About Traumatic Brain Injury (TBI) Types
Learn About the Most Common Types of TBIs in Workers Comp, Auto Accident, and Slip and Fall Claims
The type of traumatic brain injury you have affects many things:
- Whether you will require hospitalization followed by skilled nursing in a rehabilitation facility
- The therapy (physical, cognitive, occupational, vision, speech) you may need
- Your prognosis
- Whether you will require assistance with activities of daily living or be able to live independently
- Your job prospects
- Your life expectancy
In turn, these items affect the value of your workers compensation case or auto accident settlement.
This article overviews the TBI types and how your diagnosed brain injury happened.
Keep reading to learn more. And check out our pages on the levels of traumatic brain injury and the most common scale used to assess consciousness (Glasgow Coma Scale).
Then call my law firm at (804) 251-1620 or (757) 810-5614 to speak with a top-rated brain injury attorney who can help you get the medical care and money damages owed. We deal with the insurance adjusters while you focus on healing.
Mechanism of Traumatic Brain Injury: How Did the TBI Happen?
Determining the type of traumatic brain injury sustained and what it means for your treatment and recovery requires us to define a few terms.
Open vs. Closed Head Injury
A TBI is either an open brain injury or a closed brain injury.
Open and closed brain injury can lead to unconsciousness, long-term physical, mental, and emotional impairment, paralysis, and even death.
Open Brain Injury (Penetrating)
An open brain injury, or a penetrating TBI, means an object struck the skull, piercing or breaking the bone.
Then the object or bone fragments from the skull disrupt the brain and cause intracranial damage (including the dura mater, meninges, and underlying brain tissue).
Examples of open brain injuries include the following:
- A skull fracture resulting from the head slamming into the dashboard in a rear-end car crash or a piece of machinery falling from a height and hitting the accident victim.
- A slip and fall accident where the head strikes concrete hard enough to break the skull.
- A gunshot wound where the bullet punctures the skull and brain tissue
- Heavy machinery (the projectile) falls from the scaffold on a construction site and penetrates the skull.
Unfortunately, a penetrating head injury may lead to secondary brain injury because of the extensive damage it causes. And it will leave an open wound that puts you at greater risk of infection. Therefore, you should consider future medical expenses related to these consequences of penetrating brain injury when making decisions in your case.
Closed Brain Injury (Blunt Trauma)
A closed brain injury, or a blunt TBI, means no break in the skull or penetration of the brain or dura mater.
Usually, a closed brain injury results from a rapid head movement that shakes the brain inside the skull.
The quick acceleration and deceleration movement causes the brain to strike the skull, shearing and tearing nerves, axons, blood vessels, and brain tissue. And leaking blood vessels may cause hemorrhages, hematomas, or brain contusions.
Focal vs. Diffuse Brain Injury
Medical providers distinguish focal brain injury from diffuse brain injury.
A focal injury is one restricted to a specific part of the brain. The size and location of this injury influence the type and severity of your impairment.
In contrast, a diffuse injury affects a large part of the brain.
However, a focal brain injury may result in diffuse injury over time.
Primary Brain Injury vs. Secondary Brain Injury
Many TBIs insult the brain twice.
The first insult is termed the primary injury. And it refers to the type of brain function disruption that occurs as soon as the trauma happens.
The second insult is termed secondary brain injury. These conditions develop due to biochemical changes from the primary injury.
Primary Brain Injury Types
Open-head and closed-head injuries may lead to primary brain injury.
A primary injury causes direct tearing, squeezing, or stretching of the brain’s structures when the trauma happens.
You suffer a coup injury if the damage occurs at the impact site. For example, you have a coup injury to the forehead if your forehead strikes the steering wheel in a car crash.
In contrast, a contrecoup brain injury happens opposite where your brain first struck the skull.
Many primary TBIs are coup-contrecoup injuries because the brain strikes the front and back of the bony skull.
This section examines the most common types of primary TBI.
Brain Contusions (Cerebral Contusions)
Open and closed head injuries may cause brain contusions (bruises). As the name suggests, this injury involves bruising on the brain surface due to damaged blood vessels.
In addition to causing problems at the spot injured, a brain bruise may cause complications that diminish your neurological functioning. For example, a brain bruise may cause swelling and increase intracranial pressure, requiring extensive medical treatment.
Sometimes CT and MRI scans will show brain bruises as hyperdensities.
Concussion
A concussion is a temporary disturbance in mental functioning or awareness caused by a head injury (usually a blow to the head).
