What Is a Secondary Brain Injury?

Traumatic brain injuries are a leading cause of hospitalization in America. Some common causes of traumatic brain injuries (TBIs) are car accidents, falls, and acts of violence. Drivers, property owners, construction site owners, manufacturers, and others may be liable if your or a loved one suffers a TBI.

According to the US Centers for Disease Control and Prevention, more than 223,000 people were hospitalized for a TBI in 2019. In 2020, 64,362 people died due to a TBI-related injury. These statistics don’t include many types of brain injuries that go untreated or unreported. Males were almost two times as likely to be hospitalized and three times as likely to die from a TBI than females. Many TBI victims are children.

Johns Hopkins Medicine, a leading research hospital in America, states that there are two types of brain injuries – primary and secondary:

Primary brain injury refers to the sudden and profound injury to the brain that is considered to be more or less complete at the time of impact. This happens at the time of the car accident, gunshot wound, or fall.

Secondary brain injury refers to the changes that evolve over a period of hours to days after the primary brain injury. It includes an entire series of steps or stages of cellular, chemical, tissue, or blood vessel changes in the brain that contribute to further destruction of brain tissue.

Student Nurse Life states that secondary brain injuries may have more influence on the accident victim’s final health status than primary injuries. Some of the causes of secondary brain injuries are:

• Hypoxia (the brain doesn’t get the full amount of oxygen it needs)
• Hypotension (low blood pressure)
• Hypercapnia
• Acidemia
• Anemia
• Intracranial Mass
• Hyperglycemia/Hypoglycemia
• Hyperthermia/Hypothermia

Ischemia (insufficient blood flow) is another possible cause of secondary brain injuries.

These causes are “related to raised intracranial pressure (ICP).” ICP is pressure inside the skull.

The American Speech-Language-Hearing Association states that other causes of secondary brain injuries include meningitis, epilepsy, and “biochemical changes: changes in levels of sodium, neurotransmitters, potassium, etc.”

The Monro-Kellie Hypothesis and secondary brain injury

Student Nurse Life explains the Monro-Kellie Hypothesis is “that the total volumes of the brain (approximately 80%), CSF (approximately 10%), and intracerebral blood (approximately 10%) are constant.”

The cranial cavity that houses the above items cannot expand, which means that if one of the three elements increases, one or both of the other three elements should decrease. This way, the ICP shouldn’t increase. ICP is “the pressure exerted by the intracranial contents against the skull.”

Usually, the brain can “tolerate a significant increase in intracranial volume without increasing much the ICP. If, however, this normal compensation mechanism becomes exhausted and the compliance limit is exceeded, an increase in ICP becomes imminent.”

Accident victims who suffer a primary brain injury should seek immediate medical help, so doctors can take steps to reduce the risk of secondary injuries. These steps could include medications and oxygen therapy. In addition, surgery is sometimes necessary to decrease the pressure on the brain.

What are the signs of a secondary brain injury?

The doctors who treat your primary injury and/or your secondary injury will look for some of the following symptoms: Slurred speech, headaches, seizures and convulsions, dizziness, sensitivity to light and noise, different sleep patterns, confusion, personality changes, difficulty communicating, and other symptoms.

According to RECAPEM (Rational Evidence, Changing Academic Practice in Emergency Medicine), “Increased intracranial pressure can be a surrogate of secondary brain injury, as high ICP has been correlated with high mortality and poor neurological outcome.” For this reason, monitoring and controlling ICP is a key part of neurocritical care for TBI victims. The methods for monitoring ICP include:

• Invasive methods. These can include “fluid-based systems and implantable micro-transducers. Of the invasive methods, ICP monitoring using an EVD is considered as the gold standard not only for its accuracy but also because it additionally serves a therapeutic purpose by allowing CSF drainage.”
• Non-invasive methods. Invasive methods aren’t always possible. Non-invasive methods can be used, for example, where there aren’t any neurosurgeons or where there is a “relatively low suspicion of elevated ICP, but the possibility needs to be ruled out.” Non-invasive methods include:
  • Transcranial Doppler (TCD)
  • Optic Nerve Sheath Diameter (ONSD)
  • Imaging-Based Methods including CT, MRI

Other factors that doctors who treat secondary brain injuries need to monitor include the following:

• Increased blood volume
• Mass and edema
• Increased CSF volume:

What types of rehabilitation do primary and secondary brain injury victims require?

Johns Hopkins Medicine states that brain injury rehabilitation programs may include:

• Self-care skills (bathing, dressing, going to the bathroom, feeding, and sexual function);
• Physical care (nutrition, medications, and skincare);
• Mobility care (walking and self-moving in a wheelchair);
• Communication and cognitive skills (talking, writing, and other forms of communication);
• Social skills (nteracting with other people and with a community);
• Vocational training (job skills);
• Pain management (medications and other pain management strategies); and
• Psychological care (identifying emotional and behavioral problems and working to find solutions).

Other parts of a successful rehabilitation program for TBI patients include focusing on family support and education. In addition, skilled doctors review your full medical history.

A TBI rehabilitation team includes neurosurgeons, neurologists, internists, physiatrists, rehabilitation nurses, physical therapists, occupational therapists, speech pathologists, social workers, recreational therapists, audiologists, nutritionists, vocational therapists, case managers, and others.

At Harris Lowry Manton LLP, our Atlanta personal injury lawyers represent clients with catastrophic and permanent injuries, like primary traumatic brain injuries, secondary brain injuries, spinal cord injuries and paralysis, burn injuries, traumatic amputations, and broken bones. We are skilled at working with your doctors to help you understand the full scope of your injuries and how your injuries have dramatically changed your life.

To discuss your rights with a respected Atlanta secondary brain injury lawyer, call us or complete our contact form to schedule a consultation.