Cranial injury, traumatic marrow injury, and their influence in driving
Cranial injuries causes more deaths and disabilities than any other neurological problem under 50 years of age, and is the main cause of death in the adults and young people less than 35 years, mainly due to traffic accidents.
The imprudence in driving and the limited experience in driving are the leading causes that provoking traffic accidents, particularly in the youngest population.
With this regard, every year 40,000 new cases of brain injuries, most of them caused by traffic accidents, and the rest are occupation or sports accidents.
Nearly half of the serious cranial injuries die: the treatment only reduces mortality slightly.
The lesions are due to penetrating wounds in the skull or to the acceleration or fast deceleration of the brain, damaging the tissues at the site of impact, by counterattack in the opposed pole, and diffusely in the brain.
Nerve disruptions, ischemia or intracerebral and extracerebral bleeding occur, also with brain edema with intracranial hypertension.
Skull fractures can break meningeal arteries or venous sinuses, resulting in epidural or subdural hematoma. If they damage the meninges of the basis rhinorrhea or otorrhea occur.
Head injury can cause immediate loss of consciousness, that if transient and not associated with serious brain injuries, determines the concussion.
Brain contusion and brain lacerations are more serious injuries, frequently associated with hemiplegia or other focal signs of cortical dysfunction.
Chronic subdural hematoma may not cause symptoms until several weeks after the injury, and is characterized by delayed neurological impairment, with increasing daily headache, fluctuating somnolence and confusion, and mild to moderate hemiparesis.
Posttraumatic epilepsy with seizures can start until several years after the injury, hence some patients should receive a preventive anticonvulsant treatment for a long period.
The convalescence after any serious cranial injury is characterized by the presence of posttraumatic amnesia, measured up to the recovery of the complete and permanent level of consciousness.
The post-concussion syndrome is characterized by confusion, variable amnesia, lack of attention and concentration, headache, anxiety, depression and apathy, a condition that causes significant disability and improves when the patient can be calm.
Most of the recovery after a serious cranial injury occurs in the adult in the first six months, and small adjustments persists until two years later.
Advice on cranial injury
- The objective assessment of the disorders of concentration, attention, and memory, together with personality changes, determine the disability for social relations, work and driving, that is often more important than the residual neurological injuries.
- The physician, given the favorable evolution, free from sequels, for a time that can be prolonged, indicate when the patient can drive safely again.
- It is important to assess the neurological sequels that admit adapting the car to obtain the driving license with the restrictions established by the law.
- For this purpose, a medical report is required specifying clearly the disability of the driver to be compensated, as well as any conditioning factors that can exist in terms of concentration, memory and personality.
- The anticonvulsant drugs indicated in the long term in cases of posttraumatic epilepsy can lead to side effects such as somnolence, ataxia, nystagmus, nausea, visual disturbances, headache, etc., of which the patient should be warned for their possible interference with driving.
- It is important to insist to these drivers that they fulfill the treatment correctly and in no case drink alcohol, because a convulsive crisis while driving an have tragic consequences.
- Research in this field it is one of the most important tools to advance in the prevention, since it provides judgment elements that are solid and scientifically proven.
Traumatic marrow injury
The losses of neurological function for marrow injury can be short-lived due to concussion, long-lasting due to contusion or bleeding, and permanent due to laceration or section.
- Symptoms and signs: Acute cross marrow injury causes immediate flaccid paralysis and loss of all sensitivity and of the reflex activity under the level of the injury. The outcome is usually to spastic paraplegia.
Incomplete injuries of the spinal cord cause partial motor and sensory loss, depending on the affected paths.
The hemisection of the spinal cord causes a homolateral spastic paralysis and privation of postural sensitivity, with contralateral loss of the sensitivity for the pain and the temperature.
- Level of the marrow injury: Marrow injuries at the level of C4-C5 cause complete tetraplegia, although between C5-C6, the arms can carry out abduction and the flexure.
Between C6-C7, it paralyzes the legs, the wrists and the hands, but permits the movement of the shoulder and the flexure of the elbow.
The injuries between C8-D1 cause Horner syndrome with myosis and ptosis.
Between D11-D12 the muscles of thighs and legs are affected.
The injuries of D12-L1 cause paralysis below the knee.
The injuries in the cauda equina provoke hyporeflexic paresis of the legs, with pain in the innervation territory of the nerve roots.
The injuries of the sacral nerve roots 3rd, 4th and 5th or of the medullary cone at the level of L1, cause a complete loss of the control of the bladder and of the sphincters.
The section or nervous degeneration of the spinal cord cannot recover and is permanent, unlike the nervous tissue that undergoes compression, which usually recovers its function.
Advice on traumatic marrow injury
- In reversible marrow injuries, the patient cannot drive until he recovers, with immobilizations, bandages, surgical collars, corsets, etc.
- The physician will indicate the more or less prolonged period when driving is not permitted, and will inform adequately on the time when the patient, already completely recovered and with no sequels, can drive safely again.
- Any dysfunction that persists for over six months will be probably permanent. In this case we should indicate the possibility of adapting the car to the specific disability of the patient, to be able to obtain the driving license with the conditioning factors and restrictions established by the law.