Traumatic Brain Injury
A traumatic brain injury (TBI) is the most common cause of death and disability. It is a severe and debilitating loss that occurs when the brain is struck or jolted from outside forces.
The opens in a new windowCenters for Disease Control and Prevention estimates that 2.6 million emergency room visits, 235,000 hospitalizations, and 50,000 deaths occur each year because of a TBI. The actual incidences of TBI may be even higher because mild TBIs are never seen in the emergency room. As such, TBI represents a substantial source for neuropsychiatric death and disability. Greater than 30% of all car accidents result in TBI. Millions of dollars are necessary to care for these victims over their lifetime.
TBI is graded as mild, moderate, or severe based on the level of consciousness or Glasgow Coma Scale (GCS) score. Mild TBI is in most cases a concussion, and there is normally full neurological recovery, although many of these patients have short-term memory and concentration difficulties. A concussion is caused when the brain receives trauma from an impact or a sudden momentum or movement change. The blood vessels in the brain may stretch, and cranial nerves may be damaged. A person may experience a brief loss of consciousness, not exceeding 20 minutes. The victim may remain conscious but feel dazed or otherwise impaired.
In moderate TBI, the victim can be lethargic and disorganized. In severe injury, the patient is comatose, unable to open his or her eyes or follow commands. Patients with severe TBI have a significant risk of oxygen loss to their brain and swelling. If these sequelae are not prevented or treated properly, they can exacerbate brain damage and increase the risk of death. Long-term effects of a TBI can include impaired amnesia, loss of consciousness, depression, confusion, memory loss, headache, dizziness, blurry vision, nausea, vomiting, sensory loss, difficulty speaking, insomnia, and personality changes. The severity of symptoms depends on the extent of the injury. Mild TBI generally presents at the time of the injury and is usually temporary. Moderate injuries are similar to those of mild TBI but more serious and last longer periods of time. Severe TBI globally affects the person on a permanent basis as a true loss in quality of life.
Symptoms of Brain Trauma
There are several symptoms associated with brain trauma that manifest in multiple ways in a person’s body and in their behavior. Some of the physical signs that a person can experience from brain trauma include the following:
- Blurred vision
- Loss of vision
There are also cognitive signs that a person has suffered a major brain event. Among some of those symptoms include these signs:
- Short-term memory loss
- Poor concentration
Finally, brain trauma can result in certain changes in a person’s emotional response to events. Some of those emotion symptoms are as follows:
- Personality changes in general
- Changes in appetite
Types of Brain Trauma Injuries
Given the complexity of the brain and its function, there are a variety of types of injuries that can occur:
- Diffuse axonal injury occurs when the brain is shaken or rotated strongly by rotational forces, such as with a car accident. Injury occurs because the unmoving brain does not match the movement of the skull, causing brain structures to tear. There is extensive tearing of nerve tissue throughout the brain. This can cause brain chemicals to be released, causing additional injury. The tearing of the nerve tissue disrupts the brain’s regular communication and chemical processes. This disturbance in the brain can produce temporary or permanent widespread brain damage, coma, or death.
- Coup-contrecoup injury exists when the force impacting the head not only is great enough to cause a contusion at the site of impact, but also is able to move the brain and cause it to slam into the opposite side of the skull, which causes the additional contusion.
- Closed head injury occurs when a person receives an impact to the head from an outside force, but the skull does not fracture or displace. With a closed head injury, the brain swells and has no place to expand. This can cause an increase in intracranial pressure, which is the pressure within the skull. If the brain swells and has no place to expand, this can cause brain tissues to compress, causing further injury. As the brain swells, it may expand through any available opening in the skull, including the eye sockets. When the brain expands through the eye sockets, it can compress and impair the functions of the optic nerves.
In addition to the type of injuries, the area of the brain that is affected also demonstrates the outcome of lasting symptoms. Because the brain defines what it is to be human, the consequences of a brain injury can affect all aspects of a person’s life, including personality. Brain injuries do not heal like other injuries. Recovery is based on mechanisms that remain uncertain. No two brain injuries are alike, and the consequence of two similar injuries may be quite different. Symptoms may appear immediately or may not be present for days or weeks after the injury. One of the consequences of brain injury is that the person often does not realize that an injury to the brain has occurred. For example, injury to the frontal lobe of the victim’s brain, the emotional control center and home to one’s personality, can have a grave impact on that person’s motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior. In comparison, injury to the brain stem can cause difficulty with breathing, control of blood pressure and temperature, balance, swallowing, insomnia, dizziness, and organizational perception of the environment. Therefore, the location of the injury in the brain will also impact the prognosis for recovery and length of ongoing care that will be needed.
