Traumatic brain injury (“TBI”) is considered the main cause of hypopituitarism in adults and growth hormone (“GH”) deficiency is the most common pituitary deficit associated with TBI.

According to Cedars-Sinai, even after we stop growing, adults need growth hormone. Growth hormone plays a role in healthy muscle, how our bodies collect fat (especially around the stomach area), the ratio of high density to low density lipoproteins in cholesterol levels, and bone density. In addition, growth hormone is needed for normal brain function.

Continue Reading Growth Hormone Deficiency Following Complicated Mild Traumatic Brain Injury

The Journal of Head Trauma Rehabilitation recently published an article entitled “Emergency Department Evaluation of Traumatic Brain Injuries in The United States, 2009-2010.” The article examined emergency department records from the national hospital ambulatory medical care survey in 2009 and 2010 where traumatic brain injury was evaluated and diagnosed either clinically or with head computed tomographic (CT) scans. A CT scan was performed on 82% of the TBI evaluations. Of those, only 9% had CT evidence of traumatic abnormalities.

The authors concluded the emergency department is the “primary gateway” to the medical system for patients with acute TBIs. However, emergency department evaluations have not been sufficiently described. This national study fills an important void.

Continue Reading New Study finds Emergency Room Physicians Often Fail to Diagnose TBI

At the annual meeting of the Association of Academic Physiatrists, Brad Kurowski, MD, MS, a physician in the division of Physical Medicine and Rehabilitation at Cincinnati Children’ Hospital presented his research on the long term effects of TBI among children.

Continue Reading Study Finds Long Term Effect of Mild Traumatic Brain Injury in Children Seven Years Post Injury

Have you ever wondered what happens within a person’s skull when he/she suffers a traumatic brain injury?

The New York Times recently published a wonderful interactive article about brain injuries. The article describes and demonstrates what happens within a football player’s skull when he suffers a concussion.

Using a mouth guard developed by bioengineer David Camarillo and his team the KAM lab at Stanford, the information gained from the mouth guard and its sensors enabled the researchers to recreate what happens to a player’s brain in a millisecond from the collision.

Included in the article is an interactive representation of what happens to one’s brain.

Click here to read the full New York Times article.

BlueCross BlueShield just released its Health of America Report showing that concussion diagnoses have increased 43% from 2010-2015. The rise was particularly marked in children and teens with a 71% rise in diagnosed incidences. Not surprisingly the rate in male patients during the fall season was double that of females. “Connecticut, Pennsylvania and Massachusetts had the highest rates of concussion diagnoses for patients 10-19. The study also reported an increase of 84% in post-concussion syndrome diagnoses with an interesting split–“more females then males ages 20-64 experienced post-concussion syndrome (61.3% vs. 38.7%).”

Some percentage of the increase could be attributed to a growing recognition of the long term impact of concussion, particularly the increased rate of suicide linked to the condition. However, it is disturbing that the concussion diagnoses increased in nearly every state from 2010-2015. The significant change raises questions on causation and indicates the need for more research.

In 2001, Teasdale and Engberg published an article in the Journal of Neurology, Neurosurgery and Psychiatry, entitled Suicide after Traumatic Brain Injury: A Population Study. The researchers reviewed data from Danish hospital admissions covering the years 1979-93 and found that patients who had sustained a TBI had an increased risk of suicide. The authors in that study concluded, “The increased risk of suicide among patients who had an MTBI may result from concomitant risk factors such as psychiatric conditions and psychosocial disadvantage. The greater risk among the more serious cases implicates additionally physical, physiological, and social consequences of the injuries as directly contributing to…suicide.”

In a recent research article, Lauren B. Fisher, et al. evaluated data from a brain injury-focused database, the BI Model Systems National Database, to further evaluate whether or not suicide rates are higher in TBI patients. Using patient health questionnaires detailing self-reported suicide attempts over a period of twenty years, the authors concluded that those who suffer a TBI are indeed at “greater risk for depression and suicidal behavior.” The outcome of the study indicates the need for “routine screening and mental health treatment in this population.”

