Closed Head “Minor” Brain Injury

There are approximately 2 million head injuries yearly in the United States of which approximately 1.5 million are fatal. Eighty percent of the survivors have sustained what we call “mild head injuries,” leaving them with subjective and objective cognitive symptoms, personality change, and post-traumatic depression. The head need not itself come into contact with anything to induce brain injury, for it is the subsequent secondary effects–swelling, edema, excital toxicity, diffuse axonal injury–that contributes most significantly to mortality and morbidity.

I epitomize the classical brain injury case thusly:
On the morning of the accident, a man heads off unsuspectingly, for work. Some days later he returns home from the hospital, an entirely different person. More crippling than his sensory or motor losses (which can be modest), more devastating than his cognitive deficits, is that his mind, his basic personality, who he is (or was), how he sees himself, how he relates to those around him, his essential being, perhaps his very soul–those have all been altered profoundly. Irrevocably. Forever. Quite often, in time, he may recapture much of the lost strength and coordination. Executive functions, such as driving or preparing meals will return for the most part. But the person who left for the office that morning a husband and father, or wife and mother, lover or friend, daughter or son–that person returns home a stranger. Compensation for, say, loss of the use of an arm may be readily agreed upon; but what sum of money can ever replace who he was?

Approximately one third of individuals with mild traumatic brain injury never recover their pre-acccident abilities. Even those who make good functional improvement in that they appear to be going through the day with their usual competence, have nevertheless lost substantial brain resources. Thus, the patient may test out quite normally in the non-stressful, relaxed environment of the laboratory, but if re-tested under challenging conditions that more accurately reflect the complexities and demands of real life, his performance scores decline significantly.

Of the million or so mild traumatic brain injury cases reported in the United States, many have received a second or third such blow; an individual who has experienced one brain injury is statistically three times more likely to experience a second, and it is this subsequent blow that tends to be the more devastating.