Concussions vary in severity; some cause a loss of consciousness (from a few seconds to a few hours).
And although many people recover from concussions within a few weeks or months, suffering one concussion puts you at greater risk of having a second concussion (second impact syndrome). In addition, you may develop post-concussion syndrome, which causes long-term symptoms.
Diffuse Axonal Injury (DAI)
Your brain has many nerve cells. Axons are a part of these nerve cells.
Any motor vehicle collision or workplace injury that causes the rapid rotation of your may cause widespread damage and disruption to these axons. And you have suffered a diffuse axonal injury (DAI) in this situation.
Diffuse axonal injury kills brain cells and often causes immediate loss of consciousness – potentially leading to coma. Indeed, loss of consciousness lasting several hours is a clinical finding associated with diffuse axonal injury. It is a severe injury requiring immediate medical treatment.
Your brain’s frontal lobe is most susceptible to traumatic axonal injury. And that is why decreased executive functioning is a common long-term consequence in DAI victims that regain consciousness.
Intracerebral Hematomas or Hemorrhages
Traumatic brain hematomas and hemorrhages are related.
A hemorrhage refers to ongoing bleeding in the brain, while a hematoma refers to blood that has already pooled (clotted).
The specific brain hematoma or hemorrhage depends on where the bleeding comes from and collects.
Subdural Hematomas
A subdural hematoma occurs when blood pools between the dura mater’s inner layer and the arachnoid mater of the meninges surrounding the brain.
Usually, tears in the bridging veins between the cortex and dural sinuses generate subdural hematomas.
Falls from heights and car crashes are common causes of subdural hematoma.
You may function normally if the hematoma is small. However, larger subdural hematomas and those developing gradually in the days and weeks following the initial trauma (chronic subdural hematoma) may result in neurologic dysfunction.
Epidural Hematomas
You have an epidural hematoma when blood pools between the dura mater and the skull.
These hematomas often result from a head injury that breaks the temporal bone and severs the middle meningeal artery.
Epidural hematomas are catastrophic injuries that may cause headaches, confusion, seizures, and repeated loss of consciousness.
Subarachnoid Hemorrhage
A subarachnoid hemorrhage refers to bleeding between the arachnoid layer and pia matter.
You may be able to avoid surgery for a subarachnoid hemorrhage unless the bleeding blocks the flow of cerebrospinal fluid, causing hydrocephalus. In this situation, you will need brain surgery (a shunt to drain the spinal fluid).
Skull Fractures
A skull fracture is a break in one of the bones surrounding the brain. It indicates the initial accident involved significant force.
The types of skull fractures include the following:
- Depressed fractures: The fragmented bones are pushed downward into the brain tissue.
- Compound fractures: This injury refers to an open skull fracture.
- Comminuted fractures: This injury involves the skull breaking in at least two places.
- Linear fractures: The skull breaks, but the pieces stay on the same plane.
Skull fractures may lead to cerebrospinal fluid (CSF) leakage from the nose or ears and bruising near the eyes and ears.
In addition, a skull fracture increases the risk of infection.
Depending on the severity of the skull fracture, your doctor may choose to operate or monitor the situation. A primary goal of treatment is ensuring that you do not develop a bacterial infection.
Learn more about skull fracture settlements here.
Secondary Brain Injury Types
Secondary brain injury is any condition that develops from the initial trauma (primary brain injury) and evolves. Often these conditions result from swelling, bleeding, and increased pressure in the skull.
Examples of secondary brain injury include:
- Anoxic (hypoxic) brain injury occurs when the brain receives insufficient oxygen, causing neurons to die.
- Cerebral edema (brain swelling)
- Cerebral ischemia refers to inadequate blood flow in the brain, a condition found in many fatal TBI cases.
- Epilepsy causes seizures.
- Hypercapnia: This injury refers to excessive carbon dioxide levels in the blood.
- Meningitis is an infection of the meningeal layers of the brain.
- Increased intracranial pressure (ICP): If the tension in your skull gets too high, the brain may herniate.
- Repeated blows to the head cause chronic traumatic encephalopathy (CTE).
Legal Help for Survivors of Primary Traumatic Brain Injury
Few injuries are as devastating – and misunderstood – as TBIs.
Our personal injury law firm has handled cases involving traumatic brain injury in workers compensation, auto accident, and Social Security disability. And we know how to develop evidence that scares insurance adjusters into a settlement.
And we are ready to help you and your family.
Contact us today to get started.
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