The Jules Bianchi accident

electricmaker40 said:Guys... do you actually have any idea what you're talking about here?
Massa dealt with a minor suspension snap at 120mph... Berger hit a wall and lost consciousness...

The DAI situation involving Bianchi is easily the biggest thing since Schumacher’s downfall... maybe the only thing comparable to that Sennin accident, where a tire and a chunk of suspension ended up hitting him in the head...

Bianchi has maybe a 10% chance of survival... and even if he does, most patients end up in a vegetative state... the ones who actually wake up usually deal with severe disabilities... maybe try doing a little research before you start posting on the forum!

Sent from my iPhone.

Yeah, but it’s not quite that straightforward. When we're talking about a traumatic brain injury, you can't just focus on the primary trauma—the actual impact itself—because there's also... Secondary injuries.There are certain types of injuries—like what happened with Schumacher—that don't necessarily show up the second the impact occurs. Instead, they tend to develop gradually over the following hours or even days after the initial trauma. I guess that’s why it feels wrong to look at his decline in isolation, without accounting for everything that happened with his brain later on, which only really reached its conclusion once that entire process we call... I guess we should probably talk about secondary brain injuries. It’s one of those things that doesn't get enough attention, but it's arguably just as critical as the initial trauma itself. Even if the first hit seems to be managed, the cascade of events that follows—things like swelling, oxygen deprivation, or chemical imbalances—can really complicate the recovery process. Maybe it's worth looking closer at how we manage those follow-up complications to prevent further damage.That's what ultimately caused his brain injuries. And unfortunately, they were pretty severe.

Look, even though Michael's primary injury was definitely less severe than Bianchi's—which is pretty obvious at first glance given the nature of the accident and the fact that he wasn't in a coma from the jump—that doesn't really mean as much as it might seem. When you factor in these secondary injuries he sustained, things get a bit more complicated. It’s basically one long chain reaction—an incredibly complex biochemical cascade that kicks off right after that initial injury. So, there’s this secondary injury that basically builds on top of the initial one—I’ll dive deeper into that later—but by the end of that process, Michael's brain injury wasn't exactly a minor thing anymore. You really can't look at his condition through the lens of just the primary injury, or what happened at the exact moment of the accident, if you want to understand the full picture.

Let me try to clarify this: when you're looking at head trauma, you shouldn't assume the injury is "done" or "finalized" immediately after the accident occurs. Just because the initial impact and the immediate brain injury are visible right then doesn't mean you've seen the whole picture. Most of the actual damage isn't fully apparent the second the hit happens; instead, it tends to develop over time. Some people haven't even stepped up to the plate yet.And then there are the ones who haven't even stepped up yet—the ones doctors are actually fighting against. Just finished some work on the bores. Once you actually get admitted to the ER, things can go south fast. Honestly, the psychological toll of being stuck in that environment might be even worse than the initial injury itself.

But you have to look at the "total damage"—meaning the actual extent of someone's brain injury—within a broader context. I guess you can't just look at one metric in isolation. I guess you have to account for both the primary injury and the secondary one. So, basically, you’re looking at that secondary cascade—the whole follow-up process that, like I mentioned before, ends up causing even more damage. We're talking ischemia, metabolic disruptions, and the onset of edema, which then jacks up the intracranial pressure, leading to neuronal degeneration and, eventually, death. It seems like there isn't much to go on here. Just a single word. I guess we're starting from scratch? It’s kind of hard to gauge the actual severity of a brain injury if you only look at the primary damage from the initial impact. You really have to factor in how those secondary injuries build on top of the first ones. I guess you can only truly wrap your head around how serious the situation is when you look at both pieces together.

It’s worth noting if you want to understand why someone who seemingly walked away from a minor accident might end up with much worse long-term outcomes than someone who sustained a massive, obvious primary injury. It happens more often than you'd think, especially with traumatic brain injuries. You see people who looked "fine" at the scene end up with permanent deficits, while the person who took a direct hit seems to recover better. I guess it all comes down to secondary injuries—basically, the physiological domino effect that starts unfolding minutes, hours, or even days after the initial impact. To put it in layman's terms, we often see cases where—well, you know. The worst part—the part that’s actually going to fry your brain—is still on its way.Regarding the damage, the brain hasn't even hit its worst point from that initial impact yet; the real trouble comes from this cascading chain of secondary injuries.