Brain tsunamis are seizure-like waves of electrical activity in the brain caused by Traumatic Brain Injuries (TBIs) and strokes. Much like a tidal wave in the ocean, brain tsunamis build power, wash through the brain, and subside, leaving behind a path of destruction. The waves exhibit electrical signal voltage up to ten times that of normal causing changes to chemistry balance, blood flow, and transfer of oxygen through the brain. During the ebb of the wave, they also cause the brain to short-circuit as evidenced by a period of “dead air” in audio recordings. Doctors have been able to track the process of brain tsunamis for several years but only recently have been able to identify the extent of damage.

Continue Reading Tracking Brain Tsunamis in TBI Patients

A new study published in the Journal of Head Trauma Rehabilitation calls into question whether acute cognitive and physical rest improves concussion recovery times. Thomas A. Buckley, EdD, ATC of the Department Kinesiology and Applied Physiology at the University of Delaware conducted a study to determine if rest after concussion would result in a shorter recovery time in a population of college-aged student-athletes.

This hypothesis was based on the 4th International Consensus Statement on Concussion in Sport which recommends rest after injury as “a corner stone for acute concussion treatment” and outcomes. The authors noted that “rest” was achieved by discontinuing “school attendance, academic work, electronics usage and [any] exercise.” Prescribing rest was also believed to reduce the risk of repeated concussion and the “rare, but potentially fatal, second-impact syndrome.”

Continue Reading New Study Questions Whether Cognitive and Physical Rest Improves Concussion Recovery Time

It is ironic that on the same day I receive a defense neuropsychological report stating, “Individuals who have sustained a mild traumatic brain injury typically recover from neuro cognitive deficits within 6-9 months after the time of injury” that I also receive the current issue of the Journal of Neuro Trauma. And in this current edition, they discuss “the chronic consequences of neuro trauma,” which was guest edited by Brent E. Masel and Douglas S. DeWitt.

As you might recall, Masel and DeWitt are the authors of the BIAA White Paper, “Traumatic Brain Injury: A Disease Process, Not an Event,” which was also published in the Journal of Neuro Trauma (27, 1529‑1540).

Included in is issue, there is an interesting article by Helen M. Bramlett and W. Dalton Dietrich entitled, “Long-Term Consequences of Traumatic Brain Injury: Current Status of Potential Mechanisms of Injury and Neurological Outcomes.” In this article, the authors write, “In models of mild, moderate, and severe TBI, histopathological and behavioral studies have emphasized the progressive nature of the initial traumatic insult and the involvement of multiple pathophysiological mechanisms, including sustained injury cascades leading to prolonged motor and cognitive deficits.”

It is now well established in current literature that persons with mild traumatic brain injury do not all recover within the narrow 6-9 month range listed in the defense neuropsychological report I recently received. Unfortunately, many go on to suffer long term chronic consequences of mild traumatic brain injury.

If you are suffering from a traumatic brain injury, it is strongly recommended that you seek experienced legal counsel immediately.

Because of the wars in Afghanistan and Iraq, 15- to 17-percent of our soldiers have experienced a concussion. As a result, the Departments of Defense and Veterans Affairs have spent large sums of money investigating these injuries and funding research.

This research has been particularly useful in objectively demonstrating that our clients with mild traumatic brain injuries have been injured. However, a question that has arisen from this research is whether there is a difference between “blast” injuries and “blunt” injuries. A blast injury is considered to be any kind of physical trauma that occurs from a direct or indirect exposure to an explosion. On the other hand, a blunt injury is considered to be any kind of physical trauma that occurs by impact, injury or violence—for example, injuries sustained in a car crash.

As a result, this question also raises the issue of whether the scientific research arising from the war can be relied upon in cases that derive from motor vehicle crashes, falls, and other traumatic events.

Continue Reading “Blast” versus “Blunt” Concussions: Is There a Difference?