Some Typical Brain Injuries
There are several types of brain injuries that come with them a certain level of severity and side effects. They are each serious, but each needs to be addressed in different ways. Those injures are as follows:
Concussion. This is the most typical type of brain injury and is the result of a sharp blow to the head. It can also be the after effect of whiplash in which a sudden stop in momentum cases the brain to slam hard against the inside of a person’s skull. In some cases, suffering from a concussion can lead to post-concussion syndrome. It is a serious condition for which can take months or even years to recover. Concussions are often referred to as mild TBI (MTBI).
Despite the commonality of concussions, they are still serious and should never been ignored. Post-concussion syndrome can be a problem for victims, as it can greatly reduce a person’s ability to accomplish several tasks and hurt a person’s chances to function at work. Many physicians and attorneys tend to ignore concussions and focus more on orthopedic injuries because they are easier to detect. Some of the risks associated with post-concussive syndrome increase with age and the history of prior concussions. Most patients fully recover fully from concussions, and neurologists play a major role in that recuperation and the evaluation. Those who suffer a second concussion can suffer from second impact syndrome (SIS). A symptom of this is rapid swelling of the brain, which could be fatal to the victim. The severity of the concussion does not pay a role in the chances of experiencing SIS, as even a minor concussion can cause SIS to occur.
Contusion. This takes place because of an impact to the head that can cause bruising and bleeding. Specifically, it is a bruise to the brain tissue. If the lesion is larger, it could result in surgery. Contusions can also be related to blood vessel leaks and microhemorrhages. The injury generally takes place in the cortical tissue, which is under the spot where the impact took place. The location of the contusion as well as its severity will play a role in the type of symptoms the victim will suffer. For those who suffer moderate to severe contusions, the swelling victims experience is usually the most severe at five or six days and takes place in the brain tissue in and around the injury. Toxins are also released because of the contusion, contributing to the swelling.
Brain Injuries Occurring without Head Injuries
It is possible for a person to sustain a brain injury without ever hitting their head. Many doctors have said that whiplash can cause a brain injury in about 20 percent of patients. The resulting injury is known as a hernia in the brain known as a Chiari malformation. In those instances, the bottom part of the brain protrudes through the base of the skull.
Whiplash in general can cause brain trauma. The rapid acceleration/deceleration a victim experiences from a rear-end collision forces the brain to slam against the inside of a skull, causing brain trauma.
Cost of Suffering a Brain Injury and Expected Compensation
Brain injuries are a traumatic and severe injury that can take years to recover; some victims never recover fully. Owing to the significant injury and medical attention that result in these types of injuries, the amount of compensation a person can receive in a lawsuit is quite high. There are also several factors that can impact the outcome of the final settlement, including the actions of the victim themselves. If the victim bears any portion of responsibility for the accident that caused the brain injury, they could see a lesser amount than they would have otherwise.
Another factor is the severity of the injuries themselves. The more severe an injury, the more likely a person will receive a higher settlement. Of course, there is a reason for a higher settlement, in that the victim will also have higher medical bills because of the brain trauma. Working with an experienced attorney will help a victim determine what range of reward they might receive. The attorney will examine the medical records to determine what is a reasonable range of money to request from a jury.
Although there is no guarantee, there have been a range of settlements that victims have received based on the severity of the injury and the cause.
Car accidents. In Matthew Jensen v. Jonathan Coburn, a 23-year-old man was sitting in his disabled car on the shoulder of a major highway when he was rear-ended. He suffered a bulging disk and a concussion. The defendant admitted liability and offed liability. The jury rewarded the victim $160,000.
In Sheaffer v. NuCO2, a 23-year-old was stopped on a highway as the third of five cars in a row. A fire truck struck the rear car, causing a chain reaction among the five vehicles. The victim suffered a permanent TBI, which the defendant disputed. The jury awarded the victim $17.4 million at trial.
In M.C. v. Victor Mathews, a 10-year-old girl was in the passenger seat when the car was rear-ended. The girl suffered skull fractures and a TBI; the jury awarded her $10.7 million.
In Chastidy Ronan v. Antonios Panagiotopoulos, a 35-year-old woman was riding her bike while the defendant was parked on the side of the road. The defendant opened their car door, causing the victim to collide with it and fall to the ground. She suffered mild TBI with serious residual effects. The defendant offered a settlement of $119,000, whereas the victim demanded $450,000. The jury returned a verdict in the amount of $463,550. Because the plaintiff was found to be 15 percent at fault, her net settlement was $394,018.
Slip and fall cases. In Anthony Zaccaglin et al. v. Starbucks Coffee Company, the victim, a chiropractor, was a patron at the coffee shop when he slipped and fell on a wet floor that had just been mopped. He hit his head and lost consciousness. He suffered a mild TBI. The defendant offered a settlement of $100,000, which the victim did not accept. At trial, the jury returned a verdict in his favor of $7.5 million.