The severity of someone's ultimate injury—and their actual chance at recovery—really hinges on how effectively doctors can step in to halt those secondary processes. That’s where medical teams focus their energy, rather than just looking at the primary, often irreversible damage (though they're obviously linked, since the first triggers the second). The real danger to the patient lies in these subsequent stages, so the goal is to intervene and mitigate them as much as possible. You see, once cellular death occurs following that primary injury, there's no going back; in trauma cases, cell death is an immediate event that you simply can't reverse. So, what actually happens in the hospital is a fight against these secondary insults—this complex, ongoing process that leads to further tissue damage and brain degradation, which eventually results in neurological fallout and all that...

Because of that, I think it's pretty misleading to call Michael's initial injury "minor." It’s confusing for people outside the medical field, and honestly, head trauma is unpredictable by nature. Even right after the accident, you never truly know how things will unfold over the next few hours or days, or how the brain chemistry will continue to shift. That unpredictability is exactly why head injuries are so tricky.

Of course, that doesn't mean the extent of the primary injury isn't still a massive factor in the overall outcome.

I'll try to elaborate a bit more on this whenever I get a chance for anyone interested. 🙂

Looks like Grandma really left her mark on the grandkids.

Respect.

It was really just a matter of time before he finally spoke up...

Just as a quick follow-up to what I mentioned earlier, it’s actually pretty important to head to the ER even if you don't think you hit your head that hard. Especially if you start noticing any weird symptoms—things like worsening headaches, fatigue, sleepiness, or motor issues. Anything at all, really. And definitely if you lose consciousness, even for a split second, or if any symptom starts to ramp up. That can happen suddenly or maybe just a few hours later. Personally, I’d probably suggest seeing a doctor after any significant head impact, obviously excluding the times you just bump your head on a kitchen cabinet or something minor like 😁.

It matters because it’s entirely possible for someone to get up off the floor right after an impact looking totally fine—walking and talking normally—only to have their condition take a sudden turn for the worse. Usually, that happens because of this secondary injury I was talking about earlier, or rather, that secondary chain reaction that can kick off even from a seemingly minor injury.

A tragic example of this is Natasha Richardson (Liam Neeson's wife). She had a fall while learning to ski with an instructor; it looked like a relatively minor accident. She got up, went back to the hotel, and then a few hours later her condition deteriorated. By the time she reached the hospital, it was already too late—she suffered brain death and was soon taken off life support. So, essentially, it was that secondary injury that caused her death. To be clear, I don't mean a second physical blow; these "secondary injuries" are the result of—as I mentioned—a whole series of biochemical reactions in the brain (and the body as a whole) that trigger following the primary injury, which is the initial hit. It’s possible for these to be triggered by milder hits, though that’s probably less common than with moderate ones.

With severe injuries, it’s almost inevitable that these secondary injuries will occur. We often don't see the true extent of the brain damage until those secondary processes have played out, since they aren't instantaneous like the primary injury that happens at the moment of impact.

Of course, that doesn't mean they will always develop. With milder traumatic brain injuries, such as a standard concussion, they are quite rare, and most people recover fully without any secondary issues or neurological fallout.

But in Natasha Richardson's case, despite how trivial the fall seemed, it triggered bleeding—specifically an epidural hematoma. After what’s known as a "lucid interval," where she seemed completely fine, things took a turn for the worse a few hours later. By the time she hit the hospital, brain death had occurred. During that lucid window, however, the bleeding from the impact was forming an epidural hematoma (blood pooling between the dura mater and the skull), which then put pressure on the brain. That compression is usually what causes the severe neurological issues or death if the hematoma isn't surgically drained immediately.

In her specific situation, if she had gone to the hospital immediately and received a CT scan that caught the hematoma, she likely would have been operated on right away, and it’s very possible she could have avoided permanent damage altogether.

So, brain trauma is incredibly tricky; sometimes people don't survive relatively mild primary injuries, and vice versa. While there is certainly a strong correlation between the severity of the initial hit and the recovery outcome, TBI is often called an "invisible epidemic." It's predicted that starting in 2020, these types of injuries would become a leading cause of death in developed nations like the US.

