Stories of Secondary Brain Injury
The following are stories of real life survivors of brain injury. Clicking on the titles will take you to their actual story.
In contrast to the severity of her first injury, her second injury was seemingly mild. There appears to be no doubt that her capacity to function was materially changed by the second TBI. She successfully returned to work, within months of the coma. Her return to work after the concussion, ended badly. What is perplexing about the total picture of her disability is that most of her deficits are the type of deficits associated with severe brain injury, as we will detail in later Parts of the Elizabeth story. And most of these deficits were clearly there before her second injury. What seemed to have changed because of the concussion was her ability to accommodate the deficits.
Elizabeth states that when she fell the second time that it was a lot harder to get better when it came to understanding what people wanted her to do. She would get terribly upset and fearful when she didn’t understand.
Even though Elizabeth’s second injury happened far outside the time frame where we would typically think of the second impact as being potentially dangerous in Elizabeth’s case, it was one blow too many. Elizabeth states; “With that second accident it was a lot harder. The second time that I fell, instead of listening to someone and trying to understand it, I don’t get it in my head right and sometimes I lose it. I cry, I get upset, I don’t understand what they said.”
Elizabeth is a poster child as to how dangerous a second blow to the head can be for someone with a history of TBI. There are many reasons for this, but it largely comes down to the cumulative effect of each neurological insult, and even a mild TBI can be the proverbial straw that broke the camel’s back. There is little controversy in the medical world that the second injury can come with lasting deficits. A fairly conservative text on Neuropsychiatry, in a chapter written by two well-known insurance company doctors, even acknowledges such risk:aving one previous head injury increases the risk three-fold for having another head injury, and two previous head injuries increase the risk eight fold. Having a previous head injury may prolong recovery and disability from a second injury. The hypothesis is that head injuries deplete the cognitive reserve capacity that is necessary to sustain vigilance for hazards and to bounce back from injury. Of all of the risk factors that create a greater hazard for the second injury, balance problems, which come secondary to head injury, are perhaps the worst. Elizabeth explains; “The balance issues with the dizziness, and I was able to handle a lot of that really well. It took my neurologist, and my family doctor and my husband, and I have to be careful. I know I have to be careful, like using the shower, walking in the wintertime where there’s ice, walking up and down stairs. I know I can’t reach straight up over my head, but I can reach at an angle, and so working with all of that, you know, helped my dizziness and was helping me be able to do normal things. And the second accident after that the dizziness hit more if I’d sit up in bed. You know, you wake up, you sit up and, I mean, if the phone’s ringing or anything you can jump up and run, you know, to answer the phone. I can’t do it.
Elizabeth’s quandary is likely explained by this synergistic combination of structural changes to where services are
performed in her brain by her first injury and the major disruption in the communication network of her brain in the second. The combination leaves her almost completely stalled, especially when high neuronal demands are placed on her brain. In other words, look out for rush hour. For her and other TBI survivors, rush hour in the brain occurs when too many attentional demands are made upon her, particularly as a result of stress, crowds, noises, pain or any other irritant to her cerebral cortex.
While it might be easy to conclude that it was thus irrelevant, we have concerns that lack of treatment for this mild TBI may have played a part in the the circumstances that resulted in his DUI wreck. What makes the Fred situation even more puzzling is that his father was also a mild TBI survivor.
In a surprisingly common occurrence for an injury which involved severe brain swelling, she was conscious after the accident. The pathological explanation for this is that it is the secondary injury to the brain from swelling and bleeding that may cause the greatest injury, even if the person is lucid after the injury. In one large study of 1,300 people, 32% of those with fatal TBI talked after the injury.