover to full normal activity. However, a few cells may die after injury. Repeat trauma and sports related multiple concussions, lately, have been under scrutiny.


The cellular disruption is caused by an electrolyte imbalance in the brain cells. The body is working harder to resume normal balance. The injury caused reduced blood flow to the brain impedes the nutritional needs of the hard working cells and slows down the recovery process. Depending on how severe the concussion will determine if the injured person’s symptoms last a few hours or a few weeks. What is known, is that a person should be careful not to have a repeat injury to the brain until this reparative process is complete.


Medical evaluation and care should be sought for injuries with symptoms of concussion. Cognitive function (mental ability) testing can easily be done to evaluate the severity of the disturbance and it can be repeated to monitor the return to normal function. Common sense should be used to determine which injuries require more emergent care. If unsure, it is always best to err on the side of caution and seek emergency care. If symptoms are mild, such as after many minor auto accidents, the evaluation may not need to be emergent.


A person should seek emergency care for a head injury that has associated symptoms of:


•  Repeated vomiting

•  Loss of consciousness for more than 30 seconds

•  A worsening headache

•  Changes in behavior

•  Changes in physical coordination (stumbling of decreased hand dexterity)

•  Prolonged confusion or  disorientation

•  Slurred or changes in speech

•  Visual disturbance or abnormal pupil dilation


Protective head gear specific for impact sports should always be worn when involved in that sport. Seatbelts and airbags have made a large impact on reducing head injury during automobile accidents. Recognition of concussion and proper precautions has been a large proponent of full recovery after these injuries.


Eighty to ninety percent of concussions resolved within ten days. Physical and cognitive testing should be continued until all symptoms have resolved. During this time the injured person should not engage in activity that may repeat the head injury. In addition, the injured person should have cognitive rest. This would include limiting activities that involve concentration like prolonged school work, computer and cell phone texting and musical instrument use.


Physical and cognitive activities can slowly be reintroduced into a person’s daily activities and monitored before the activity is upgraded to full. Younger people with concussive injuries have a higher incidence of complete recovery and tend to return to pre injury function at faster rate than older people.


In closing, do not get too concerned about terminology. Concussion, Traumatic Brain Injury, and Closed Head Injury can all be used interchangeably. Treatment should be based on symptoms and not terminology. At Bluegrass Injury Care Center, we have objective computer testing to determine cognitive impairments on many levels. We recommend anyone with symptoms and mechanisms of concussion to seek evaluation by a physician.

HOWARD D. MARKOWITZ, MD


more articles by HOWARD D.MARKOWITZ