By the way, right before heading to bed last night (instead of hanging out on 😬 ), I came across this: If anyone happens to be interested, you might want to give it a read. I'll try to summarize some of the interesting bits later—though I did have some pretty bad nightmares about people dropping weights on tiny little mice, which was awful... I might share those details later too, if anyone actually cares 😁.

ruggedhawk20 said:Looks like Grandma really left her mark on the grandkids.

Respect.

😁

But my grandma really just gave me the basics 😳 mostly so I could follow along while doing my own research. 😁

cosmicridge5 said:Just as a quick follow-up to what I mentioned earlier, it’s actually pretty important to head to the ER even if you don't think you hit your head that hard. Especially if you start noticing any weird symptoms—things like worsening headaches, fatigue, sleepiness, or motor issues. Anything at all, really. And definitely if you lose consciousness, even for a split second, or if any symptom starts to ramp up. That can happen suddenly or maybe just a few hours later. Personally, I’d probably suggest seeing a doctor after any significant head impact, obviously excluding the times you just bump your head on a kitchen cabinet or something minor like 😁.

It matters because it’s entirely possible for someone to get up off the floor right after an impact looking totally fine—walking and talking normally—only to have their condition take a sudden turn for the worse. Usually, that happens because of this secondary injury I was talking about earlier, or rather, that secondary chain reaction that can kick off even from a seemingly minor injury.

A tragic example of this is Natasha Richardson (Liam Neeson's wife). She had a fall while learning to ski with an instructor; it looked like a relatively minor accident. She got up, went back to the hotel, and then a few hours later her condition deteriorated. By the time she reached the hospital, it was already too late—she suffered brain death and was soon taken off life support. So, essentially, it was that secondary injury that caused her death. To be clear, I don't mean a second physical blow; these "secondary injuries" are the result of—as I mentioned—a whole series of biochemical reactions in the brain (and the body as a whole) that trigger following the primary injury, which is the initial hit. It’s possible for these to be triggered by milder hits, though that’s probably less common than with moderate ones.

With severe injuries, it’s almost inevitable that these secondary injuries will occur. We often don't see the true extent of the brain damage until those secondary processes have played out, since they aren't instantaneous like the primary injury that happens at the moment of impact.

Of course, that doesn't mean they will always develop. With milder traumatic brain injuries, such as a standard concussion, they are quite rare, and most people recover fully without any secondary issues or neurological fallout.

But in Natasha Richardson's case, despite how trivial the fall seemed, it triggered bleeding—specifically an epidural hematoma. After what’s known as a "lucid interval," where she seemed completely fine, things took a turn for the worse a few hours later. By the time she hit the hospital, brain death had occurred. During that lucid window, however, the bleeding from the impact was forming an epidural hematoma (blood pooling between the dura mater and the skull), which then put pressure on the brain. That compression is usually what causes the severe neurological issues or death if the hematoma isn't surgically drained immediately.

In her specific situation, if she had gone to the hospital immediately and received a CT scan that caught the hematoma, she likely would have been operated on right away, and it’s very possible she could have avoided permanent damage altogether.

So, brain trauma is incredibly tricky; sometimes people don't survive relatively mild primary injuries, and vice versa. While there is certainly a strong correlation between the severity of the initial hit and the recovery outcome, TBI is often called an "invisible epidemic." It's predicted that starting in 2020, these types of injuries would become a leading cause of death in developed nations like the US.

By the way, right before heading to bed last night (instead of hanging out on 😬 ), I came across this: If anyone happens to be interested, you might want to give it a read. I'll try to summarize some of the interesting bits later—though I did have some pretty bad nightmares about people dropping weights on tiny little mice, which was awful... I might share those details later too, if anyone actually cares 😁.

Fair enough. But how much time has to pass before you can be absolutely certain there won't be any lingering consequences after a "benign" hit like that? And would it actually be wise to get a CT scan, say, a month after the impact, even if there aren't any symptoms like headaches or anything else?

steelmaker83 said:Fair enough. But how much time has to pass before you can be absolutely certain there won't be any lingering consequences after a "benign" hit like that? And would it actually be wise to get a CT scan, say, a month after the impact, even if there aren't any symptoms like headaches or anything else?