A 51-year-old medical sales representative slipped and fell in the Tuttle v. Ukiah Adventist Hospital and Ukiah Valley Medical Center case. The victim fell two flights of stairs after he slipped on a landing. The cause of the fall was determined to be some pooled rainwater that had accumulated on the landing. The jury rewarded the victim and his wife a settlement of $2,626,378 because he suffered a TBI causing permanent memory impairments.
Examining Brain Injuries Digitally
Much of what can be learned from the brain following a TBI can be viewed digitally. Some of the more frequently used tests include these imaging techniques:
- Three-dimensional brain magnetic resonance imaging (MRI) with susceptibility weighted imaging (SWI) and diffusion tensor imaging (DTI) provides the microstructure of the organ by quantifying water diffusion over the brain’s surface.
- Computed tomography (CT) produces multiple pictures of the inside of the body through cross-sectional imaging CT scanning of the head. This imaging technique is typically used to detect bleeding, brain injury, and skull fractures.
- Positron emission tomography (PET) scan is an imaging test that helps reveal how a patient’s tissues and organs are functioning using a radioactive drug. On a PET scan, these areas show up as bright spots revealing or evaluating several conditions, including some cancers, heart disease, and brain disorders.
- Single-photon emission computed tomography (SPECT) scan allows a doctor to analyze the function of a patient’s brain through nuclear imaging that creates a three-dimensional image. A SPECT scan produces images that show how the human organs work. For instance, a SPECT scan can show what areas of the brain are more active or less active.
- Functional magnetic resonance imaging (fMRI) measures the metabolic changes that occur within the brain. It may be used to examine the brain’s anatomy, determine which parts of the brain are handling critical functions, and evaluate the effects of stroke or trauma that cannot be found with other imaging techniques.
- Magnetic resonance (MR) spectroscopy measures biochemical changes in the brain by comparing the chemical composition of normal brain tissue with that of abnormal tumor tissue. MR spectroscopy analyzes molecules such as hydrogen ions or protons to look for issues.
Following a TBI, treatment options are typically only short-term professional assistance, leaving family members to care for the long-term needs of the person with brain injury. Without adequate training and professional support for this caregiver role, a variety of challenges are commonly reported by family members, including social isolation, changes in family roles, depression, anxiety, and increased somatic difficulties.
Victims of TBI often require long-term cognitive rehabilitation, physical therapy, counseling, adaptive modifications, case coordination, and attendant care. Expert consultants need to carefully work with the victim to establish a base line condition, develop a treatment protocol including needs and duration, and establish the costs associated with implementing a life care plan.
Dispelling Brain Trauma Myths
There are several theories relating to TBI, but not all of them are accurate. In fact, some of them can be considered dangerous if people continue to believe them. They could lead to further injury or worsening an injury when a person should be seeking medical attention. Some of these myths are as follows:
A person must lose consciousness or hit their head. The brain, which has a gelatinous consistence, can quickly move through the skull during a car accident. The rigid skull is lined with numerous bony protrusions. The brain can easily hit one side of the skull and slam against the other end, in what is called a coup-contrecoup injury.
TBI can also occur because whiplash can cause the sudden jerky motion of the skull and the brain inside. When a person suffers whiplash, their head jerks forward and suddenly stops. There have been examples in which whiplash has disrupted the brain’s nerve cells, which are the cells responsible for sending messages.
A negative brain scan means no TBI. There have been tremendous advances in the field of imaging diagnostic systems. However, despite all their sophistication, these modalities are not perfect and will miss details. Specifically, when small lesions form on the brain or there is damage to the neurons, these tend to get overlooked by the basic MRI or CT scan. Given that uncertainty, many doctors and neurologists will rely on medical history to determine if there might be a problem. In fact, even though there might be a negative result on the test, there can still be cognitive or functioning problems detected during neurological or neuropsychological testing.
Recovery from brain injury is quick. This myth has been perpetuated by insurance defense lawyers and some claim adjusters to minimize an injury a person might have sustained as a result of an accident or a workplace mishap. Actually, in many cases it may take an extended period for people to recover. For approximately 10 to 15 percent of those who suffer a mild case of TBI, it can still take them at least a year to fully recover.
There are patients who start to develop symptoms later that they might not have suffered in the first few days of the injury. Some patients have one nagging symptom such as headache, neck pain, or dizziness. Others have more persistent and systemic problems throughout their body.
In both cases, patients run the risk of developing permanent symptomatic persistent post-concussive syndrome.
Los Angeles Brain Injury Lawyers at ACTS Law Assist Brain Injury Victims in Obtaining Fair Compensation
The Los Angeles brain injury lawyers at ACTS Law are well-versed in the cause, treatment, and prognosis of traumatic brain injuries. If you or your loved one has suffered a TBI, please contact us to see how we can help. ACTS Law has a skilled legal team that is dedicated to working meticulously to ensure that you are properly compensated for your loss. To schedule a free, confidential consultation, call us today at or contact us online.
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