Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

Nevada Brain Injury Law 

We know that repeated traumatic brain injury can lead to Alzheimer's disease.  But did you know that even one traumatic brain injury can as well.  So whether multiple blast injuries, sports injuries or even just one car accident with traumatic brain injury, you could raise the chances of developing Alzheimer's in later years.

Over 1.7 million Americans suffer a traumatic brain injury each year, and beyond the immediate effects, growing evidence demonstrates that a single traumatic brain injury, or TBI, may initiate long term processes that further damage the brain. Boxers call this "punch-drunk" syndrome.

Douglas Smith, MD, professor of Neurosurgery and director of the Center for Brain Injury and Repair at Penn's Perelman School of Medicine states:

"A single traumatic brain injury is very serious, both initially, and as we're now learning, even later in life. Plaques and tangles are appearing abnormally early in life, apparently initiated or accelerated by a single TBI."

If you or someone you know has suffered a traumatic brain injury, be on the look out for symptoms of Alzheimer's later in life.  Even at a younger age than you would otherwise think.

The first symptoms of Alzheimer's disease you may notice are increasing forgetfulness and mild confusion.  Here are some others:

Memory

• Repeat statements and questions over and over
• Forget conversations, appointments or events, and not remember them later
• Routinely misplace possessions, often putting them in illogical locations
• Eventually forget the names of family members and everyday object

Disorientation and misinterpreting spatial relationships

 Speaking and writing
Those with Alzheimer's may have trouble finding the right words to identify objects, express thoughts or take part in conversations. Over time, the ability to read and write also declines.

Difficulty with Thinking and reasoning

Difficulty Making judgments and decisions

Difficulty Planning and performing familiar tasks

Changes in personality and behavior
Brain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People with Alzheimer's may experience:

• Depression
• Anxiety
• Social withdrawal
• Mood swings
• Distrust in others
• Increased stubbornness
• Irritability and aggressiveness
• Changes in sleeping habits
• Wandering

 If you or someone you know has suffered traumatic brain injury, contact the Titolo Law Office today.

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 A common legal defense in cases of traumatic injury is that pain complaints, like low back pain, are the source of brain injury symptoms and reported cognitive impairments.  For instance, depression.  And while it is true that chronic or lasting pain can have symptoms that mimic those found with cognitive impairments, those symptoms are often not caused by pain or are at least exacerbated by pain components.

The Journal of Neuroscience recently published a study that supports relief of chronic pain as a precursor to the relief of brain injury symptoms and cognitive impairments.   Those with chronic pain also experience cognitive impairments and reduced gray matter in parts of the brain associated with pain processing and the emotional components of pain, like depression and anxiety.

Traumatic Brain Injury Attorneys must be able to distinguish cognitive impairments caused by organic brain injury from those associated with chronic pain.  A competent Traumatic Brain Injury Attorney works closely with neuropsychologists, neurodiagnosticians, and neurologists.

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 Depression is something that can be related to brain activity.  It is frequently associated with traumatic brain injury as a sign, symptom or consequence.

The frequency of depression can also be affected by external situations.  Recent data reveals that depression for Men due to Social and Economic Environment is prevalent.  Emory University School of Medicine experts write in the  British Journal of Psychiatry about the tendency.

"Dubbed by some the 'Mancession', the economic downturn has hit men particularly hard because of its disproportionate effect on traditional male industries such as construction and manufacturing. Research has shown that roughly 75% of jobs lost in the United States since the beginning of the recession in 2007 were held by men. There is little reason to believe that traditional male jobs will return in significant numbers with economic recovery.

 Neuroscientists at Cold Spring Harbor Laboratory (CSHL), Brookhaven National Laboratory (BNL) and UC San Diego (UCSD) have collected evidence suggesting that a previously overlooked portion of the brain could be a prime locus of human depression. An upcoming article in the journal Nature will contain the findings.

 "It covers an area only about 1-2 mm across." So far only two brain imaging studies have implicated the LHb in depression because of the difficulty in resolving it using existing technologies such as PET and fMRI.

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Brain Injuries often occur fast (in milliseconds) to small places in the brain (microscopic cells).   Speed and size require specific understanding in relation to forces.  This must be important to all of us since just a moment of inattention can result in significant forces being imposed on our heads.  Think of the truck or car crash you did not see coming.  Or the fall you took.  The resulting impacts can change our brains and cause a whole constellation of symptoms and consequences.

