Bicycle Crashes and Brain Injury

Courtesy of Sunday Is For Lovers

It may not take much to injure that gelatinous cauliflower inside your cranium.  Suffering even mild trauma to your head can begin a process that leads to years of muddled thinking, spotty memory and poor focus, among other things.  That was the message delivered and received at a conference on traumatic brain injury that I attended last week in San Francisco, hosted by the North American Brain Injury Society.

I am not going to jump up and down, telling bicyclists to wear helmets.  That is a choice to be left to the individual.  On the one hand, the medical profession believes that helmet use will reduce the risk of serious head injury.  On the other, helmets may do a better job of protecting against some kinds of injuries more than others.  Also, laws requiring helmet use may reduce the rate of bicycle use.  So, wear a helmet, or do not. Brain injuries can and do happen to cyclists with and without helmets.

A traumatic brain injury is a disease process that begins with an event, i.e., an impact, a skull fracture, a cut or laceration.  Having your head whacked may begin a long term condition that never goes away, and may indeed get worse over time.  Often, the severity of the brain injury is measured by the size of the whack, the degree of impact, the amount of blood.  This is wrong.  The severity of the injury is to be measured by the effect it has on the injured person's life over time.  Sometimes a seemingly minor whack can have profound consequences.  These consequences may include problems with attention and concentration, poor memory, problems with initiating a task, problems with organization, difficulty stopping a particular behavior, increased anxiety, mood changes and problems with impulse control.  There may also be an increased risk of Alzheimer's type dementia and/or earlier onset of age related dementia.  One need not lose consciousness or suffer intracranial bleeding to have sustained a brain injury.  The damage is often at the microscopic level that cannot been seen on CT or MRI scans.  It is enough, that there was an incident, an impact, and symptoms.

Once concern has been raised by the presence of symptoms, specialized medical testing can be run to determine if there is indeed a traumatic brain injury, or what is termed neurocognitive disorder due to traumatic brain injury in the latest edition of The Diagnostic and Statistical Manuel of Mental Disorders (DSM-5).  This is done by having a properly trained expert run neuropsychological testing.  This battery of tests is designed to run the test taker through a series of tasks used to measure particular functions that are know to be linked to a particular brain structure or pathway.  If testing reveals a problem with a particular function then that is powerful evidence of damage to a specific area or area(s) within the brain.  Specialized radiological testing can also be done to uncover additional objective findings of brain injury.  Diffusion tensor imaging (DTI), sometimes also called diffusion MRI, looks at microscopic details about the brain's tissue architecture to highlight areas of injury.  These tests are very helpful in assisting physicians and psychologists to determine where the brain has been harmed and how.

If you are involved in a crash it is important for you and those close to you to pay attention for possible signs and symptoms of a significant brain injury.  Some 15 years ago the first case I ever tried involved a mild traumatic brain injury.  The defense in that case asserted that because my client looked fine and sounded fine he was fine.  It was only after speaking to the people who new him best, his wife and children, who discribed disconcerting changes in the man's behavior since the incident that we worried that the injury was more severe than initially thought.  We had neuropsychologists test him and learned that he indeed sustained a major brain injury.  Do not hesitate to follow up with your physician if you are continuing to have problems even several months following a crash.  He or she may decide to refer you for testing to determine whether you have a brain injury.