No, a month later isn't the time for that anymore; at this point, it's just what happened, happened (btw, what kind of fall was it? Did you lose consciousness, or did you have other issues? Oh, wait, I see you mentioned there were no symptoms. In that case, if a month has passed, you're likely fine, so don't sweat it 😁)

Regarding the CT scan, it'll eventually become the standard practice to run one after even minor head trauma. It's not quite the norm here yet (mostly because it's expensive, obviously), and they won't just do it for no reason—they usually only order imaging if they're actually concerned. If you really want one after a light bump, you'd probably have to pay out of pocket at a private clinic.

As for being completely sure it "passed without consequences," if you're talking about potential neurological issues, those from milder traumas generally only show up when you return to your normal routine. For instance, if you're a student, you might notice changes in how studying feels or if concentration is harder than usual, or maybe some subtle shifts in mood. But again, that’s all pretty subjective.

If you mean secondary injuries, those typically develop within the first few hours up to about three days, if I recall correctly (though I should probably double-check if it's exactly three days or ask my grandma 😁). Regardless, you definitely aren't going to develop an edema or similar secondary issues a full month down the line. 🙂

p.s. Please, for the love of god, don't quote this entire wall of text of mine. 😁

cosmicridge5 said:No, a month later isn't the time for that anymore; at this point, it's just what happened, happened (btw, what kind of fall was it? Did you lose consciousness, or did you have other issues? Oh, wait, I see you mentioned there were no symptoms. In that case, if a month has passed, you're likely fine, so don't sweat it 😁)

Regarding the CT scan, it'll eventually become the standard practice to run one after even minor head trauma. It's not quite the norm here yet (mostly because it's expensive, obviously), and they won't just do it for no reason—they usually only order imaging if they're actually concerned. If you really want one after a light bump, you'd probably have to pay out of pocket at a private clinic.

As for being completely sure it "passed without consequences," if you're talking about potential neurological issues, those from milder traumas generally only show up when you return to your normal routine. For instance, if you're a student, you might notice changes in how studying feels or if concentration is harder than usual, or maybe some subtle shifts in mood. But again, that’s all pretty subjective.

If you mean secondary injuries, those typically develop within the first few hours up to about three days, if I recall correctly (though I should probably double-check if it's exactly three days or ask my grandma 😁). Regardless, you definitely aren't going to develop an edema or similar secondary issues a full month down the line. 🙂

p.s. Please, for the love of god, don't quote this entire wall of text of mine. 😁

In an underground parking garage, a woman ran straight into a concrete beam—dead center on her forehead. It made such a sound that everyone present jumped. I immediately called my buddy, who's a surgeon, to see if I should rush her to the ER, but he said there was no need if there were no immediate red flags (vomiting, confusion, dizziness, etc.), because they wouldn't do anything with just a standard X-ray anyway.

Aside from her head ringing for a few hours, she had no other symptoms (none of the stuff mentioned above). She did tell me she felt her brain shift inside her skull, though. Anyway, we never went anywhere, and it has definitely been over a month now. There are no issues currently. Everything functions normally, but I'm wondering if there could be something hidden that would still warrant a CT scan.

I just realized (based on what my buddy told me) that if nothing happens in those first few hours after the impact, then you're in the clear. Your comment has me a little worried now.

We finally managed to get a doctor's perspective in here... thanks for breaking all of this down for us! ☕

Sent from my iPhone.

@steelmaker83

Generally speaking, with these types of minor injuries, if you're worried about complications like bleeding or a hematoma developing, those usually happen pretty fast—either immediately or within a few hours. That’s the critical window; seeing things develop days later is pretty rare. (I guess I can't be 100% certain if the limit is exactly three days, or if that's just how I remember it, but it's definitely not longer than that. Regarding bleeding and hematomas, they almost always show up within a couple of hours, if not sooner. So, you'd likely be out of the woods by then anyway.) 😁 Edit: oh, I see you mentioned just now that this isn't about you.