Biomechanical forces  (the research and analysis of the mechanics of living organisms and the application of engineering principles to and from biological systems) to the head and body are predictors of brain injury.  In cases of trauma, like car, motorcycle and truck collisions, in addition to sports trauma, like hockey, football and boxing (to name a few), the amount of pressure exerted on the head and the amount of time that elapses during the application of pressure, cause microscopic changes to the structure of the brain.  Microscopic because the damage occurs at the cellular level with axons and dendrites shearing. 

This, in turn, causes metabolic changes (biochemical processes) and other changes in chemistry that result in cognitive impairments, emotional impairments and physical impairments.

Head injury expert Kim Gorgens, a neuropsychologist at the University of Denver (DU), says that most concussions deliver 95 g's to the human body upon impact.

Concussions range in significance from minor to major, but they all share one common factor — they temporarily interfere with the way your brain works. They can affect memory, judgment, reflexes, speech, balance and coordination.

Usually caused by a blow to the head, concussions don't always involve a loss of consciousness. In fact, most people who have concussions never black out. Some people have had concussions and not even realized it.

Concussions are common, particularly if you play a contact sport such as football. But every concussion, no matter how mild, injures your brain. This injury needs time and rest to heal properly. Luckily, most concussions are mild and people usually recover fully.

G-force is a unit of force equal to the force exerted by gravity. In addition, the average football player receives 103 g's when hit during a game. In comparison, the average g-force experienced by military fighter pilots is nine g's. 

Let that sink in for perspective.
 

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PET Scans Affirmed

New research has identified the memory and brain scan tests that appear to predict best whether a person with cognitive problems might develop Alzheimer's disease. The research is published in the June 30, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology. (AAN)

Longevity tests are tests that examine data over time rather than at one moment in time.  The study looked at participants between the ages of 55 and 90 and were followed for an average of 1.9 years. During that time, 28 of the participants developed Alzheimer's disease.

People who showed abnormal results on both PET scans (positron emission tomography) and episodic memory tests were nearly 12 times more likely to develop Alzheimer's disease than those who scored normally on both measures.

Thin people statistically face higher risks of dementia

Researchers at Milan University examined a total of 245 patients averaging 74 years old who had been suffering from mild cognitive impairment for approximately two-and-a-half years. The mental capabilities of about half the patients remained stable during that period. About two thirds of those whose condition had deteriorated developed Alzheimer's Disease. The remaining third developed another form of dementia. Those whose cognitive disturbance deteriorated had a significantly lower BMI (mean value of 23.81) than those whose condition had remained unchanged (BMI mean of 25.47). Especially significant was the elevated risk of deterioration among those patients with a BMI of 23 or under. 

Illustration of patient inside scanner
 

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Exercise is a form of anti-dementia.  A May 2010 online issue in the journal Annals of Neurology, the official journal of the American Neurological Association and the Child Neurology Society, reveal results of the study by Boston University School of Medicine.

In the new study, U.S. researchers confirmed the known link between obesity and lower total brain volume and also found that abdominal fat in otherwise healthy middle aged people is associated with lower total brain volume, suggesting a greater risk of dementia and Alzheimer's later on in life.

A clinical diagnosis of dementia is made when two or more brain functions are significantly impaired. The condition shows as short term and long term memory decline, and deterioration of language, problem solving and other cognitive abilities. It can result from irreversible causes such as Alzheimer's disease, vascular dementia, and Huntington's disease, or it can result from treatable causes such as brain tumor, reaction to drugs, or metabolic problems.

According to World Health Organization (WHO) figures released in 2005, there are about 24 million people in the world living with dementia, with 4.6 million new cases coming forward every year.

So the take away here is do not forget to stay slim, eat well, excercise and stay healthy or, later,  you might forget!

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With the War in Iraq technically over, many veterans are returning home. 

The American Academy of Neurology reports Soldiers With Brain Injuries are at Higher Risk Of Epilepsy Years after Returning Home. 

The new research is published in the July 20, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology, entitled correlates of posttraumatic epilepsy 35 years following combat brain injury (cme). - Raymont, V., Salazar, A.M., Lipsky, R., Goldman, D., Tasick, G., Grafman, J.. Pages: 224-229.

This is certainly consistent with what I have posted about previously including previous studies and articles.  We have known for years that traumatic brain injury increases the chance of developing epilepsy.

Epilepsy is a general term for conditions with recurring seizures. There are many kinds of seizures, but all involve abnormal electrical activity in the brain that causes an involuntary change in body movement or function, sensation, awareness, or behavior.  Epilepsy can be caused by many different conditions that affect a person’s brain. Examples of these conditions include stroke, head trauma, complications during childbirth, infections (such as meningitis, encephalitis, cysticercosis, or brain abscess), and certain genetic disorders. Often, no definite cause can be found.

