Traumatic Brain Injury (TBI) is a serious public health problem in the United States. While it can be easy to think of traumatic brain injuries as just an injury affecting football players and veterans, it is important to remember TBI is much more widespread. Each year, traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability. Nearly 50% of all reported traumatic brain injuries are the result of an automobile or trucking Accident.
Whiplash can be very damaging for the brain. When the head is suddenly twisted with the deceleration of an automobile crash, the brain will move around as well. Billions of nerve cells communicate with other distant cells through long nerve fibers. These delicate fibers can be stretched during an accident, damaging the ability for cells to communicate with each other. The pituitary gland suffers its own damage when the stalk of the pituitary is stretched, causing blood vessels to rupture and not allow the proper travel of hormones to the body.
For a long time, many of the long term Endocrinological effects of TBI were not understood. To this day many doctors are not aware of the connections between Traumatic Brain Injuries and Endocrine Deficits. Following rehabilitation for a TBI, many patients have lasting symptoms such as mood swings, loss of energy, and other significant changes in behavior. Research has shown that a part of the brain, called the pituitary, can sustain damage in an accident that can diminish its ability to tell other parts of the body to produce the hormones necessary for normal function; this is called an Endocrine Deficit. The lack of these necessary hormones in the body, can be the cause of many of the ongoing symptoms of Traumatic Brain Injury victims.
Endocrine deficits can be treated with ongoing hormone therapy prescribed by a medical professional. Hormonal therapy can be very expensive; however the costs for this treatment is becoming more affordable as pituitary injuries and their treatment are more readily understood and properly diagnosed.
What is a Traumatic Brain Injury (TBI)?
A traumatic brain injury occurs when an external force causes the brain to shift, striking the inside of the skull cavity and damaging brain tissue. These injuries can range from mild to severe, sometimes resulting in life altering and debilitating symptoms.
For Military service men and women, the risk is also high. Combat zone explosions, concussions, and other accidents have a high rate of TBI diagnosis, and some studies have shown a strong correlation between Traumatic Brain Injuries, and Post Traumatic Stress. In recent years, there has been a strong community push for awareness of these problems in the veteran and active military communities. We link organizations in the Resources and Advocacy section later in this blog.
Traumatic Brain Injury symptoms range with the severity of the injury sustained, with minor concussions delivering minor and temporary symptoms, to more severe cases that can leave a victim irrevocably changed.
The symptoms of a Mild TBI (Such as a concussion) can consist of:
- Concentration/Attention Problems
- Memory Problems
- Dizziness and balance problems
Symptoms of a Moderate to Severe TBI can consistent of:
- Severe Cognitive Deficits: including memory, concentration, and impulsiveness.
- Language Problems: Such as Aphasia, slurred speech, and problems reading or writing.
- Sensory Problems
- Perception Problems
- Vision Problems, including a partial or total loss of sight.
- Diminished or a complete loss of hearing, and Tinnitus.
- Diminished or a complete loss of the sense of smell.
- Diminished or a complete loss of the sense of taste
- Chronic Pain
- Loss of bowel or bladder control
- Irritability and Aggression
- Many others.
These symptoms can leave a victim un-able to resume the normal pace of their life, and in extreme cases require around the clock care. However, as we stated before, research has shown some of these symptoms may be related to a hormonal issue otherwise known as an Endocrine deficit, because of damage sustained to the pituitary or surrounding area in the accident.
What is the Pituitary?
Near the center of the brain, is a narrow bone line structure that is often referred to as the “Turkish Saddle”, or “Sulci”. Inside is a small bean shaped gland known as the pituitary. It is responsible for regulating many of the hormone signals in the body. Inside the Turkish saddle, the pituitary gland hands from a nerve stem, called the pituitary stem much like a punching bag, or chandelier.
The area near the pituitary, as well as the brain stem, are key points where the brain is tethered to the skull. The force of a collision, causes the brain to move inside the skill cavity which can put large amounts of stress on the areas where the brain is tethered. This stress can cause damage to the pituitary stem, as well as the pituitary gland itself that can result in Hypopituitarism, and can be a cause of many of the long-term effects of a traumatic brain injury.
