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TYPES OF TRAUMATIC BRAIN INJURY COMMONLY SUFFEREDIf it can be demonstrated that negligence was a factor in the accident that resulted in your brain injury, you may be entitled to compensation to cover your losses. Filing a claim is a complicated process, but it gives victims the best chance of regaining control of their lives.
If you or a loved one recently sustained a head injury in an accident, doctors may have informed you that the injury is one of the following common types of brain damage:
Coup-contrecoup. TBI of this type occurs when both sides of the brain are damaged. When the force of impact is so great on one side of the brain that the brain is forced against the opposing side of the skull, an injury occurs. As a result, a contusion on the opposite side of the brain occurs. Memory, coordination, swallowing, balance, muscular abilities, and sensation can all be affected.
Penetration. When the skull is broken by an impact, pieces of bone and/or a foreign object may enter the skull cavity and severely damage brain tissue. Shearing and rupture of nerves and tissue in the brain can result in permanent impairment or death. These are considered severe TBIs and typically necessitate brain surgery to remove foreign objects and repair the skull. The injury could be permanent and result in significant disability.
A concussion is a brain injury. This mild form of TBI may cause a person to be dazed, confused, and disoriented while remaining conscious for a few seconds or minutes. It can cause severe headaches, balance issues, and dizziness, as well as personality changes, depression, anxiety, and other emotional problems. A single concussion makes the victim susceptible to further concussions. Repeated concussions can cause dementia or chronic traumatic encephalopathy, a degenerative disease (CTE).
Axonal Diffuse. This type of TBI causes extensive brain damage. It is usually caused by a strong jolt, shaking, or a sudden and powerful rotation of the head. As the head moves, the brain lags behind and slams against the interior skull, causing damage in multiple places. One of the most common types of brain injuries from car accidents is diffuse axonal injury, which occurs in roughly half of all severe head traumas.
Contusion. A bruise on the brain is typically caused by a direct impact to the head. A contusion-related swelling, or brain herniation, is dangerous. The injury may necessitate surgical intervention to relieve pressure and maintain a safe level of oxygen flow to the brain.
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Accidental Brain TraumaWhen an external mechanical force causes brain dysfunction, this is referred to as traumatic brain injury (TBI). TBI is typically caused by a violent blow or jolt to the head or body. TBI is typically classified as mild, moderate, or severe based on the characteristics of the injury.
Traumatic brain injury (TBI) is a major public health issue. The public is becoming more aware of the devastating effects of even mild traumatic brain injury. TBI is the “signature injury” of the Afghan and Iraqi wars. Many US troops who have suffered concussive force blast injuries have developed TBI symptoms. In many cases, no visible signs of head or brain injury were found. As a result, the federal government has invested significantly in research into traumatic brain injury, particularly mild traumatic brain injury.
Mild traumatic brain injuries are a “silent epidemic” because the problems caused by TBI, such as those of thinking and memory, are often not visible, and because there is a lack of awareness about TBI among the general public. There has long been a lack of awareness among the general public about the potential significance of even minor brain injuries.
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TBI ACCORDING TO THE CDCA traumatic brain injury (TBI) is caused by trauma, such as a penetrating head injury, a blow to the head, or a jolt to the head. Some jolts may cause TBI, while others may not. If someone does sustain a TBI, the severity can range from mild to severe. According to the CDC, every year, approximately 1.7 million people suffer a TBI.
In 2019 there were 61,000 people who died from TBI. 275,000 people are hospitalized yearly from TBI, and 1.365 million visit an emergency room and are released. Every year, 2685 children under the age of 14 die, 37,000 are hospitalized, and 474,000 visit the emergency room. There are no estimates on the number of people who suffer a TBI each year but do not seek medical attention.
UNDERSTANDING THE GLASGOW COMA SCALEThe Glasgow Coma Scale, or GCS, is frequently used during the acute trauma phase of a TBI. The GCS is a neurological scale used to assess a person’s level of consciousness following a head injury. Unfortunately, lawyers frequently misunderstand or intentionally misrepresent what a “normal” GCS entails. In a typical TBI case, the defense might argue that the plaintiff had a normal GCS when evaluated by EMS or in the emergency department. A normal GCS, on the other hand, does not imply the absence of a brain injury.