Epilepsy affects an estimated 2.5 million people in the United States and each year accounts for $15.5 billion in direct costs (medical) and indirect costs (lost or reduced earnings and productivity). More than one-third of people with epilepsy continue to have seizures despite treatment.

Each year, about 200,000 new cases of epilepsy are diagnosed in the United States. Children younger than age 2 years and adults older than age 65 are most likely to be affected. In addition, people of low socioeconomic status, those who live in urban areas, and members of some minority populations are at increased risk for epilepsy.
 

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According to Medilexicon's medical dictionary scoliosis is:

Abnormal lateral and rotational curvature of the vertebral column. Depending on the etiology, there may be one curve, or primary and secondary compensatory curves; scoliosis may be "fixed" as a result of muscle and/or bone deformity or "mobile" as a result of unequal muscle contraction.

Scoliosis is a condition in which the spine bends to the side abnormally; either to the right or left. The curvature can be moderate to severe. Any part of the spine can be bent in scoliosis; but the most common regions are the chest area (thoracic scoliosis) or the lower part of the back (lumbar scoliosis).

Scoliosis is thought to be caused by heredity but some other reasons are different leg lengths.  Scoliosis affects 2-3% of the population, or an estimated 6 million people in the United States, and there is no cure.

Signs and symptoms of scoliosis may include:

■Uneven shoulders
■One shoulder blade that appears more prominent than the other
■Uneven waist
■One hip higher than the other

The National Scoliosis Foundation can be contacted at  NSF@scoliosis.org  to help answer questions you may have or seek care.

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Pediatric traumatic brain injury (TBI) is a major public health concern and challenge to critical care practitioners. The prevention of secondary injury is key to improving morbidity and mortality outcomes. Interventions are targeted at maintaining adequate cerebral blood flow and minimizing oxygen consumption by the brain. The anticipation and prevention of systemic complications are also of vital importance.

A new book focuses on evaluating what is currently known about childhood TBI and the challenges faced by researchers and clinicians in this arena. The book is entitled "Pediatric Traumatic Brain Injury: New Frontiers in Clinical and Translational Research," edited by Vicki Anderson and Keith Owen Yeates and published by Cambridge University Press. 

The following is an Introduction I ran across:

Traumatic brain injury (TBI) is a major public health problem among children and
adolescents. Surveillance data reveal that 1 in every 20 emergency department presentations at pediatric hospitals is for a TBI, making TBI more common than burns or
poisonings. For children, such injuries represent a common interruption to normal
development, with population estimates ranging from 200 to over 500 per 100 000 a year,
and with well-established variations across age and gender (Crowe et al., in press; Langlois et al., 2006).

The majority of TBI in children and adolescents are mild, typically with few
long-term consequences; however, a significant proportion of children will suffer more
serious injuries and will experience a range of residual physical, cognitive, educational,
functional, and social and emotional consequences, requiring the lifelong involvement of
health professionals across a range of disciplines and leading to a significant social
and economic burden for the children’s families and for the community more broadly
(Cassidy et al., 2004).

This book, New Frontiers in Pediatric Traumatic Brain Injury, aims to evaluate what we
have learned about TBI in childhood to date and, perhaps more importantly, to articulate
the challenges we face and how we should go forward in the future. Over the past two or
three decades, researchers and clinicians working with children with TBI have become
aware that injuries to the developing brain cannot be understood or treated in exactly the
same manner as those occurring in adulthood. Although we may be guided by science and
practice in adult TBI, unique developmental and contextual issues need to be taken into
account at all stages of recovery and treatment in children. Thus, a separate knowledge base is needed for pediatric TBI. As a consequence, until recently our understanding of recovery and outcomes in pediatric TBI has lagged behind that for adults. This is changing. Research in pediatric TBI now has more solid foundations. A number of principles have been established, some consistent with the adult literature, such as the predictive value of injury severity (Anderson et al., 2004; Taylor et al., 2008).

Others are specific to early brain injury, such as the unique mechanics and characteristic pathology of inflicted injury in children (Coats & Margulies, 2006; Prange & Margulies, 2002), or reflect the importance of developmental and contextual factors, such as the age at injury, developmental stage of brain development, and functional maturation (Anderson et al., 2005; Taylor & Alden, 1997), the key role of the family, and implications of life tasks specific to children (Yeates et al., 1997). 

