An estimated 5.3 million Americans have at least one thing in common: they are living with a disability related to a traumatic brain injury (TBI).
Each year, approximately 1 million people in the U.S. are treated for a brain injury; of those, 80,000 leave the hospital with some TBI-related disability, according to the International Brain Injury Association. TBIs are among the most common injuries cyclists face – but not all TBIs are the same.
TBIs come in many forms, some with more severity than others. Sometimes even those “mild” cases have long-lasting effects.
With cycling becoming a growing activity across the Bay Area and northern California, it’s important to know the differences in brain injuries one might sustain. Crashes with negligent drivers can leave cyclists with pain, suffering, medical bills, and sometimes, a totally different life than the one they knew before the crash.
These common brain injuries that cyclists experience are all treated differently depending on severity and the individual case. If you’re in a crash and experiencing symptoms that may be a brain injury, seek medical care.
Concussions
Cyclists often experience mild TBIs, often called concussions, in crashes. These injuries happen when there is a jolt or blow to the head that forces the brain to rapidly move inside the skull and causes a disruption to brain function, which may include headaches, confusion, sleeping issues, balance and other symptoms.
While the crash may happen fast, the symptoms of a concussion may not occur right away. Current medical guidance is to commit to a 24-48 hour period of physical and cognitive rest — avoid extreme exercising, harsh lights and sounds, and activities that require intense concentration — with a gradual return to normal daily life thereafter.
For symptoms such as headache, people should take over-the-counter medications like acetaminophen, but avoid ibuprofen and aspirin as these can increase the chance of bleeding.
Check in with a medical professional after a crash and follow-up as necessary if your symptoms linger. Concussions are considered “mild” brain injuries, but they can have lasting impacts on people.
Contusions
Even though the brain is protected by the skull, bruising can still occur. Cerebral contusions typically originate in the brain’s cortical area, doctors say, but can also happen in other places of the brain in severe cases.
Here’s how medical researchers describe the seriousness of these injuries:
Cerebral contusions cause permanent damage to the tissues of the brain. The severity of the damage is related to the primary injury initiated by the kinetic energy absorbed during the collision and the cascade of secondary injury responses that exacerbate the primary damage. The hemorrhagic lesion is produced in the immediate moments after the head impact. These contusions extend to variable depths within the cortical gyri and invariably into subcortical regions, ranging from tiny punctate lesions to large lesions causing brain herniation.
Essentially, cerebral contusions can be extremely serious and damaging injuries to the brain.
For cyclists, contusions can occur because of the force involved in most crashes. In the Netherlands, road traffic accidents resulted in a contusion incidence of 46.6% among cyclists, according to a 2014 study.
Coup-Contrecoup Injuries
A coup-countrecoup injury could be considered a double whammy. It happens when damage occurs at the site of impact (coup) and then also on the opposite side of the brain (contrecoup).
“Intracerebral hemorrhage occurs in 13% to 48% of adults with traumatic brain injury. Of these patients, 13% to 77% have contrecoup hemorrhages, which most often occur with an occipital and temporal site of skull impact,” researchers say.
Like other TBIs, coup-contrecoup injuries can range in severity and symptoms vary. Headaches, dizziness, balance issues, cognitive difficulties, and nausea or vomiting may indicate a person has this type of injury, but imaging techniques will reveal the diagnosis. MRIs can help show what’s happening in the brain and the intensity of the injury.
While some people may need surgical intervention, others may require physical and cognitive therapies to recover.
Diffuse Axonal Injuries
High-speed collisions that create shaking or strong rotation of the head can cause the brain to shift in the skull and cause a severe TBI known as a diffuse axonal injury.
“Injury occurs because the unmoving brain lags behind the movement of the skull, causing nerve structures to tear. The tearing of the nerve tissue disrupts the brain’s regular communication and chemical processes,” the Brain Injury Association of America says.
As a result, a person may experience brain damage, coma, or death – depending on severity of the injury. Following the injury it’s common for a person to have cognitive challenges, trouble with memory, and even learning new information.
Skull Fractures
Cyclists may encounter skull fractures in high-impact crashes, especially when a helmet isn’t in the picture. Skull fractures can happen in conjunction with other head and brain injuries. A person might experience swelling, bleeding, bruising, and severe headaches as a result of a skull fracture, which can be either compound (visible through the skin) or closed (when the skin remains intact). Compound skull fractures are especially troublesome and require immediate medical care.
A range of treatment approaches are deployed depending on the severity of the skull fracture. Medications for pain and seizures may be required as well as fluid drainage when a fracture causes cerebrospinal fluid leaks.
Skull fractures, especially when severe, can be life altering. Cycling and medical experts alike say this is why helmets should be worn by every cyclist.
Researchers who conducted a 2023 review in London found that “…helmeted cyclists have a considerable reduction in skull fracture and focal brain pathologies compared to non-helmeted cyclists, as well as a reduction in all brain pathologies.”
Injured? It’s Best to Act Quick
While some of these common brain injuries will warrant immediate care, others, like concussion, may take days to fully develop. However, treating a mild TBI as soon as possible is important to prevent lasting damage and worsening the injury.
When you’re in a crash, pay close attention to symptoms, keep track of them as best as possible, and don’t hesitate opting for a medical professional’s opinion. This is critical for your health, and in the case of a lawsuit, it will be necessary to have evidence of your injury.
Working with the legal experts at Bay Area Bicycle Law can help with the complexities and nuances of the legal process. For a free consultation, call (415) 466-8717.