What is the Hypopituitarism?
Hypopituitarism is when the pituitary gland does not produce enough the hormones it controls, which leaves parts of the body unable to operate in its natural way. Damage sustained to the pituitary gland, or to the pituitary stem can cause signals required to trigger these hormones in the body to be reduced, or simply stop transmitting. A lack of these hormones can cause severe symptoms and can often be diagnosed with a blood hormone test, and treated with hormone therapy.
Some common symptoms include:
- Dizziness and headaches
- Join Stiffness
- Weight loss, or gain
- Constant fatigue, and a feeling of weakness
- Decreased appetite
- Stomach pain and associated symptoms of nausea and vomiting
One of the most common types of Hypopituitarism in men occurs when the pituitary does not trigger the product of enough HGH (Human Growth Hormone). This can cause men to have drastic loss of energy, and can cause noticeable mood changes and in some cases can make previously outgoing people quiet and withdrawn. In some cases men, can become effectivity sterile, leaving them with sexual dysfunction and unable to start a family. Without proper treatment, men with low growth hormones can face several long-term consequences such as:
- Increased chance of developing diabetes.
- Increased abdominal mass
- Reduced Bone and Lean Muscle Mass
- Higher chance of cardiovascular (Heart) problems or death.
- Higher risk of developing hypertension.
Many of these risks can be prevented, and existing symptoms treated with daily hormone injections of HGH. These treatments are effective, but costly. A monthly hormone therapy can cost $500 to over $1,000 a month and could be necessary until you turn 65. If you have been in a car accident, or suffered a Traumatic Brain Injury it is important to ask your doctor to include hormone testing in your treatment plan, when it’s appropriate in the progress of your medical care
How common is this?
Some studies have shown that 30%-50% of victims that have sustained Traumatic Brain Injuries, have also sustained damage to their pituitary. Other studies have suggested that around 42% of veterans with blast related injuries, have irregular hormones because of a pituitary injury. The good news is that while the damage its self cannot be un-done, many of the endocrine symptoms from TBI can be mitigated though hormone testing and therapy.
How do I get tested?
Hypopituitarism typically does not show up on an MRI, and so many people recovering from a Traumatic Brain Injury are left to believe that many of their lingering symptoms are either caused by a secondary issue such as Bi-Polar disorder, or are simply not a result of the damage they sustained in the accident. Many doctors still do not know the protocol, or even the need to for hormone testing after a Traumatic Brain Injury.
Hormone testing can be inconclusive, or deliver false positives if given too early in the recovery process. The established timeline for Hormonal testing following a TBI is one year post injury. This allows the body to recover much of the internal damage, and leaves an unseen pituitary injury as the mostly likely cause of lingering hormone based symptoms. Following a positive blood test, there are numerous specific and more conclusive tests to establish the extent of the damage, and for your doctor to design a hormone replacement plan to treat your symptoms.
Hormonal testing, and treatment cannot guarantee anyone a full recovery, but the treatment of many of these lingering symptoms can drastically improve the quality of life of Traumatic Brain Injury victims.
Resources and Advocacy
What should I do next?
If you have been involved in an accident under no fault of your own, or have previously been diagnosed with a Traumatic Brain Injury (ICD10,) an experienced personal injury attorney can help you get a settlement for your loss and to cover the long-term cost of your care. If it has been one year following your Traumatic Brain Injury, request that your doctor perform a blood test to check for hormonal problems.
At Russell and Hill, PLLC, the team that makes up our Everett Law Firm are experienced with Traumatic Brain Injury cases, and are advocates for education of patients struggling with the symptoms of Hypopituitarism following their TBI. Many of us have at Russell and Hill, PLLC, have had personal experiences with the effects of Traumatic Brain Injuries, and we want to work to make sure everyone understands the need for Endocrinological testing and treatment following a TBI.
If you have been involved in an accident, have questions or concerns about the injuries sustained in your accident, or the ongoing symptoms of your Traumatic Brain Injury, contact the team at Russell and Hill, PLLC.