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When my grandmother got old enough to officially be considered "blind" we decided it was time to take away her car and driving ability.  First off, I bought her the car a few years ago and so she spent her last years driving a new sporty car as opposed to the 20 year old Toyota her late husband left her.  And second, I moved her in with me to help make up for the transportation burden.  We drive her wherever she needs to go.  But a responsible decision needed to be made to get her less than safe driving skills off the road.  For her sake, our sake, and most importantly, for the sake of other drivers and passengers including little babies.

But taking away an elder's ability, or right, to drive is a dire move.  It supports the reality that as we age, more and more is taken away from us.

Dementia from normal aging also requires difficult decisions regarding driving.  Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.And since, statistically, those who suffer brain injury are more likely than not to develop dementia, driving may be an issue for those with mild and moderate brain injury.

Caregiver.org blogs "As a general rule, individuals with early stage or mild dementia who wish to continue driving should have their driving skills evaluated immediately (see “Arrange for an Independent Driving Evaluation” below). Individuals with moderate or severe dementia should not drive."

Insurance Company studies state Yes, there is enough small-scale research to tell us that over time, driving and dementia don't mix. The harder question is exactly when driving skills deteriorate? This question is harder to answer and the research is not clear enough to give a simple answer. That is why we recommend an approach that includes observation of driving skills right from the point of diagnosis and planning ahead for the time when the person must stop driving.

The American Academy of Neurology has issued a new guideline to help determine when people with Alzheimer's disease or another type of dementia should stop driving. The guideline is published in the April 12, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Dementia reveals itself in many ways.  For example Dementia symptoms include difficulty with many areas of mental function, including:

Language
Memory
Perception
Emotional behavior or personality
Cognitive skills (such as calculation, abstract thinking, or judgment)

 The guidelines also found that caregivers should trust their instincts. A study found that caregivers who rate a patient's driving as "marginal" or "unsafe" were often proven correct when the patient took an on-road driving test. On the other hand, patients who deemed their own driving as "safe" were not necessarily accurate in their own assessments.

Caregivers and family members play a role in identifying warning signs from unsafe drivers with dementia. These include:

Decreased miles being driven

Collisions

Moving violations

Avoiding certain driving situations, such as driving at night or in the rain

Aggressive or impulsive personality traits.

Read the full report and guidelines at www.neurology.org/cgi/rapidpdf/WNL.0b013e3181da3b0fv1.pdf.

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Findings published in Nature Neuroscience help explain why light makes Migraine Headaches worse. 

Ask anyone who suffers from migraine headaches what they do when they're having an attack, and you're likely to hear "go into a dark room." And although it's long been known that light makes migraines worse, the reason why has been unclear. 

Migraine is a recurring, episodic neurological disorder characterized as throbbing headache that is commonly associated with a variety of other symptoms (for example, nausea, vomiting, irritability and fatigue).  Migraines are chronic headaches that can cause significant pain for hours or even days. Symptoms can be so severe that all you can think about is finding a dark, quiet place to lie down.

For light to make pain worse, the pathways have to converge somewhere, thought the researchers at Beth Israel Deaconess Medical Center.  Exacerbation of migraine headache by light is prevalent among blind individuals. Light can increase the electrical activity in neurons.

One expert said these findings should put to rest any suggestion that patients exaggerate their sensitivity to light; they are not whining or imagining their symptoms.

"A neural mechanism for exacerbation of headache by light."
Rodrigo Noseda, Vanessa Kainz, Moshe Jakubowski, Joshua J Gooley, Clifford B Saper, Kathleen Digre & Rami Burstein.
Nature Neuroscience, Advance online publication 10 January 2010.
DOI:10.1038/nn.2475

 

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Now the million of cell phone users have good reason to keep on talking.  It baffles my mind to learn of something typically regarded as negative being cast into a positive light.  Reminds me of Woody Allen's Sleeper where future scientists discover cigarette smoking and eating fat is healthy.

An international team of researchers studying the long term effects of electromagnetic waves like those emitted by cell phones on mice were surprised to find they protected their brains against Alzheimer's and even reversed the memory damage caused by the disease.

The neuroscientists, electrical engineers, and neurologists published the study and findings in the Journal of Alzheimer's Disease. 

The research results are exciting.  But since they occur in mice, the ultimate human affects are still not known.  Dr. Susan Sorenson, Alzheimer's Society Head of Research, comments, 'This study could open new doors in Alzheimer's research but it also poses some interesting questions that need answers. However, dementia research is dramatically underfunded. The government currently spends eight times less on dementia research than cancer research. In order to make further scientific advances dementia needs to be given higher priority.' 

