Amnesia Victim Chronicles Plight In His Memoir ‘My Life, Deleted’

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Posted on 25th September 2011 by Gordon Johnson in Brain Injury

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Popular culture, both films and TV shows, have often used amnesia as a dramatic plot device. But when this kind of thing happens in reality, it proves to be a cruel twist of fate for all those involved.

Such was the case with Scott Bolzan, a former pro football player and jet-company official. Bolzan’s life was changed forever on Dec. 17, 2008. He fell on an oil slick in his office and woke up in Scottsdale Healthcare Hospital in Arizona.

Not only did Bolzan not know his name, he didn’t know what the word “name” meant. He not only didn’t know that he had a wife, he didn’t know what the word “wife” meant. He had lost his memory in a phenomenon called retrograde amnesia.

The New York Post recently wrote a story based on Bolzan’s memoir about his experience, “My Life, Deleted,” which Harper One is releasing next month.

http://www.nypost.com/p/news/national/one_fall_and_life_erased_ioObt6juZkj8Bc6JHDHr0M

When he was initially hospitalized, Bolzan at one point asked, “What’s the NFL?” Yet he had played briefly for the New England Patriots and the Cleveland Browns.

According to The Post story, Bolzan’s episodic and conceptual semantic memory were both damaged when he fell and hit his head. So he could no longer remember his childhood or make sense of idioms. Yet he still retained his procedural memory, meaning he could remember things like how to drive a car and what a touchdown was.

After testing, Bolzan was diagnosed with a concussion and released from the hospital two days after he was admitted. Physicians assured Bolzan that his memory would come back in a few weeks.

But the amnesia continued, and Bolzan began having bad headaches, mood swings and insomnia, according to The Post. He went to several doctors, to no avail.

Finally, an Arizona neurologist ordered a SPECT scan of Bolzan’s brain. It found that the blood flow to his frontal and temporal lobes has been restricted. The temporal lobe is the part of the brain that controls memory and its storage.

The prognosis wasn’t good: Bolzan was told he would never recover his memories.

There is new research being done on bringing back the memory of amnesia victims, and maybe someday there will be a way for Bolzan to recall his past.

In the meantime, Bolzan said he is grieving the loss of his original identity.

Focal Brain Injuries

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Posted on 20th September 2011 by Gordon Johnson in Brain Injury

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Diffuse versus Focal Injuries:

“Contact phenomenon”, typically result in what is called a “focal” brain injury as opposed to a “diffuse” brain injury.

The term “diffuse” is used to describe the situation where the pathology is spread throughout the brain.

Focal Brain Injuries:

Focal injuries are typically large enough that they can be identified “macroscopically” (meaning without the use of a microscope) and diffuse injuries are typically microscopic.

Impact Phenomenon can result in the following focal injuries:

  • Contusions on the surface of the brain;
  • Hematoma, (a localized area of blood as a result of vessel leakage or bleeding);
    • Epidural (above the dura – a collection of blood between the dura and the skull);
    • Subdural (below the dura – a collection of blood between the dura and the brain);
    • Intracerebral (a collection of blood within the brain.)
    • The dura is the protective sheath around the brain, between the brain and the skull
  • Hemorrhage;
    • Epidural,
    • subdural
    • or intracerebral.
  • Edema; Excessive water accumulation resulting in swelling.

Internal Mechanisms of Brain Injury

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Posted on 19th September 2011 by Gordon Johnson in Brain Injury

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While we often picture the brain being injured as a result of the external force on the head, it is what happens inside the skull, which causes the “closed head injury”. The term “closed head injury” means an injury to the brain where the skull is not broken or penetrated.

While there are many complex interrelationships which explain the internal injury, the two most significant causes of injury to the brain are the “contact” of the head with a blunt object and the “inertia” which may occur as a result of a rapid acceleration or deceleration of the brain. The terms “impact” and “shear” are also often used to differentiate the internal mechanisms of injury between the contact and inertial causes of injury.

In using the term “impact injury” it is not the impact with the head with something that is being described, but the impact of the brain with the hard, often sharp interior of the skull. The term “contact phenomenon” is used to describe the sequence of events which occurs when the energy of the impact of the head with something is transferred to the brain. These “contact phenomenon” include deformation of the skull and shock waves which emanate at the speed of sound from the point of impact throughout the brain.
Source: Greenfield’s Neuropathology, ©1997, Arnold, page 199.

Coup – Contrecoup Brain Injury

Injury from contact forces often occurs in two places – the site of the initial impact of the brain with the skull and the diametrically opposite part of the brain. This happens because of the rebound of the brain from the initial impact with the skull. To describe this phenomenon, the terms coup and contrecoup are used.

For more information go to http://www.subtlebraininjury.com

 

Mechanisms of Brain Injury

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Posted on 16th September 2011 by Gordon Johnson in Brain Injury

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There are many events which can result in brain injury, such as a blow to the head, the head striking an object, a penetration of the skull such as in a gunshot, or particularly relevant to auto accident cases, by rapid acceleration and deceleration of the brain.

