Mild Brain Injury 101, The Top 5 Myths About Mild Brain Injury – #4

By Paul Mitchell, Q.C.
Categories: Blog, Brain Injury

Mild brain injury cases are very complex. This series of 5 articles by BC brain injury lawyer Paul Mitchell, Q.C., will explain the Top 5 Myths about Mild Brain Injury.

Find out what is involved in these challenging and difficult cases, and separate fact from fiction.

Myth # 4 You need to have an Impact to the Head to Have a Brain Injury

FACT

The diagnosis of a mild traumatic brain injury (MTBI) in fact does not require an impact to the head. Many defence lawyers,  insurance companies, and defence medical experts, are of the opinion that without an impact to the head, there can be no MTBI.

They are wrong.

Brain injury leading to permanent damage and even death can occur in the absence of any blow or impact to the head.

Shaken baby syndrome and severe whiplash are only two examples of brain injuries where there has been no evidence of a blow to the head.

Sudden acceleration/deceleration, such as those incurred in a whiplash, can cause the brain to strike the inside of the skull with sufficient force to cause bruising of the brain and shearing injuries, particularly to the frontal lobe. This type of traumatic brain injury-called a “coup contre coup”-can cause damage to the area of impact, as well as the area opposite the impact area, as the brain bounces against the front and back of the inside of your skull.This can result in micro-scopic axonal shear.

Neuropsychologist, Muriel Lezak, in her text, Neuropsychological Assessment, summarized the literature:

  • A direct blow to the head is not necessary for this kind of bruising to occur, only rapid deceleration with energy translation to the brain such as occurs when a vehicle comes to a sudden stop (Sweeney, 1992).  For example, brain damage can result from a whiplash injury (R.W. Evans, 1992).
  • Diffuse axonal injury can occur without any direct impact on the head, as it requires only the condition of rapid acceleration/deceleration such as takes place in whiplash in rapid flexion-extension movement of the neck (Alves and Jane, 1985; R.W. Evans, 1992; C.M. Fisher, 1982b; Gennarelli, Thibault, et al., 1982; R.S. Parker, 1990; Yarnell and Rossie, 1988).[i]

Dr.Arthur Croft has written a textbook on this very issue, called ‘Whiplash and Mild Traumatic Brain Injuries”(2009, Spine Research Institute of San Diego Press).

Dr Croft explains in his textbook how whiplash can cause a MTBI, without any direct severe blow to the head, by causing very high intracranial pressure gradients ( changes).

These can cause the brain tissue to be damaged on a micro scale, with transient “shear forces” that mechanically deform the nerve tissues , called axons ( this is called “axonal shear’). During the initial acceleration of the head, the brain is exposed to very high pressure at it’s rear, and low pressure on the frontal portion. This rapidly reverses during the “whipping” of the head back. The result is the brain violently smashing into the inside of your skull, causing bruising. This can result in cellular calcium homeostasis, the production of free radicals, and tissue acidosis, causing neuronal death.

A picture, or video, is worth a thousand words.

Watch this video animation of a whiplash causing a brain injury.

This 3D medical animation depicts a closed head coup and contrecoup injury resulting in traumatic brain injury (TBI). An external force causes the head to move rapidly forward. The brain, within the cranial cavity, suffers an injury by striking the inside of skull, causing axonal shear.

http://www.brainline.org/content/multimedia.php?id=848

As Dr Croft says, “Because the whole brain is subject to these forces, the injuries tend to be widely distributed, and in fact are called “diffuse axonal injury”.

Brain injuries can also cause injury to the pituitary gland, which is the master endocrine gland of the body, controlling growth, metabolism, sex hormones, and stress hormones.

So despite numerous medical papers and journals, some defence experts, and insurance companies, still refuse to accept that MTBI does not require an impact to the head, or that whiplash can cause a MTBI.

In summary, it’s a myth that Mild Traumatic Brain Injury requires an impact to the head.

And that’s a fact.

Paul Mitchell, Q.C.is a BC personal injury lawyer who has extensive experience with brain injury claims.

He acts for the brain injured all over BC, and will not act for ICBC or any other insurance company.

Paul was a founding Director of BrainTrust Canada (Central Okanagan Brain Injury Society), and was on their board for over 25 years.

He has presented at numerous brain injury conferences, including the Naramata Brain Injury Conference, and the BC Brain Injury Conference in Vancouver.

He is also the author of many articles and publications on brain injury.

For more information on brain injuries, or for a confidential discussion of your brain injury claim, contact Paul Mitchell, Q.C. at 250-869-1115 (direct line), or send him a confidential email at mitchell@pushormitchell.com