"Electromagnetic Field Treatment Protects Against and Reverses Cognitive Impairment in Alzheimer's Disease Mice."
Gary W. Arendash, Juan Sanchez-Ramos, Takashi Mori, Malgorzata Mamcarz, Xiaoyang Lin, Melissa Runfeldt, Li Want, Guixin Zhang, Vasyl Sava, Juan Tan and Chuanhai Cao.
Journal of Alzheimer's Disease, Volume 19:1 (January 2010).
 

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The American Medical Association (AMA) reports that PET (postron emission tomography) is able to detect the progression of Alzheimer's in patients with dementia.  Preclinical Alzheimer's disease can be detected by screening an individual's cerebrospinal fluid for biomarkers of the condition. In addition, imaging with positron emission tomography (PET) can detect deposits of the substance linked to dementia in living patients.

159 older adults (average age 71.5) who had undergone PET scans and did not have symptoms of dementia were assessed. These patients were followed for between 0.8 and 5.5 years after having the scan and underwent between two and six assessments for dementia during that timeframe.

A total of 23 participants progressed to clinically detectable dementia during follow-up, and nine were diagnosed with dementia of the Alzheimer type. These diagnoses were made by specialist clinicians who diagnosed the condition at an earlier stage than typically occurs and corroborated the diagnosis by declines in multiple cognitive domains as well as a loss of volume in certain areas of the brain.
 

If this new discovery can assist clinicians in detecting dementia and Alzheimer's symptoms earlier, treatment can be more effective.

This study provides support for the premise that preclinical Alzheimer's disease, detected by the cerebrospinal fluid signature for Alzheimer's disease predicts symptomatic Alzheimer's disease.  The study is published at Arch Neurol. 2009;66[12]:1469-1475.
 

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People often confuse coma as being necessary for brain injury to occur.  This is far from the facts or truth.  However coma usually confirms that brain injury has, in all probability, robbed the individual of cognition or motor function.  Only rarely does one recover completely from coma.

I thought a refresher on what Coma and Glasgow Coma Scale are would be helpful.

A coma, or being comatose, is a deep state of unconsciousness - longer-term comatose patients may be reclassified as being in a permanent vegetative state. Recall Terry Schiavo. The patient cannot be awakened and does not respond to pain, light or sound in a normal way - the person in coma cannot react with the surrounding environment. A person in a coma does not take voluntary actions and does not have sleep-wake cycles.

The inability to waken differentiates coma from sleep. Levels of unconsciousness and unresponsiveness vary, depending on how much of the brain is functioning.  Neurological Experts and family often argue about whether the comatose patient can hear voices or perceive events or the presence of people. 

Coma may occur for various reasons, such as intoxication, CNS (central nervous system) diseases, a traumatic injury, and hypoxia (oxygen deprivation). Coma can be induced deliberately with pharmaceutical agents - perhaps in order to protect the patient from intense pain during a healing process, or to preserve higher brain function following another form of brain trauma.

Comas generally do not last for more than a few weeks. A patient whose state does not change after an extended period is often reclassified as being in a persistent vegetative state. Unfortunately, those in a persistent vegetative state for over twelve months rarely wake up.

Another condition is known as "Locked-In Syndrome."  Locked-in syndrome is a rare neurological disorder characterized by complete paralysis of voluntary muscles in all parts of the body except for those that control eye movement. It may result from traumatic brain injury, diseases of the circulatory system, diseases that destroy the myelin sheath surrounding nerve cells, or medication overdose. Individuals with locked-in syndrome are conscious and can think and reason, but are unable to speak or move. The disorder leaves individuals completely mute and paralyzed. Communication may be possible with blinking eye movements

A book and movie called "The Butterfly and Diving Bell" was written by Jean-Dominique Bauby who could only move his eyelid.  Through the help of an interpreter, he wrote the entire book, letter by letter, by moving his eyelid when the letter was identified.
 

What are the possible causes of a coma?

A coma can have several possible causes, including:

• Diabetes - if the blood sugar levels of the diabetes patient rise too much they will have hyperglycemia, the opposite is hypoglycemia (blood sugar levels are too low). Sustained periods of hyperglycemia or hypoglycemia can result in coma.
   
• Hypoxia (lack of oxygen) - a person who nearly drowned may not awaken because of a shortage of blood (which carries oxygen) to the brain. The same may occur to somebody who is resuscitated after a heart attack.
   
• Infections - those which cause inflammation of the brain, spinal cord or tissues surrounded the brain can result in coma if symptoms are severe enough. Examples include encephalitis or meningitis.
   
• Stroke - a condition where a blood clot or ruptured artery or blood vessel interrupts blood flow to an area of the brain. A lack of oxygen and glucose (sugar) flowing to the brain leads to the death of brain cells and brain damage, often resulting in impairment in speech, movement, and memory - and sometimes coma.
   