In each of the above events, the brain can be injured both by impact and rotational or shear forces. While it is the common conception that impact damage comes from blows to the head and shear damage from whiplash forces, both types of damage can occur from either mechanism.

Impact damage tends to be focal, meaning concentrated in specific parts of the brain, whereas shear injuries tend to be diffuse, meaning occurring throughout widespread portions of the brain. Thus, the term “Diffuse Axonal Injury” meaning widespread injury to the axons, the long thin portion of the neuron.

Mechanisms of Brain Injury:
  • A Blow to the Head;
  • The Head Hitting an Object;
  • A Rapid Acceleration/Deceleration Movement, such as Whiplash.

Grades of Concussions

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Posted on 12th September 2011 by Gordon Johnson in Brain Injury

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“There is no such thing as a minor concussion.” – American Academy of Neurology.

The AAN defines concussion as a “alteration of mental status due to a biomechanical forces affecting the brain.” The AAN definition does not require a loss of consciousness. The AAN guidelines, break down concussion into three grades:

  • Grade 1:
    • Transient confusion;
    • NO loss of consciousness;
    • Concussion symptoms clear in less than 15 minutes.
  • Grade 2:
    • Transient confusion;
    • NO loss of consciousness;
    • Concussion symptoms or mental status abnormalities last longer than 15 minutes.
  • Grade 3:
    • Any loss of consciousness, either brief (seconds) or prolonged (minutes).

The AAN guidelines make it clear that permanent brain injury can occur with either Grade 2 or Grade 3 concussion. Thus, it is clear that subtle brain injury can have permanent consequences if the acute symptoms of the concussion continue for more than 15 minutes.

A major development in the arena of increasing awareness of the seriousness of all brain injury, has come with the American Academy of Neurology’s, (in conjunction with the Brain Injury Association) development of guidelines for the “Management of Concussion in Sports.”*

*Source: James P. Kelly, MD, and Jay H. Rosenberg, MD. “Diagnosis and management of concussion in sports”. ©Neurology. 1997. p 575-580.

After A Concussion, Filling In A Memory Loss With A GPS

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Posted on 10th September 2011 by Gordon Johnson in Brain Injury

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A veteran cyclist, who couldn’ t remember how and why he crashed while riding among the redwoods in California, found a way to put together the pieces. He used his GPS.

John Markoff wrote a first-person story for The New York Times last week about the memory loss he suffered after sustaining a concussion, and other injuries, after an accident on his bike. Markoff wrote that he broke his nose, had scrapes and stitches on his face, had a deep cut on his knee and was knocked unconscious in his July 3 crash.

But Markoff, who had been riding alone, had a 20-minute memory gap. He could not remember the accident or what caused it.

In The Times, Markoff said he watched the Tour de France when he was recovering. American entrant Chris Horner had sustained a concussion, but still finished. Then, according to Markeoff, Horner “turned to his coach and asked, ‘I crashed? I finished?’”

Markoff said he could relate. He was determined to find out why he crashed.

He wound up doing that, as other cyclists apparently have, by using data from his GPS device. He has a Garmin model that not only tracks location and speed but also a rider’s heart rate and pedaling rate.

Markoff uploaded that data and learned that at the time of his accident his speed in eight minutes had gone from 30 mph to 10 mph to zero, according to his account in The Times. He also saw the exact location of his crash.

So Markoff went back to the wooded area where he had his accident. He saw a slim long pothole that easily could have caused his accident, and flashes of what happened that day finally came back to him.

Markoff isn’t the only one who has used a GPS device to figure out exactly what happened in an accident. His account quotes a lawyer who believes that witnesses  who can testify about accidents based on GPS readings could become a new category of expert witnesses in court.  

  

 

 

http://www.nytimes.com/2011/09/06/science/06accident.html?ref=science

 

Focal neurological deficit

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Posted on 9th September 2011 by Gordon Johnson in Brain Injury

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The last alternative of the American Congress of Rehabilitation Medicine’s Acute Event element, is the focal neurological deficit. Focal, (meaning restricted to one particular part of the body), neurological deficit, (meaning something wrong in the way in which the nervous system is responding), is the one element that the best source, will likely be the medical records. Most emergency room examinations will look for this type of indicator. Examples would be problems with vision, smell, hearing, taste and eye movements.

However, even the neurological exam is often incomplete. The most likely focal neurological deficit after head injury is the sense of smell. Yet even though there actually is a smell test available, of the scratch and sniff variety, in our experience this is never administered in the ER and rarely in followup neurological exams. If the smell test has not been given, the neurological exam is not complete. Insist on it the next time you see a neurologist if you have any concerns in this area.

Another focal neurological deficit that is often present, but goes undiagnosed, is one that relates to the vestibular system. Balance problems, vertigo and dizziness are very common after head injury, and can be objectively quantified if the proper tests are administered, especially in the acute stage, yet they are rarely administered. See our page on Vestibular Disorders, which addresses issues of vertigo and dizziness associated with trauma to the brain.