The GCS scale is used in acute medical and trauma patients by First Aid, EMS, nurses, and doctors. The scale is made up of three different tests: eye, verbal, and motor responses. The lowest possible GCS is a sum of three (indicating deep coma or death), while the highest possible GCS is a sum of fifteen (indicating a fully awake person).
The patient’s eye response is graded on a four-point scale: no eye-opening (1 point), eye-opening in response to a pain stimulus (2 points), eye-opening in response to speech (3 points), and spontaneous eye-opening (4 points) (4 points). Five grades are assigned to the patient’s verbal response, ranging from none (1 point) to incomprehensible (2 points), inappropriate (3 points), confused (4 points), or oriented (5 points). Similarly, the patient’s motor response is graded on a six-point scale. These primarily assess conscious or subconscious reactions to pain, with the highest score going to someone who can follow simple commands.
The GCS categorizes brain injury as severe, moderate, or minor. Severe is defined as a GCS of less than 9, moderate as a GCS of 9 to 12, and minor as a GCS of 13 to 15. The GCS is controversial, especially in cases of moderate and mild brain injury. This is due to the GCS’s primary function as a tool for acute patient management. In mild and moderate TBI, GCS does not predict post-acute recovery.
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BRAIN TRAUMA CONSEQUENCESAccording to the CDC, approximately 5.3 million people in the United States have long-term/lifelong needs for assistance in daily life as a result of traumatic brain injuries (TBI).
TBI can have a variety of consequences for individuals. Emotions, thoughts, language, and sensations are examples of these. TBI can cause or trigger epilepsy. It raises the risk of Alzheimer’s disease, Parkinson’s disease, and other age-related brain abnormalities. Approximately 75% of all TBIs are mild (concussions or other mild TBI). Mild TBIs can cause cognitive and/or neurological problems if they occur repeatedly. They can be fatal or catastrophic if they occur in quick succession (several in a month).
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BRAIN INJURIES AND THEIR CAUSESThe majority of TBI is caused by falls, automobile accidents, being struck by objects or being struck by objects, and being assaulted. Motor vehicle–traffic injury is the leading cause of TBI-related death. The leading causes of non-fatal TBI in the United States are falls (35%), motor vehicle-related injuries (17%). These account for approximately 78 percent of all TBIs. Many of these are the result of negligence.
From 2002 to 2010 there were 232,240 emergency room visits, 53,391 people hospitalized, and 14,795 deaths due to TBI caused by motor vehicle accidents in the USA.
Those who have suffered a brain injury as a result of the negligence of another should consult a Dallas brain injury lawyer to ensure they have recovered compensation from those who caused the harm.
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UNDERSTANDING MILD TRAUMATIC BRAIN INJURIESThe term “mild brain injury” can be deceptive. The term “mild” typically refers to the severity of the initial trauma that resulted in the injury. It may also refer to other symptoms that occur within the first 24 hours after an injury. The term “mild” is not intended to describe the long-term severity of the injury’s consequences.
The terms mild traumatic brain injury and concussion are frequently used interchangeably. For each term, several definitions have been proposed. These are similar but not identical definitions. The definition of TBI, and particularly mild TBI, varies slightly across medical specialties. The terms brain injury and head injury are frequently used interchangeably, as is a concussion. These injuries could be linked to neurologic deficits or not. The need for clarity on which definition is being used is especially important for lawyers when questioning medical witnesses.
Definition of Mild TBI by the American Congress of Rehabilitation Medicine (ACRM) – offers one of the most widely accepted definitions:
A person with mild traumatic brain injury has had a traumatically induced physiological disruption of brain function, as evidenced by at least one of the following symptoms:
- Any period of unconsciousness;
- Any memory loss for events that occurred immediately before or after the accident;
- Any change in mental state at the time of the accident (for example, feeling dazed, disoriented, or confused); and
- Transient focal neurological deficits are possible.
Where the severity of the injury is less than:
- A loss of consciousness lasting 30 minutes or less;
- A Glasgow Coma Scale (GCS) score of 13-15 after 30 minutes; and
- Post-Traumatic Amnesia (PTA) lasting less than 24 hours.
Routine diagnostic tests or neurological evaluations may be normal, according to the ACRM. Some patients may not have the above factors medically documented in the acute stage due to a lack of medical emergency or the realities of certain medical systems. In such cases, it is appropriate to consider symptomatology, which, when associated with a traumatic head injury, can indicate the presence of a mild traumatic brain injury.