• Toxins and drug overdoses - exposure to carbon monoxide can result in brain damage and coma, as can some drug overdoses.
   
• Traumatic brain injuries - these include injuries from vehicle accidents and violent attacks. They are the most common cause of comas.

Diagnostic Tools

Lumbar puncture (spinal tap) - this can determine whether there is an infection. The doctor inserts a needle into the patient's spinal canal, measures pressure and extracts fluid.   Ruling out meningitis usually utilizes spinal tap.

Imaging scans of the brain - these will help determine whether there is any brain injury/damage, and where. Examples include:

• CT (computed tomography) scan - also known as a CAT (Computer Axial Tomography) scan. It is a medical imaging method that employs tomography. Tomography is the process of generating a two-dimensional image of a slice or section through a 3-dimensional object (a tomogram). The medical device is called a CTG scanner; it is a large machine and uses X-rays. It used to be called an EMI scan, because it was developed by the company EMI.
   
• MRI (magnetic resonance imaging) scan - an MRI machine uses a magnetic field and radio waves to create detailed images of the body, which in this case would be the brain. Most MRI machines look like a long tube, with a large magnet present in the circular area. When beginning the process of taking an MRI, the patient is laid down on a table. Then depending on where the MRI needs to be taken, the technician slides a coil to the specific area being imaged. The coil is the part of the machine that receives the MR signal. MRI scans are good for examining the brainstem and deep brain structures. The doctor may inject a special dye which shows up on the scans and distinguishes healthy tissue from damaged tissue. 
   
• EEG (electroencephalography) - the device measures the electrical activity within the brain. Electrodes are placed on the patient's scalp; they pick up electrical impulses that occur in the brain. These impulses are recorded on the EEG device. An EEG can tell whether the patient is having non-convulsive seizures. 
•  
• PET (Positron Emission Tomography) - a nuclear medicine imaging technique which produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide (tracer), which is introduced into the body on a biologically active molecule. Images of tracer concentration in 3-dimensional space within the body are then reconstructed by computer analysis.

 Glasgow Coma Scale (GCS)

This scale is very useful for determining conciousness in severe cases.  Unfortunately it is fequently misused in cases of mild and moderate traumatic brain.  For instance, Mild Traumatic Brain Injury, which many times has devasting consequences, is defined by the same value on GCS as for a completely normal individual.  Hence those with incentive to discredit the reality of brain injury point to the "normal" GCS.

The GCS scores patients according to verbal responses, motor responses (physical reflexes), and how easily they can open their eyes.

• Eyes - Glasgow Coma Scale
  
  Score of 1 - does not open eyes.
  Score of 2 - opens eyes in response to painful stimuli (when given pain).
  Score of 3 - opens eyes in response to voice.
  Score of 4 - opens eyes spontaneously.
  
  
   
• Verbal - Glasgow Coma Scale
  
  Score of 1 - makes no sound.
  Score of 2 - incomprehensible sounds (mumbles).
  Score of 3 - utters inappropriate words.
  Score of 4 - confused, disorientated.
  Score of 5 - oriented, chats normally.
  
   
• Motor (physical reflexes) - Glasgow Coma Scale
  
  Score of 1 - makes no movements.
  Score of 2 - extension to painful stimuli (straightens limb when given pain).
  Score of 3 - abnormal flexion to painful stimuli (moves in a strange way when given pain).
  Score of 4 - flexion/withdrawal to painful stimuli (moves away when given pain).
  Score of 5 - localizes painful stimuli (can pinpoint where pain is).
  Score of 6 - obeys commands.
  
  
   
• Brain injury will be classified in the Glasgow Coma Scale as:
  
  Coma = a score of 8 or less.
  Moderate = a score of 9 to 12.
  Minor = a score of 13 or more.

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Researchers working with NASA have developed a non-synthetic substance made of bone cells that replicates actual bone.  They intend to study how growth occurs in living bone.

We all have, or know someone who has, broken a bone.  Interestingly, there are numerous types of broken bones.  Not only is the probability of developing arthritis increased in the area of fracture, but additional complications result near joints.

The best way to prevent a fracture is to stop bones from reaching the point where they are prone to breaking, but understanding the process of how bones form and mature has been challenging.  A fracture, also referred to as a bone fracture, is a medical condition where the continuity of the bone is broke. A significant percentage of bone fractures occur because of high force impact or stress; however, a fracture may also be the result of some medical conditions which weaken the bones, for example osteoporosis. A fracture caused by a medical condition is known as a pathological fracture.

