The signs and symptoms of traumatic brain injury vary, and may present immediately, days or even weeks after the incident.
Phineas P Gage was born in Grafton County, New Hampshire into a farming and mining community. Little is known about his early life but he grew up to become “perfectly healthy, strong and active, with an iron will as well as an iron frame.” His employers, the local rail road company, said that he was “the most efficient and capable foreman in their employ, a shrewd, smart businessman, very energetic and persistent in executing his plans of operation.” On the afternoon of 13 September 1848 Gage – a work-gang blasting supervisor – was setting a blast to remove a rocky outcrop.
- The true story of Phineas P Gage (1823 – 1860)
An unusual case of TBI
At about 16:30 on that afternoon, 13 September 1848, Gage’s life would change forever and he would make his name in medical history, always being cited in medical textbooks as a classic case of TBI. An explosion occurred and the force of the blast turned the tamping rod into a missile, which entered Gage’s head vertically, at approximately the position of the left upper-jaw, passed through the portion of brain behind his left eye, and out the top of his head, to land some 25m away. You would think that such a traumatic incident would have killed Gage instantly, but history recalls that despite being thrown onto his back and experiencing a number of convulsions, he was soon able to speak, was able to walk with a little help and was able to sit up in an ox cart while being taken to his lodgings. When Dr Edward H Williams arrived about half an hour later, to examine Gage, the doctor did not at first believe Gage’s account of how he had sustained the head injury.
By 27 September, Gage was now extremely ill, and he was not expected to live. He was refusing food and experiencing complications to his left eye and the brain itself. Harlow, however, treated Gage for what was probably a cerebral abscess, and it is this treatment that is likely to have saved the foreman’s life.
While Gage appears to have overcome the physical injury he sustained, he did experience significant personality and behavioural changes. Before the accident, he was considered to be “hard-working and responsible”, a “great favourite with the men he worked with”, “efficient and capable”. After the accident he is described as being “fitful and irreverent, impatient of restraint or advice”.
From this strange, but true account of someone who sustained traumatic brain injury, it may be said that even today, with modern medical equipment such as scanners, and sophisticated surgical procedures, TBI remains one of the most difficult of medical emergencies, not just at the time of injury but also well into the patient’s recovery from the immediate physical injury.
What to look out for
In today’s modern world the most common causes of TBI include falls (falling out of bed, slipping in the bathroom, falling from a ladder); vehicle collisions and collisions involving pedestrians; violence (such as gunshot wounds, domestic assault, child abuse and shaken baby syndrome); sports injuries (for example, football, boxing, skateboarding and hockey) and, as in Gage’s case, blasts.
Physical symptoms of mild traumatic brain injury may include:
- Losing consciousness for a short while
- Being dazed, confused or disorientated, without losing consciousness
- Prolonged or severe headaches
- Nausea and vomiting
- Sleeping difficulties or sleeping more than usual
- Dizziness and difficulties with balance
Sensory symptoms of mild TBI may include:
- Blurred vision, tinnitus, an unpleasant taste in the mouth, changes in the ability to smell
- Light and sound sensitivity
Symptoms of the mind and thinking:
- Problems concentrating or memory problems
- Mood swings and changes
- Being depressed or anxious
Physical symptoms of moderate to severe TBI may include:
- Losing consciousness for quite some time – several minutes to hours
- A constant headache or one that gets worse
- Repeated nausea and/or vomiting
- Convulsions and/or seizures
- One or both pupils of the eyes dilating
- Clear fluids being discharged from the nose or ears
- Being unable to wake up from sleep
- Weakness/numbness in the fingers and toes
- Loss of co-ordination
Symptoms of the mind and thinking:
- Serious or deep confusion
- Being agitated, combative or displaying unusual behaviour
- Speech being slurred
- Falling into a coma or displaying other consciousness disorders
Children – if they are young and therefore without an adult’s communication skills - may display the following symptoms:
- Changed eating or breastfeeding habits
- Uncontrollable and inconsolable crying
- Odd or easily aroused irritability
- A changed ability to pay attention
- Sleeping habit changes
- Appearing to be sad or depressed
- Loss of interest in favourite toys or pastimes
In all cases where TBI is suspected seek immediate medical advice.
Claiming in the event of TBI
Because of its very nature, whether mild, moderate or severe, TBI always requires the intervention of medical experts and, if the cause of the injury involves a third party for example, a traffic collision caused by the another person; a violent crime or an injury at one’s workplace, you will also need to liaise with allied professionals such as the police, lawyers and psychologists. No article on TBI, no matter how authoritative the source may be, will provide the advice or resources needed when you or a loved one suffers the misfortune of receiving a traumatic brain injury. Because any disorder that affects the brain has or can have profound effects on the individual and her family and friends, claiming compensation may indeed not be the immediate focus of attention. Because the life of the affected person may be at stake, when the patient recovers from the immediate injury, there may be profound physical and mental issues that need to be treated. Normal life changes to coping with the new realities of changed relationships, changed financial circumstances and broader social changes.
For this reason there can be no fixed or determined approach to claiming compensation other than to seek the expert advice of all those involved: your family doctor and the medical specialists you are referred to; your insurance company and medical aid society; lawyers and (in the event of an accident at work) company executives and labour law experts.
Unless one has experienced TBI – either in person or having a loved one who suffers the effects of TBI – trite words of advice or comfort are likely to fall on deaf ears as it is perhaps impossible to truly empathise in such a situation without experiential knowledge.
Perhaps, however, the best we can do is to act sensibly and wisely. Don’t attempt to drive when your alcohol level is over the legal limit; drive carefully at all times; weigh up your decisions -Do I climb the ladder to fix the roof tile when I’m feeling tired and am therefore more likely to not be paying full attention, or can the job wait until I am rested and alert, aware that I need to secure the ladder properly and take extra care to avoid falling from a significant height.
Always think carefully before putting yourself at risk of suffering a traumatic brain injury.