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MODERATE TRAUMATIC BRAIN INJURY (TBI)Moderate TBI is typically associated with a prolonged loss of consciousness lasting more than fifteen minutes but less than twenty-four hours. There are usually focal neurologic deficits. These patients typically stay in the hospital for several weeks before being transferred to a rehabilitation facility once their acute medical crisis has been managed. The majority of moderate TBI survivors are unable to return to their pre-injury level of function.
SEVERE TRAUMATIC BRAIN INJURY (TBI)When a patient suffers a severe TBI, he or she becomes comatose. This type of injury is usually associated with significant neurologic deficits, and structural lesions revealed by neuroimaging. Skull fractures, intracranial hemorrhages, defuse cerebral edema, and other similar conditions are examples of this. These patients typically necessitate advanced medical attention. A neurosurgeon is frequently called in to perform an operation, usually to reduce brain swelling or to remove an intracranial hematoma. Recovery from severe TBI is typically slow and incomplete, and many of these patients have a significantly reduced life expectancy.
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DAMAGES FROM A BRAIN INJURYIt may not take a blow to the head to cause confusion, loss of consciousness, or other cognitive impairment. When the head is whipped back and forth, the brain may be injured when it collides with the skull. Alternatively, the liquid surrounding the brain may stream back and forth across it, irritating the brain’s surface. Experts are frequently required to demonstrate the physical location of the brain within the cranial cavity so that a jury can comprehend the biomechanical implications of the injury.
Soft tissue makes up the majority of the brain. Unless there is an obvious fracture, an x-ray of the head will not reveal brain injury. It can be difficult to show objective symptoms of soft tissue damage without bleeding in the spinal fluid or through an examination of the eyes. It can be difficult to tell if there is soft tissue damage if there is no significant bleeding or swelling. Experts can attest that this does not imply that the soft tissue was unharmed in any way.
Traumatic head injuries can alter a patient’s thinking and induce emotional disturbances. A critically injured patient may have a different look and even voice. Their movements could be jerky, their speech could be distorted, and they could make strange motions and facial expressions.
It’s almost as bad as death for many patients’ families because what’s left can be an incompetent or even physically aggressive individual.
Head injuries can result in three outcomes:
Psychosocial damages – The most common sign of a head injury is increased aggressiveness, which is the most difficult to handle. In many cases, there is no projected improvement over time. Irritability and hostility may even worsen with time.
The aftermath of a head injury does not always “resolve” itself when it comes to calculating damages. It’s possible that the patient’s condition will deteriorate. The impact on the family can be increasingly serious as impulse control deteriorates, and the family’s emotional anguish and stress, as well as loss of consortium, may grow over time. When the psychosocial element of the injured individual does not improve, families’ initial excitement about the success of physical recovery often fades.
There may be other organic personality illnesses that are similar to functional psychiatric diseases, in addition to heightened aggressiveness. Patients with mood disorders after a head injury may experience manic episodes, or become apprehensive, schizoid, or psychotic.
Patients with pre-existing personality issues have a lower success rate. Even if it has been in remission for several years, a head-trauma patient may experience a recurrence of pre-existing psychiatric disorder, which may be accompanied by the addition of impulse control issues. Depression, as well as self-hatred, inappropriate sexual conduct, theft, and bulimia, are all very common.
Impaired cognition – Cognition is described as a combination of observations, memories, and thinking that allows an individual to interpret the world in their own way. Successfully relating to people is the most challenging cognitive task, and divorce is highly common among brain-injured patients. They are difficult to manage as patients because they are highly reactive to unsaid tension and rage. There could also be serious memory problems.
Impaired physical ability – Many physical abilities can be damaged as a result of a head injury. Physical medicine, psychiatry, and neurology experts are all needed to cope with the potential physical problems that a brain-injured patient may face.
In circumstances when the injury is not severe, determining the diagnosis and assessing the long-term consequences might be challenging because personality changes can be mild. It’s possible that the neuropsychologist or neurosurgeon will have to rely on feedback from family and friends. Obviously, substantial changes will be noted in the case of the badly damaged patient. It’s possible that the psychological alterations will be more difficult to determine.
Expert testimony is also required to prove the injury’s actual outcomes. The use of neuropsychological and neurological testimony that is based on the expert’s actual examination and treatment is required for proof. Employers, relatives, and friends can provide “before and after” evidence to demonstrate a loss of ability, personality, or other mental functions.