The word break is commonly used by lay (non-professional) people. Among health care professionals, especially bone specialists, such as orthopedic surgeons, break is a much less common term when talking about bones.

A crack (not only a break) in the bone is also known as a fracture. Fractures can occur in any bone in the body. There are several different ways in which a bone can fracture; for example a clean break to the bone that does not damage surrounding tissue or tear through the skin is known as a closed fracture or a simple fracture. On the other hand, one that damages surrounding skin or tissue is known as a compound fracture or an open fracture. Compound or open fractures are generally more serious than simple fractures, with a much higher risk of infection.

Most human bones are surprisingly strong and can generally stand up to fairly strong impacts or forces. However, if that force is too powerful, or there is something wrong with the bone, it can fracture.  With travel speeds and related sudden stop velocity (crash) in cars, trains and planes far exceeding the old fashioned modes of walking, horseback riding (or elephant riding if you are from India), forces have greatly varied in modern times.

The older we get the less force our bones can withstand. Approximately 50% of women and about 20% of men have a fracture after they are 50 years old (Source: National Health Service, UK).

Because children's bones are more elastic, when they do have fractures they tend to be different. Children also have growth plates at the end of their bones - areas of growing bone - which may sometimes be damaged.

Some different types of fracture:

• Avulsion fracture - a muscle or ligament pulls on the bone, fracturing it.
   
• Comminuted fracture - the bone is shattered into many pieces.
   
• Compression (crush) fracture - generally occurs in the spongy bone in the spine. For example, the front portion of a vertebra in the spine may collapse due to osteoporosis.
   
• Fracture dislocation - a joint becomes dislocated, and one of the bones of the joint has a fracture.
    
• Hairline fracture - a partial fracture of the bone. Often this type of fracture is harder to detect. 
   
• Impacted fracture - when the bone is fractured, one fragment of bone goes into another.
   
• Longitudinal fracture - the break is along the length of the bone.
   
• Oblique fracture - A fracture that is diagonal to a bone's long axis.
   
• Pathological fracture - when an underlying disease or condition has already weakened the bone, resulting in a fracture (bone fracture caused by an underlying disease/condition that weakened the bone).
   
• Spiral fracture - A fracture where at least one part of the bone has been twisted.
   
• Stress fracture - more common among athletes. A bone breaks because of repeated stresses and strains.
   
• Torus (buckle) fracture - bone deforms but does not crack. More common in children. It is painful but stable.
   
• Transverse fracture - a straight break right across a bone.

 Now researchers at the University of Houston department of health and human performance have created a process that grows real human bone in tissue culture, which can be used to investigate how bones form and grow. 

The research is ready to market and hopefully will help in the prevention of broken bones and advance our ability to heal them.

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Robert C. Griggs, MD, FAAN, President of the American Academy of Neurology and The American Academy of Neurology, the world's largest professional association of neurologists, is encouraged by news reports that the National Football League will soon implement a new policy requiring an independent neurologist to evaluate players who have suffered a concussion. The Academy would welcome an opportunity to work with the NFL to implement this new policy change as it is imperative that an unbiased neurologist be involved in determining when it is safe for a player to return to play. The Academy has a network of sports neurologists available nationwide who are members of the Academy's Sports Neurology Section. For more information about the American Academy of Neurology, visit http://www.aan.com.
 

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Size is not what counts in the hunt for the most intelligent.  Whales have brains weighing 9 kg (with over 200 billion nerve cells), and human brains vary between 1.25 kg and 1.45 kg (with an estimated 85 billion nerve cells). A honeybee's brain weighs only 1 milligram and contains fewer than a million nerve cells. 
 

Insects may have tiny brains, but they can perform some seriously impressive feats of mental gymnastics.

According to a growing number of studies, some insects can count, categorize objects, even recognize human faces -- all with brains the size of pinheads.

WATCH VIDEO: Take a closer look at the lives of mosquitoes, maggots and other creepy crawlies.

Despite many attempts to link the volume of an animal's brain with the depth of its intelligence, scientists now propose that it's the complexity of connections between brain cells that matters most. Studying those connections -- a more manageable task in a little brain than in a big one -- could help researchers understand how bigger brains, including those of humans, work.

Scientists at Queen Mary, University of London, state that contrary to popular belief, we can't say that brain size predicts the capacity for intelligent behavior.

Research repeatedly shows how insects are capable of some intelligent behaviors scientists previously thought were unique to larger animals.

Research suggests that bigger animals may need bigger brains simply because there is more to control - for example they need to move bigger muscles and therefore need more and bigger nerves to move them.

