The attorneys at Hall Law are experts in handling brain injury cases and have more than 35 years of experience obtaining full, fair compensation for people who have sustained brain injuries. As a result, we are well acquainted with the complex medical and damage issues presented by brain injury claims and are uniquely positioned to ensure our clients receive the best possible result for their individual circumstances. Brain injury cases regularly involve significant current and future damages, and it is important that the injured party receive proper representation by an experienced brain injury attorney.
Traumatic brain injury (TBI) is the term used to describe damage to the brain resulting from physical trauma to the head. Often, TBI is caused by the impact of the head with an object, such as when hitting a windshield or the dashboard of a car in an auto accident or hitting the ground in a fall. TBI can also be caused by a penetrating head injury, whereby an object penetrates through the skull and into the brain. TBI may also occur when the brain undergoes a severe forward or backward shaking, such as with infants who are mishandled or in cases involving whiplash suffered during an automobile accident. In some cases a brain injury will be accompanied by obvious external damage to a person’s head or skull. However, it should be noted that many severe brain injuries result where there are no obvious external symptoms of injury. Also not every head trauma is associated with TBI.
The brain gives us our identity, our ability to think, and it manages all of our body functions. It is an enormously complex organ which runs our central nervous system and processes millions of messages and signals. As such, when the brain suffers a significant injury, the effects can be devastating. The personal injury attorneys at Hall Law have extensive experience handling traumatic brain injury cases. As a result of our experience in the field, our attorneys are well acquainted with the unique damages issues presented by such claims and have been successful in ensuring that our clients are properly compensated for both the current and future damages related to such claims.
How a Traumatic Brain Injury Occurs
There are several mechanisms by which TBI can take place. All these mechanisms are capable of producing similar impairments of mental function. Some of the possible mechanisms of TBI include the following:
- Direct trauma to the brain from physical impact to the head. This can be blunt as with a concussion or can be a penetrating injury as with a depressed skull fracture or a gunshot wound.
- Low blood oxygen (hypoxemia) or absent blood oxygen (anoxia) to the brain such as from carbon monoxide inhalation, smoke inhalation, drowning, or prolonged periods of shock (very low or absent blood pressure).
- Swelling (edema) of the brain following trauma. Swelling compresses parts of the brain, cutting off the blood supply and sometimes causing death.
- Toxic injuries such as heavy metal poisoning or poisoning from solvents like methyl alcohol, carbon tetrachloride and ethylene glycol.
Causes of TBI
The most common causes of TBI are generally acknowledged to include:
- Motor vehicle accidents of all kinds (including accidents involving pedestrians and bicycles);
- Sports-related injuries; and
- Penetrating trauma, consisting primarily of gunshot wounds.
Rehabilitation of severe and moderate injuries can be extensive and expensive. The long term consequences of the injury can affect every aspect of the victim’s life, as well as rendering the victim more susceptible to a variety of disorders, including epilepsy and, quite possibly, Alzheimer’s disease.
Immediate complications of TBI may include seizures, enlargement of the fluid-filled chambers within the brain (hydrocephalus or post-traumatic ventricular enlargement), leaks of cerebrospinal fluid, infection, injury to blood vessels or to the nerves supplying the head and neck, pain, bed sores, failure of multiple organ systems, and trauma to other areas of the body.
Long-term survivors of TBI may suffer from persistent problems with behavior, thinking, and communication disabilities, as well as epilepsy; loss of sensation, hearing, vision, taste, or smell; ringing in the ears (tinnitus), coordination problems, and/or paralysis. Recovery from cognitive deficits is most dramatic within the first six months after TBI, and less apparent subsequently.
Memory loss is especially common in patients with severe head-injuries, with loss of some specific memories and partial inability to form or store new memories. Antero-grade post-traumatic amnesia refers to impaired memory of events that occurred after TBI, while retrograde post-traumatic amnesia refers to impaired memory of events that occurred before the TBI.
Personality changes and behavioral problems may include depression, anxiety, irritability, anger, apathy, paranoia, frustration, agitation, mood swings, aggression, impulsive behaviors or “acting out,” social inappropriateness, temper tantrums, difficulty accepting responsibility, and alcohol or drug abuse.
Following TBI, patients may be at increased risk of other long-term problems such as Parkinson’s disease, Alzheimer’s disease, “punch-drunk” syndrome (dementia pugilistica), and post-traumatic dementia.
Because of all the above problems, some patients may have difficulty returning to work following TBI, as well as problems with school, driving, sports, housework, and social relationships.
Types of TBI
The least severe and most common type of TBI is termed a concussion, which is technically defined as a brief loss of consciousness after a head injury without any physical evidence of damage on an imaging study such as a CT or MRI scan. In common parlance, concussion may refer to any minor injury to the head or brain. With concussion, the injured person may experience a brief or transient loss of consciousness, much like fainting or passing out, or merely an alteration in consciousness described as “seeing stars” or feeling dazed or “out of it.”
Closed Head Injury
Closed head injury refers to TBI in which the head is hit by or strikes an object without breaking the skull.
