Can Brain Injury Lead to Death Years Later?

An 8-year-old traumatic brain injury may or may not have led to man's death.

June 25, 2009, 9:20 PM

June 26, 2009— -- Eight years after he was struck in the back of the head with a baseball bat, a 26-year-old Colorado man was found lifeless in his bed last week with no obvious cause of death and no sign of foul play, Sgt. Bruce Whittich of the Longmont Police Department said.

Timothy Whalen was 18 years old when Matthew Bauer, also 18 at the time, attacked him from behind in a disagreement about a keg of beer allegedly stolen from a party near the University of Colorado at Boulder campus, according to reporting by the Associated Press.

Now local officials are trying to determine whether the events of that summer night led to his death years later. Tom Faure of the Boulder County Coroner's office said an autopsy will be expected in a couple of months.

While the cause of Whalen's death is yet to be determined,brain injury experts said it is possible that people who suffered from a traumatic brain injury can die from a related seizure years later.

In fact, research shows that those who suffer from the most severe brain injuries are statistically more likely to die early -- from a variety of causes.

"There are a couple of lines of evidence to suggest that after a particularly acute brain injury that you have shorter life expectancy, even if you survive the acute injury phase," said Dr. Steven Flanagan, director of The Rusk Institute of Rehabilitation Medicine at the New York University Langone Medical Center in New York City.

A 2007 study in the Oxford journal Brain showed 767 people admitted to a United Kingdom hospital with a traumatic brain injury were twice as likely to die as the general population in seven years following the injury.

A larger 2004 study of 2,178 patients cited in an Institute of Medicine report last year showed that people with moderate to severe traumatic brain injuries had a reduced Life expectancy by five to nine years.

However, neither study could specify whether the premature death was related to the brain injury or not.

Flanagan said doctors do know, "The longer you survive after traumatic brain injury, the more that risk of early death decreases."

Eight Years of Surviving a Single Blow

Whalen survived many physical challenges in the years after his attack. Following multiple skull fractures, he spent a week in a coma and a month in the hospital, according to the Associated Press. Three lobes of his brain were affected by the attack.

Bauer pled guilty to second-degree assault in 2003 and was sentenced to seven years in prison. Even if the autopsy concludes Whalen died as a result of the bat attack, lawyers say Bauer's sentence and conviction will not change.

"It is double jeopardy because the criminal act [the beating] was already charged and he was already convicted for it," said Barry Latzer, professor of Criminal Justice at John Jay College of Criminal Justice, City University of New York in New York City.

"Under double jeopardy rules you can only get one bite at the apple," he said.

However, Latzer said double jeopardy rules only work in the criminal courts. Many families choose to bring wrongful death civil suits despite the results of criminal suits.

Whalen's family did not return messages from and Bauer's brother, Art Bauer, declined to comment for the story.

However shortly after Bauer's conviction, Whalen spoke out to the Boulder Daily Camera about his struggles and the seizures that interfered with his life following that night.

"My throat seized up first," Whalen told the Daily Camera. "It felt like every muscle in my body tightened, and I couldn't move, couldn't talk. ... I remember seeing everything; all I wanted to do was close my eyes."

Brain injury experts said seizures may affect upwards from 30 to 40 percent of people treated in the Intensive Care Unit with a traumatic brain injury. While most of those seizures are "clinical seizures" where one sees the body shake, there are other seizures that onlookers may not notice at all.

"Sometimes seizures occur when you don't see their body shake," said Dr. David Hovda, professor of neurosurgery and Director of the University of California Los Angeles brain injury research center.

Some Seizures Can Go Undetected

"These are seizures where the neurons in the brain are just firing a lot but they're not causing convulsions. You'll see it sometimes in children where they nod off and look away," said Hovda.

Hovda said cases such as Bauer's -- where the throat closes up and he couldn't move -- are likely sub-clinical seizures without convulsions.

In some cases, Hovda said those seizures can lead to death either by cardiac arrest or by closing of the airways.

"After somebody survives, it's very unlikely for them to die from the pathobiology or the pathology of the brain injury," said Hovda. "Usually something else has to happen. That something else could be a seizure, or it could be another blow to the head."

Hovda said looking for evidence of hypoxia (or lack of oxygen) to the brain could signal a seizure death, evidence of blood in the brain could signal a death from a blow to the head or another cause unrelated to an old brain injury.

Despite the statistics indicating an associated early death after a traumatic brain injury, Flanagan said anyone who has bumped their head or worse should not worry.

"What's important to realize here is don't think 'oh I had a traumatic brain injury, I'm going to die early' --no," said Flanagan."

"People with seizures -- They have regular medical follow ups so their health is maintained," he said.