The issue is that if you don't head to the doctor right away, you might already be too late—if you happen to fall into that unlucky minority, like Natasha, where secondary injuries develop even from a relatively minor impact. In those cases, surgery becomes an emergency, and you really need a diagnosis BEFORE the secondary loss of consciousness kicks in. Once someone loses consciousness after a lucid interval, it's basically too late because their life is already at risk. That's why getting to the ER immediately after the injury is vital, rather than waiting until things actually take a turn for the worse.

p.s. Just as an illustration (I was actually reading this in Tudor's dissertation last night), for epidural hematomas like what happened to Natasha, the people who had good outcomes were the ones operated on within two hours of losing consciousness. On the other hand, those with acute subdural hematomas who weren't operated on until four hours after the injury tended to have poor outcomes.

...

steelmaker83 said:In an underground parking garage, a woman ran straight into a concrete beam—dead center on her forehead. It made such a sound that everyone present jumped. I immediately called my buddy, who's a surgeon, to see if I should rush her to the ER, but he said there was no need if there were no immediate red flags (vomiting, confusion, dizziness, etc.), because they wouldn't do anything with just a standard X-ray anyway.

Aside from her head ringing for a few hours, she had no other symptoms (none of the stuff mentioned above). She did tell me she felt her brain shift inside her skull, though. Anyway, we never went anywhere, and it has definitely been over a month now. There are no issues currently. Everything functions normally, but I'm wondering if there could be something hidden that would still warrant a CT scan.

I just realized (based on what my buddy told me) that if nothing happens in those first few hours after the impact, then you're in the clear. Your comment has me a little worried now.

Ask your brother if he'd actually go through with getting a CT scan just to end it all. 😬

And honestly, you hit the nail on the head there. Even if she heads to the ER, they'll probably just tell her they can't do anything about it anyway. In your particular situation, since I mentioned earlier, we don't actually have a standardized protocol in place yet that mandates a CT scan—it’s mostly just X-rays for now. Unless you sustain a more significant injury and they decide it's absolutely necessary, they might order one, but it isn't an automatic process like it's eventually supposed to become here in the States.

That’s bound to change, though. I think Tudor actually mentioned this in his dissertation back in 2010—if I remember correctly—noting that this would eventually become the standard protocol for all head traumas, including the more minor ones. It's all because of these secondary processes and what happened in Natasha's case. The way things work under the current protocol here in the States, someone like your wife could show up at the ER, get scanned, and if they don't see a skull fracture, that's basically it; you can't see hematomas on an X-ray. If she had ended up in a situation like Natasha did, they might have just sent her home. Unless she was lucky enough to take a turn for the worse while still at the hospital, she could have easily died once she actually got home.

So, what’s the actual issue here? What’s really going on behind the scenes? I guess the point is that you need to actually understand these things for yourself instead of just blindly trusting whatever our healthcare protocols tell you. 😬

Aside from having that ringing sensation in her head for a few hours, she didn't really have any other symptoms—nothing from the list we discussed. She did mention, though, that she could distinctly feel her brain shifting inside her skull... which sounds intense. Anyway, we haven't ended up going anywhere to get checked out, and since it's been over a month now, I guess it's probably fine. Everything seems fine right now. Things are functioning normally, but I guess you have to wonder if there's something hidden under the surface that could trigger an unexpected trip to the CT scanner later on.

No, actually, what I mentioned earlier regarding that secondary process doesn't really apply here. It just wouldn't make sense given how much time has already passed. Maybe it could happen within the next few hours, or at most over the next day or two in really rare instances, I guess.

If she were actually experiencing lasting symptoms right now, that might suggest a concussion that left some lingering effects—which is rare, but you can definitely still feel those issues a month later. However, if that were the case, she’d need an MRI rather than a CT scan. You use an MRI to look for structural damage, whereas a CT might miss things. But honestly, that's getting too technical and isn't really relevant here. Most likely, she’s fine, so don't sweat it. 🙂

because I just realized (or rather, my brother pointed out to me) that if nothing happens in those first few hours after the impact, then everything is fine—so what you said actually made me a little worried