In a penetrating head injury, an object fractures the skull and enters brain tissue. When the skull cracks or breaks, the resulting skull fracture can cause a contusion, or an area of bruising of brain tissue associated with swelling and blood leaking from broken blood vessels. A depressed skull fracture occurs when fragments of the broken skull sink down from the skull surface and press against the surface of the brain. In a penetrating skull fracture, bone fragments enter brain tissue. Either of these types of skull fracture can cause bruising of the brain tissue, called a contusion.
Coup – Contrecoup Injury
Diffuse brain damage associated with closed head injury may result from back-and-forth movement of the brain against the inside of the bony skull. This is sometimes called coup-contrecoup injury. “Coup,” or French for “blow,” refers to the brain injury directly under the point of maximum impact to the skull. “Contrecoup,” or French for “against the blow,” refers to the brain injury opposite the point of maximum impact.
For example, coup-contrecoup injury may occur in a rear-end collision, with high speed stops, or with violent shaking of a baby, because the brain and skull are of different densities, and therefore travel at different speeds. The impact of the collision causes the soft, gelatinous brain tissue to jar against bony prominences on the inside of the skull. Contrecoup injury can also lead to brain contusion.
Because of the location of these prominences and the position of the brain within the skull, the frontal lobes (behind the forehead) and temporal lobes (underlying the temples) are most susceptible to this type of diffuse damage. These lobes house major brain centers involved in speech and language, so problems with communication skills often follow closed head injuries of this type.
The symptoms of TBI may occur immediately or they may develop slowly over several hours, especially if there is slow bleeding into the brain or gradual swelling. Depending on the cause, mechanism, and extent of injury, the severity of immediate symptoms of TBI can be mild, moderate, or severe, ranging from mild concussion to deep coma or even death.
Symptoms, complaints, and neurological or behavioral changes following TBI depend on the location(s) of the brain injury and on the total volume of injured brain. Usually, TBI causes focal brain injury involving a single area of the brain where the head is struck or where an object enters the brain. Although damage is typically worst at the point of direct impact or entry, TBI may also cause diffuse brain injury involving several other brain regions.
Depending on which areas of the brain are injured, other symptoms of closed head injury may include difficulty with concentration, memory, thinking, swallowing, walking, balance, and coordination; weakness or paralysis; changes in sensation; and alteration of the sense of smell.
Consequences of TBI can be relatively subtle or completely devastating, related to the severity and mechanism of injury.
Diffuse axonal injury, or shear injury, may follow contrecoup injury even if there is no damage to the skull or obvious bleeding into the brain tissue. In this type of injury, damage to the part of the nerve that communicates with other nerves degenerates and releases harmful substances that can damage neighboring nerves.
If the physical trauma to the head ruptures a major blood vessel, the resulting bleeding into or around the brain is called a hematoma. Bleeding between the skull and the dura, the thick, outermost layer covering the brain, is termed an epidural hematoma. When blood collects in the space between the dura and the arachnoid membrane, a more fragile covering underlying the dura, it is known as a subdural hematoma. An intracerebral hematoma involves bleeding directly into the brain tissue.
All three types of hematomas can damage the brain by putting pressure on vital brain structures. Intracerebral hematomas can cause additional damage as toxic breakdown products of the blood harm brain cells, cause swelling, or interrupt the flow of cerebrospinal fluid around the brain.
When a person with TBI regains consciousness, some symptoms are immediately apparent, while others may not be noticed until several days or weeks later. Symptoms which may be obvious right away after mild TBI include headache, changes in vision such as blurred vision or tired eyes, nausea, dizziness, lightheadedness, ringing in the ears, bad taste in the mouth, or altered sense of smell which is usually experienced as loss of the sense of taste.
With more severe injuries, there may also be immediate numbness or weakness of one or more limbs, blindness, deafness, inability to speak or understand speech, slurred speech, lethargy with difficulty staying awake, persistent vomiting, loss of coordination, disorientation, or agitation. In addition to some of these symptoms, young children with moderate to severe TBI may also experience prolonged crying and refusal to nurse or eat.
While the injured person is preoccupied with headache or pain related to other physical trauma, symptoms such as difficulty in thinking or concentrating may not be evident. Often these more subtle symptoms may appear only when the individual attempts to return to work or to other mentally challenging situations. Similarly, personality changes, depression, irritability, and other emotional and behavioral problems may initially be attributed to coping with the stress of the injury, and they may not be fully appreciated until the individual is recuperating at home.
Seizures may occur soon after a TBI or may first appear up to a year later, especially when the damage involves the temporal lobes. Other symptoms which may appear immediately or which may be noticed only while the individual is returning to usual activities are confusion, fatigue or lethargy, altered sleep patterns, and trouble with memory, concentration, attention, and finding the right words or understanding speech.
Many brain injuries are not objectively obvious at the time of an accident. Common indications that a traumatic brain injury may have occurred include loss of consciousness, the inability to recall events immediately before or after an accident, and an altered mental state in which the injured party may feel disoriented, or confused. Any individual who suspects they may have suffered a traumatic brain injury should be examined by a trained medical professional.
The handling of a TBI claim requires an experienced personal injury attorney with a thorough understanding of traumatic brain injury. The personal injury attorneys at Hall Law have more than 35 years of experience successfully representing clients with brain injuries. Let us take care of all the issues involved in the legal process so you can concentrate on your recovery and rehabilitation.