The trauma of the damage has a significant influence on the “new” person’s family. The family is the most affected by the shift in the injured person’s “before and after”, as well as how the injured person now interacts with family members.
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COMMON DEFENSES USED IN MILD TBI CASESThe “prove it” defense is the main defense in many mild TBI cases. In these cases, the plaintiff will typically show no visible signs of injury. They will appear normal. The injury is subtle, and it is revealed through details provided by the plaintiff, his family, friends, coworkers, and doctors. This is one of the most difficult issues when trying a mild traumatic brain injury case. The plaintiff appears normal, there is no objectively verifiable evidence of lingering injury, and yet the plaintiff seeks millions of dollars in damages. How can we be certain that the claim is true?
The defense frequently focuses on the fact that the neuro-imaging of the brain was normal. This is common because a mild TBI is defined by the absence of visible lesions on the brain. In other words, you should expect a normal CT and MRI. The fact that an injury cannot be objectively verified with a diagnostic test does not mean it is not real. This concept has shaped the entire field of neuropsychology. Even defense expert witnesses must agree that the majority of mild TBI patients have symptoms that are real to them and are strongly linked to brain trauma.
In auto accident cases, the plaintiff’s brain is often one of several parts of the body injured. Mild brain injury is often overlooked in cases involving multiple traumatic injuries. The emphasis in the ER is usually on visible traumatic injuries. It is not until several weeks later that TBI symptoms begin to be recognized. This often gives rise to a defense based on the idea that if the other doctors did not diagnose it, then it must not have been there. Emergency departments have been shown to miss 56% of mild traumatic brain injuries.
Another defense is the plaintiff’s mild TBI symptoms should have gone away after three months because that is what happens to most people. Most people do recover with little or no treatment. But many do not. 15 to 20% of patients develop a chronic persistent post-concussive syndrome that lasts more than a year after the injury. These symptoms have been documented to be lifelong for some.
If the plaintiff demonstrates a high I.Q. on neuropsychological testing following the injury, the defense will be that the injury had no effect on the plaintiff’s cognitive abilities. In the case of a mild TBI, the plaintiff rarely claims a complete loss of cognitive function. The typical claim is that the TBI has impaired part of the plaintiff’s cognition, such as the ability to multitask or maintain attention in the face of distractions. These functions are especially vulnerable to mild traumatic brain injury.
Because the injury is difficult to objectively verify, it lends itself to claims that the plaintiff is fabricating or exaggerating the injury in order to obtain monetary compensation.
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CONTACT USWe represent people in the Dallas, North Texas area, who have been victims of negligence that has caused TBI (brain injuries).
Brain trauma from accidents can change a life permanently and in a severe way. We know that the goals are usually to ensure that medical bills are covered, to alleviate suffering due to financial loss, and to take action against the appropriate insurance companies to make sure the injury is covered. We will discuss your case with you and help you to make sure your needs are handled in a way that is fast and appropriate. If you or a loved one has suffered a brain injury due to an auto accident, our attorney will help you recover what is owed for your injury.
If you are suffering due to a brain injury to yourself or someone you love, call (972) 599-4100 to set up a free consultation to discuss your case.
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COMMON HEAD INJURY MEDICAL TERMSAcalculia – Loss of ability to perform basic arithmetic.
Agnosia – is defined as a loss of ability to recognize objects, people, sounds, shapes, or smells.
Agraphia – Loss of writing ability.
Alexia – Loss of understanding of printed words or sentences.
Anomia – Loss of the ability to recall object names.
Anti-Convulsive Medications – Dilantin, Tegretol, and Phenobarbital are examples of anti-convulsive medications.
Apathy – is defined as a lack of interest or concern.
Aphasia – Loss of ability to express oneself and/or comprehend language. There are numerous types, including Receptive Aphasia (inability to understand what someone is saying, which is frequently associated with damage to the temporal area of the brain) and Expressive Aphasia (inability to express oneself, often associated with the left frontal area of the brain).
Apraxia – The inability to perform purposeful movements, such as skilled or learned motor acts, in the absence of paralysis—particularly the ability to use objects.
Astereognosia – is the inability to recognize objects by touch.
Ataxia – The inability to coordinate muscle movements or the presence of irregular muscle movements.
Brain Stem – The lower portion of the brain that connects to the spinal column and coordinates the vital functions of the body.
Cerebellum – A region of the brain located beneath the cortex that is responsible for movement coordination.