The entire article is presented in the journal Current Biology.  Read more here.

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 The belief that healthy older brains are substantially smaller than younger brains may stem from studies that did not screen out people whose undetected, slowly developing brain disease was killing off cells in key areas, according to new research. As a result, previous findings may have overestimated atrophy and underestimated normal size for the older brain.
 

The seeming age-related atrophy in gray matter more likely reflected pathological changes in the brain that underlie significant cognitive decline than aging itself, the authors wrote. As long as people stay cognitively healthy, the researchers believe that the gray matter of areas supporting cognition might not shrink much at all.

"The Prevalence of Cortical Gray Matter Atrophy May Be Overestimated In the Healthy Aging Brain,"
Saartje Burgmans, PhD student, Martin P. J. van Boxtel, PhD, MD, Eric F. P. M. Vuurman, PhD, Floortje Smeets, PhD student, and Ed H. B. M. Gronenschild, PhD, Maastricht University; Harry B. M. Uylings, PhD, Maastricht University and VU University Medical Center Amsterdam; and Jelle Jolles, PhD, Maastricht University;
Neuropsychology, Vol. 23, No. 5.
 

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Advance in neuroimaging are always exciting as they assist doctors and clinicians in treating patients with traumatic brain injury. 

Functional magnetic resonance imaging (fMRI) is a technique widely used in studying the human brain. However, it has long been unclear exactly how fMRI signals are generated at brain cell level. This information is crucially important to interpreting these imaging signals. Scientists from the Academy of Finland's Neuroscience Research Programme (NEURO) have discovered that astrocytes, support cells in brain tissue, play a key role in the generation of fMRI signals.

Functional magnetic imaging has become a highly popular method in basic neurobiological research, psychology, medicine as well as in areas of study that interface with the social sciences and economics, such as neuroeconomics. fMRI imaging does not directly measure the activity of nerve cells or neural networks, but local changes in cerebrovascular circulation during the execution of certain functions. Interpretation of the measurement data obtained with this method therefore requires a close knowledge of the cell-level mechanisms that are responsible for these local changes in cerebrovascular circulation.
 

Read morehere.

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A New Study from  the University of Tulsa, published in the Journal of Clinical and Experimental Neuropsychology (Neuropsychological impairment and psychosis in mania. Journal of Clinical and Experimental Neuropsychology, 2009;31(5):523-532),  finds Deficits involving executive function, working memory, speed of information processing, and new learning Occur in many people with mania. Factors that predict impairment remain poorly understood, but there are indications that psychotic features may correspond with increased risk of neurocognitive dysfunction during manic episodes.

"The current study examined neuropsychological function in 40 inpatients with bipolar I mania, 24 of whom presented with psychotic features. Compared to a control group, the inpatients showed worse executive function, speed of information processing, new learning, and dexterity. Nonetheless, presence of psychotic features failed to distinguish the inpatients with mania. Thus, psychotic features do not appear to increase neurobehavioral morbidity in people with mania, but presence of mania clearly corresponded with neurobehavioral dysfunction," wrote M.R. Basso and colleagues, University of Tulsa.

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Reporting their results in the Journal of Neuroscience, Scientists show that Inhibiting an enzyme in the brains of newborns suffering from oxygen and blood flow deprivation stops a type of brain damage that is a leading cause of cerebral palsy, mental retardation and death, according to researchers at Cincinnati Children's Hospital Medical Center.

This is a breakthrough which will save lives and promote healthy delivery of newborns.  Although it is still experimental.

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The American Association of Neurological Surgeons reported research on Depression this month.

Electroconvulsive therapy (ECT) is effective in approximately 70 percent of cases in which antidepressant medications do not provide adequate relief of symptoms. However, as many as 20 to 50 percent of patients who initially respond well to ECT treatment, suffer a relapse within six months, therefore, periodic maintenance therapy is often required.

Researchers at three medical schools, Harvard, University of Pittsburg and Medical College of Wisconsin, counducted a study entitled "Long Term Follow-up of Cortical Stimulation to Treat Major Depressive Disorder."  They investigated ECT stimulation for patients with major depressive disorder.

The World Health Organization rates major depression as the top cause of disability worldwide, with an estimated 340 million people suffering from an episode of major depression every year. While most patients with major depression find relief through a combination of psychotherapy and medication, about 20 percent of patients fail to respond. Patients who are most resistant to medications, psychotherapies, and electroconvulsive therapy (ECT) have little hope of recovery, and suffer a heightened risk of suicide and mortality. Sadly, statistics show that the suicide rate in people with major depression is as high as 15 percent.

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