Oh man, I guess I wasn't being clear enough, sorry. I tend to do that sometimes 😬 Let me try to clarify: everything I wrote above was specifically about traumatic brain injuries. Your wife might not have actually sustained a TBI at all since she didn't lose consciousness (which would suggest a concussion), and she hasn't had headaches, dizziness, nausea, or vomiting—all of which are symptoms used to diagnose a mild TBI. Not every single hit to the head results in a TBI, you know? 🙂

Anyway, in her case, there's probably no cause for concern and there's no need to go anywhere if she isn't experiencing any issues (as for those secondary injuries, they don't just pop up much later; they usually show up immediately or within a few hours, maybe a day at most 🙂

But again, that only applies to a TBI. For an injury to even be classified as a TBI—even a mild one—you’d need to see loss of consciousness or symptoms like confusion or disorientation (though for a mild TBI, that disorientation has to last less than 30 minutes). But yeah, not every bump on the head is automatically a traumatic brain injury. Sorry if I wasn't clear and ended up scaring someone; that really wasn't my intention 😬

steelmaker83 said:In an underground parking garage, a woman ran straight into a concrete beam—dead center on her forehead. It made such a sound that everyone present jumped. I immediately called my buddy, who's a surgeon, to see if I should rush her to the ER, but he said there was no need if there were no immediate red flags (vomiting, confusion, dizziness, etc.), because they wouldn't do anything with just a standard X-ray anyway.

Aside from her head ringing for a few hours, she had no other symptoms (none of the stuff mentioned above). She did tell me she felt her brain shift inside her skull, though. Anyway, we never went anywhere, and it has definitely been over a month now. There are no issues currently. Everything functions normally, but I'm wondering if there could be something hidden that would still warrant a CT scan.

I just realized (based on what my buddy told me) that if nothing happens in those first few hours after the impact, then you're in the clear. Your comment has me a little worried now.

Since when does your buddy work at Mayo Clinic?

Isn't he supposed to be in your neck of the woods, man?

There is one permanent danger—the kind that lingers indefinitely—where you carry some dormant injury that stays quiet for years, only for a vessel to suddenly rupture. You end up with a brain hemorrhage and are found dead in the morning, all because of a head injury sustained twenty years ago.

@steelmaker83

Regarding that bit about CT scans from Tudor:

Nowadays, neurosurgeons are constantly being asked if they should run a head CT for even mild TBIs. It’s likely—or will be soon—that anyone who loses consciousness will need a brain CT. In one study, 57% (!) of patients with a mild TBI (GCS=15) showed pathological findings on their CT.

Can you imagine? 57 percent had pathology. 😲

And I guess all of those are cases that wouldn't even get a CT scan here in the States. 😁

Oh, and just for context, the Glasgow Coma Scale goes up to 15 (I've actually had a lower score myself), but since these were people with the highest/best scores, it means over half of them still had a pathological CT (meaning it wasn't clear). 😲

Generally speaking, a mild TBI is classified by a GCS of 12-15, moderate is below 12 (down to 8), and anything below 8 is considered severe (down to a minimum of 3).

ruggedhawk20 said:Since when does your buddy work at Mayo Clinic?

Isn't he supposed to be in your neck of the woods, man?

?

In Washington, D.C. slang (after being around for sixty-something years), "bro" is standard. It’s not actually my favorite word, but I clearly find myself using it more often than I realize.

steelmaker83 said:?

In Washington, D.C. slang (after being around for sixty-something years), "bro" is standard. It’s not actually my favorite word, but I clearly find myself using it more often than I realize.

But wait, aren't you from Miami?

ruggedhawk20 said:But wait, aren't you from Miami?

Dammit, Joe, just pull one of my posts where I’m actually using some Southern slang.

No, I'm from Washington, D.C.

ruggedhawk20 said:But wait, aren't you from Miami?

Maybe it's just because I actually enjoy waiting.😬

Edit: Aha, Joe just reached another wrong conclusion.

electricmaker40 said:We finally managed to get a doctor's perspective in here... thanks for breaking all of this down for us! ☕

Sent from my iPhone.

I'm not a medical professional (just so there's no confusion), though I have shared my credentials for this topic over on the Paddock 😁

I find the subject interesting enough to do some reading in my spare time, too. But regardless, I'm not just making things up as I go, so you can take my word for it. 🙂