Wednesday, November 13, 2013

Brain Injuries After An Auto Collision--And The Value Of Neuropsychological Testing

A car crash can often be a like a tsunami. Suddenly, without much warning, it subjects occupants to high speed collisions, rotating or rolling vehicles, and sudden changes in velocity (known as deltaV).

As a result, one of the most vulnerable organs can be damaged: the brain. Frequently, brain injuries after auto accidents are immediately apparent, in the form of a hematoma or bleed in the brain. They usually present rather acute clinical symptoms, like confusion, or inability to speak or speak properly. And, often, they will appear on a CT Scan.

If the bleed is bad enough, a surgery known as a craniotomy may be necessary to temporarily remove part of the skull and evacuate the bleed. But some bleeds that don't require evacuation can nevertheless be equally troubling. Like real estate, location of brain trauma can be important. If the bleed is in the frontal lobe, it can often affect a person's memory, emotions, and higher thinking or "executive" functions of the brain.

What's more, a person can sustain a "closed head" injury to the brain that doesn't involve a brain bleed or some other obvious evidence of direct trauma to the brain. A serious concussion, where the brain may swell due to forces acted upon it, is a classic example of a closed head injury. In many cases of closed head injuries, a CT Scan will be "normal."

After the tsunami of possible immediate medical treatment, hospitalization, and rehabilitation is over, traumatic brain injury patients and their families are left to wait...and see if all the ripple effects from the tsunami have subsided. Unfortunately with brain injuries, some very subtle effects can remain, even months or years down the road.

It's all too common to hear family members say things like this after a crash:

  • "He flies off the handle for no reason now at the smallest things and we don't know why"
  • "She can't get the right words out any more and it embarrasses her"
  • "He used to work the hardest crossword and sudoku puzzles and now he just stares at the pages" 
  • "The doctors have all cleared her and it's been close to a year now so why is she so emotional and depressed and still somewhat forgetful?"

These are just a few symptoms of the lingering effects of traumatic brain injury. In situations like this, a neuropsychological evaluation can be extremely valuable in assessing the ongoing effects of brain injury. A neuropsychologist can run a series of tests to determine if cognitive or behavioral problems remain after a brain injury.  

But here's the real value of neuropsychological testing: brain injury victims, and their families, are no longer left to wonder why their loved one is "still not right," long after the CT Scan is clean of trauma, and the primary doctors are out of the picture. Neuropsychological testing provides some contours and measuring sticks of what ripples remain, and when they can be expected to hopefully subside.   

Many of my clients after neuropsych testing had a much greater understanding of how and why they were still struggling with getting back to normal. And the good news is that the neuropsychologist can often prescribe a treatment plan or regimen that can help traumatic brain injury victims get their lives back together. 

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