Tracy Morgan Faces Uncertain Recovery from Traumatic Brain Injury

 30 Rock star Tracy Morgan is facing a more difficult recovery than previously reported. Morgan was one of six injured when a Walmart truck hit his tour bus on the New Jersey Turnpike on June 7. Comedian James McNair, who performed under the name Uncle Jimmy Mack, was killed in the multi-car accident. Morgan not only had a broken leg, a broken femur, a broken nose and several broken ribs, but according to his lawyer, Benedict Morelli, also sustained a traumatic brain injury.

And it is uncertain whether Morgan will be able to fully recovery or to return to work as a comedian. Morelli told PEOPLE magazine:

“He’s fighting to get better, and if there’s a chance for him to be back to the Tracy Morgan he once was, he’s going to try to do that. But we just don’t know because of the severity of the injuries that he sustained and the fact that he had such a severe brain injury…. When you have a traumatic brain injury it takes a very long time to find out how you’re going to do and how much you’re going to recover.”

Morgan is suing Walmart for punitive and compensatory damages. The driver of the Walmart had been driving for over 24 hours without sleep at the time of the accident. Walmart has countered that Morgan and the others injured in the accident are partially to blame as they were not wearing seat belts at the time of the crash.

What is Traumatic Brain Injury (TBI)?

Traumatic brain injury (TBI), a form of acquired brain injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. In the U.S., an estimated 1.7 million people sustain a traumatic brain injury (TBI) each year.


What Are the Different Types of TBI?

Concussion is the most minor and the most common type of TBI. Technically, a concussion is a short loss of consciousness in response to a head injury, but in common language the term has come to mean any minor injury to the head or brain.

Other injuries are more severe. As the first line of defense, the skull is particularly vulnerable to injury. Skull fractures occur when the bone of the skull cracks or breaks. A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain. A penetrating skull fracture occurs when something pierces the skull, such as a bullet, leaving a distinct and localized injury to brain tissue.

Skull fractures can cause bruising of brain tissue called a contusion. A contusion is a distinct area of swollen brain tissue mixed with blood released from broken blood vessels. A contusion can also occur in response to shaking of the brain back and forth within the confines of the skull, an injury called . contrecoup .. This injury often occurs in car accidents after high-speed stops and in shaken baby syndrome, a severe form of head injury that occurs when a baby is shaken forcibly enough to cause the brain to bounce against the skull. In addition, contrecoup can cause diffuse axonal injury , also called shearing , which involves damage to individual nerve cells ( neurons ) and loss of connections among neurons. This can lead to a breakdown of overall communication among neurons in the brain.

Damage to a major blood vessel in the head can cause a hematoma , or heavy bleeding into or around the brain. Three types of hematomas can cause brain damage. An epidural hematoma involves bleeding into the area between the skull and the dura. With a subdural hematoma , bleeding is confined to the area between the dura and the arachnoid membrane . Bleeding within the brain itself is called intracerebral hematoma .

What are the symptoms of a TBI?

Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.  A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include:

  • headache
  • confusion
  • lightheadedness
  • dizziness, blurred vision or tired eyes
  • ringing in the ears
  • bad taste in the mouth
  • fatigue or lethargy
  • a change in sleep patterns
  • behavioral or mood changes
  • trouble with memory, concentration, attention, or thinking.

A person with a moderate or severe TBI may show these same symptoms, but may also:

  • have a headache that gets worse or does not go away
  • repeated vomiting or nausea
  • convulsions or seizures
  • an inability to awaken from sleep
  • dilation of one or both pupils of the eyes
  • slurred speech
  • weakness or numbness in the extremities
  • loss of coordination
  • increased confusion, restlessness, or agitation.

What Disabilities Can Result From a TBI?

Disabilities resulting from a TBI depend upon the severity of the injury, the location of the injury, and the age and general health of the patient. Some common disabilities include problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).

Within days to weeks of the head injury approximately 40 percent of TBI patients develop a host of troubling symptoms collectively called postconcussion syndrome (PCS). A patient need not have suffered a concussion or loss of consciousness to develop the syndrome and many patients with mild TBI suffer from PCS. Symptoms include headache, dizziness, vertigo (a sensation of spinning around or of objects spinning around the patient), memory problems, trouble concentrating, sleeping problems, restlessness, irritability, apathy, depression, and anxiety. These symptoms may last for a few weeks after the head injury. The syndrome is more prevalent in patients who had psychiatric symptoms, such as depression or anxiety, before the injury. Treatment for PCS may include medicines for pain and psychiatric conditions, and psychotherapy and occupational therapy todevelop coping skills.

Cognition is a term used to describe the processes of thinking, reasoning, problem solving, information processing, and memory. Most patients with severe TBI, if they recover consciousness, suffer from cognitive disabilities, including the loss of many higher level mental skills. The most common cognitive impairment among severely head-injured patients is memory loss, characterized by some loss of specific memories and the partial inability to form or store new ones. Some of these patients may experience post-traumatic amnesia (PTA) , either anterograde or retrograde. Anterograde PTA is impaired memory of events that happened after the TBI, while retrograde PTA is impaired memory of events that happened before the TBI.

Many patients with mild to moderate head injuries who experience cognitive deficits become easily confused or distracted and have problems with concentration and attention. They also have problems with higher level, so-called executive functions, such as planning, organizing, abstract reasoning, problem solving, and making judgments, which may make it difficult to resume pre-injury work-related activities. Recovery from cognitive deficits is greatest within the first 6 months after the injury and more gradual after that.

Many TBI patients have sensory problems, especially problems with vision. Patients may not be able to register what they are seeing or may be slow to recognize objects. Also, TBI patients often have difficulty with hand-eye coordination. Because of this, TBI patients may be prone to bumping into or dropping objects, or may seem generally unsteady. TBI patients may have difficulty driving a car, working complex machinery, or playing sports. Other sensory deficits may include problems with hearing, smell, taste, or touch. Some TBI patients develop tinnitus, a ringing or roaring in the ears. A person with damage to the part of the brain that processes taste or smell may develop a persistent bitter taste in the mouth or perceive a persistent noxious smell. Damage to the part of the brain that controls the sense of touch may cause a TBI patient to develop persistent skin tingling, itching, or pain. Although rare, these conditions are hard to treat.

Language and communication problems are common disabilities in TBI patients. Some may experience aphasia , defined as difficulty with understanding and producing spoken and written language; others may have difficulty with the more subtle aspects of communication, such as body language and emotional, non-verbal signals.

What Kinds of Rehabilitation Should a TBI Patient Receive?

Rehabilitation is an important part of the recovery process for a TBI patient. During the acute stage, moderately to severely injured patients may receive treatment and care in an intensive care unit of a hospital. Once stable, the patient may be transferred to a subacute unit of the medical center or to an independent rehabilitation hospital. At this point, patients follow many diverse paths toward recovery because there are a wide variety of options for rehabilitation.

The overall goal of rehabilitation after a TBI is to improve the patient’s ability to function at home and in society. Therapists help the patient adapt to disabilities or change the patient’s living space, called environmental modification, to make everyday activities easier.

Some patients may need medication for psychiatric and physical problems resulting from the TBI. Great care must be taken in prescribing medications because TBI patients are more susceptible to side effects and may react adversely to some pharmacological agents. It is important for the family to provide social support for the patient by being involved in the rehabilitation program. Family members may also benefit from psychotherapy.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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