Amnesia

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Posted on 8th September 2011 by Gordon Johnson in Brain Injury

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Amnesia After Brain Injury Is Not Typically A Total Loss. No need for total loss, ala Hollywood. The American Congress of Rehabilitation Medicine definition talks about “any loss of memory for events immediately before or after the accident.”

Loss of memory for events before the accident is called retrograde amnesia, i.e. similar to the use of the term retroactive, i.e. something that relates back to a time prior to the event.

Loss of memory for events after the accident is called anterograde amnesia. This also includes problems with new learning.

In all likelihood, there will holes in memory, but no predicting where and when the holes will appear. That is why the term “Swiss Cheese Memory” is used. The location of the memory holes, at any given layer of memory, may be as difficult to predict as the location of the holes in a slice of Swiss cheese.

Amnesia is perhaps the easiest element to reconstruct. A detailed interview of the injured person and his or her family, will often identify the amnesia. Watch for “confabulation”, the brain injured person reconstructing memory, and/or filling in the blanks.

The length of amnesia may be a better predictor of the severity of brain injury than the traditional method of classifying based upon the length of loss of consciousness. Injuries are regarded as severe if post traumatic amnesia (PTA) exceeds 24 hours and very severe if the PTA exceeds one week.

For more information see http://www.subtlebraininjury.com

Change In Mental State After Brain Injury

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Posted on 6th September 2011 by Gordon Johnson in Brain Injury

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  • Ambulance CrewAny Alteration in Consciousness.
  • Confusion, acting unusual.
  • Not just at the scene, but hours later.
  • Repeating themselves.
  • Difficulty with Routine Tasks

If the inquiry does not identify a period of loss of consciousness, it may very well identify a change in mental state, such as being dazed or confused. Here the ambulance reports can be particularly helpful.

Also accident scene witnesses – police officers, ambulance attendants, passers by, even the driver of the other car may provide clues as to a change in mental state.

Accident ReportThe change in mental state can also occur hours after the accident: was the patient confused when they returned home? Were they just not themselves?

One particularly common symptom in our experience is the patient continually asks the same question, again and again. Or as common, tells the same person, over and over again, what happened in the accident.

For more information see http://www.subtlebraininjury.com

Tennessee Women’s Basketball Coach Goes Public With Alzheimer’s Diagnosis

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Posted on 5th September 2011 by Gordon Johnson in Brain Injury

Pat Summitt, the veteran women’s basketball coach at the University of Tennessee, made a remarkable and brave admission last month. She told the world that she has Alzheimer’s disease.

Summitt, who is only 59, announced her diagnosis through a letter and video clip posted on the university’s website. She was diagnosed with early-onset Alzheimer’s at the Mayor Clinic in Rochester, Minn. And she intend to continue coaching, increasingly depending on her staff,

 http://www.utk.edu/tntoday/2011/08/23/pat-summitt-letter/

 The New York Time ran a story about Summitt’s news on its front page.

 http://www.nytimes.com/2011/08/24/sports/ncaabasketball/tennessees-summitt-reveals-dementia-diagnosis.html?scp=4&sq=pat%20summitt&st=cse

But the coach’s eloquent letter, with portions reprinted below, speaks for itself:

“Throughout my career, I have always made it a point that my life and my basketball program were an open book.

With that in mind, I have something I’d like to share with my Tennessee families – the university, boosters and fans of Lady Vol basketball.

Once last season concluded, I addressed some ongoing concerns regarding my health. After consulting with my local physicians, I decided to visit the Mayo Clinic in Rochester, Minn.

Earlier this summer, the doctors at the Mayo Clinic diagnosed me with early onset dementia (“Alzheimer’s Type”) at the age of 59.

I plan to continue to be your coach. Obviously, I realize I may have some limitations with this condition since there will be some good days and some bad days.

For that reason I will be relying on my outstanding coaching staff like never before. We have always collaborated on every facet of Lady Vol basketball; and now you will see Holly Warlick, Dean Lockwood and Mickie DeMoss taking on more responsibility as their duties will change significantly.

I love being your coach, and the privilege to go to work every day with our outstanding Lady Vol basketball student-athletes. I appreciate the complete support of UT Chancellor Dr. Jimmy Cheek and UT Athletics Director Joan Cronan to continue coaching at the University of Tennessee as long as the good Lord is willing.”

 Summitt’s gutsy move will make her a national poster child for Alzheimer’s. If anyone, she looks like someone who is up to the task. She’s tough and determined. Her women’s team has won right national championships. And she told The Knoxville News Sentinel that she doesn’t want any “pity party.”

 Summitt addressed her problem head on. At the end of last season, after she was having memory problems – like not being able to remember when meetings were scheduled – she want to her doctor. He sent her to the Mayo Clinic.   

 Perhaps her diagnosis was not such a surprise. There is a history of dementia in her family.

 In any event, I salute her bravery. And I hope this disease’s affect on Summitt is slow-moving, taking an eternity.

 

 

 

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