Cognition – Knowledge, awareness, perceiving objects, thinking, and remembering ideas. The learned set of rules that underpins all thinking.
Coma – Unconsciousness that lasts longer than a short time.
Contra-Coup – When the brain is struck with enough force that it ‘bounces’ against the opposite side of the skull, causing injuries on both impact sites.
Cortex – The largest portion of the brain, consisting of two cerebral hemispheres connected by “corpus callosum” tissue. The majority of cognition and thinking occurs here. Also known as the "cerebrum".
CT-Scan – A series of x-rays taken at various levels of the brain. A series of tests may be performed over time to monitor recovery.
Diffuse – Brain damage that affects multiple areas of the brain rather than just one. Is common in closed head injuries because the brain can move around and tissue can be torn, bruised, and stretched.
Diplopia – Double vision, also known as seeing two images of the same object.
Disinhibition – The inability to control or suppress impulses and emotions.
Disorientation – Not knowing where you are, what time it is, or what day it is.
Dysarthria – Difficulty articulating and forming words, as well as damage to the motor area of the cortex or brain stem. Speech can be slurred, as well as extremely fast or slow.
Edema – A buildup of fluid in the brain tissue that causes swelling.
Emotional liability – Exhibiting sudden and dramatic changes in emotions; mood swings and fluctuations accompanied by extreme variations.
Frontal lobe – The frontal lobe of the brain, on both sides. Aids in the control of emotions, social skills, and impulse inhibition.
Frustration tolerance – The ability to deal with upsetting events in everyday life. When that ability is lost, the person reacts with aggression, yelling, or other loss of control.
Glasgow Coma Scale – Scale developed to assess the severity of injury by incorporating three factors: motor responses, eye opening, and verbal responses.
Hematoma – A condition in which a tissue swells and fills with blood.
Hemiparesis – Weakness on one side of the body caused by injury to the brain’s motor areas.
Hemispheric asymmetry – Differences in the types of functions performed by the two sides (hemispheres). The right side is typically associated with spatial abilities, whereas the left side is typically associated with verbal functions and abilities.
Hemorrhage – Bleeding that occurs after trauma and may occur within the brain if vessels within the brain or skull are damaged.
Inflexibility – The inability to adapt to daily changes in routine (often seen with frontal lobe-injured patients).
Limbic system – A collection of structures that play important roles in memory, behavior, and emotion (normally considered part of the temporal lobe).
Memory – The process of perceiving, organizing, and storing information. There are three types: immediate (repeating a phone number), recent (recalling events from the previous day), and remote (recalling names from childhood).
Occipital lobe – The posterior or back portion of each side of the brain, which is involved in perceiving and comprehending visual information.
Parietal lobe – The upper-middle lobe on each side of the brain that is involved in perceiving and comprehending sensations. Involved in both writing and speaking fluency.
Perseveration – the state of being “stuck” on a single task.
Post-trauma amnesia – Memory loss that occurs immediately following an injury. It is possible that this will continue. Some experts believe that the length of PTA is an indicator of recovery.
Proximal instability – Muscle tone weakness in the trunk, hip, or shoulder girdle. Poor posture, abnormal leg and arm movements, or inability to sit upright or hold head upright may result. Damage to the motor strip of the brain causes this condition.
Quadriparesis – is characterized by the weakness of all arms and legs.
Spasticity – An abnormal increase in muscle tone causes muscles to resist stretching, causing the patient to appear stiff or curled up.
Spontaneous recovery – This type of recovery occurs with or without rehabilitation and occurs naturally as the brain heals. This happens early in the recovery process.
Tactile defensiveness – Excessive sensitivity to touch, manifested by crying, yelling, or striking out when touched.
Temporal lobe – The lower middle portion of each side of the brain that receives information from the auditory system and is involved in memory.
Unilateral neglect – Failure to respond to stimuli on one side; usually occurs on the opposite side of the injury site.
Ventricles – Four cavities in the brain filled with cerebrospinal fluid that act as a cushion when the brain is hit. When brain tissue is damaged, the ventricles may enlarge.
Vestibular – Being aware of movement involving the head. Disorders in this system can result in a lack of awareness of movement or movement direction, or, conversely, hypersensitivity to movement.
Visual field neglect – The inability to perceive information in a specific area of the visual field. Normally involves either the left or right half of the visual field, but in some cases, only a quarter of the field is involved.
By Doug Goyen, douggoyen@goyenlaw.com
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