Traumatic Brain Injury
People suffer traumatic brain injuries in a wide range of ways including car, truck and motorcycle accidents as well as falls. They are among the most common disabling neurological disorders. They also raise serious legal issues as they may leave the injured person unable to care for themselves or their family, unable to earn income and with substantial medical expenses.
In the United States, at least 1.4 million traumatic brain injuries occur every year and there are over five million people living with a disability from a traumatic brain injury. The impact of a traumatic brain injury can be profound. A traumatic brain injury can involve the cognitive, emotional and behavioral functioning of a person. Motor and sensory problems may also occur with a more severe injury. An individual with a traumatic brain injury which appears less severe, may not have any physical sign of injury. The person may, however, experience a profound impact on their ability to function. This can be a challenge for the doctors managing the patient’s care as well as the Chicago attorney advocating fair compensation on their behalf.
Mild traumatic brain injuries
Most brain injuries are “mild”. The vast majority of emergency department visits and hospital admissions for brain injury are for people who have suffered a “mild” traumatic brain injury. Approximately 80% of the hospital admissions for a brain injury are for a “mild” traumatic brain injury, 10% for moderate and 10% for a severe injury.
A mild traumatic brain injury can be a difficult condition to diagnose and treat. Although there may be damage, it may not be reflected on a CT scan or MRI. Some bruising of the brain falls below the threshold of study of a CT scanner. This can lead to difficulty in persuading an insurer or a jury of the nature and extent of the brain injury.
It is often difficult to predict the long-term outcome of a mild traumatic brain injury or for that matter a moderate injury as well. A few factors are relied upon by doctors to predict outcome after head trauma. The Glasgow coma scale (GCS) evaluates the eyes, verbal skills, and motor skills of the patient. A score of 15 is normal. The lowest possible score is 3 which suggests deep coma or death. A 15 represents a fully awake person. A low GCS score also may predict poor outcome. Hemorrhage and fracture are important predictive factors for an unfavorable outcome as are CT scan irregularities, abnormal pupillary responses. Patients older than age 60 may also have a poor prognosis.
Even a small amount of brain damage can profoundly change and damage someone’s life. The issues involved in medical care can be complex and the legal issues challenging.
Oftentimes a neuropsychologist will become involved in examining a traumatic brain injury patient to address the extent to which the traumatic brain injury affects the ability of the individual to function. A neuropsychological examination may include evaluation of attention, memory, executive functioning, speech and language, intelligence and motor skills. Neuropsychological testing can assist in the evaluation of mild, moderate and severe traumatic brain injuries and the increased risk of the onset of psychiatric illness.
Traumatic brain injury and the elderly
Although motor vehicle accidents are the most common cause of a traumatic brain injury in a younger individual, falls account for the highest proportion of traumatic brain injury in older individuals. Motor vehicle accidents remain the second most common cause of traumatic brain injury in people over the age of 65. Older patients tend to have more cognitive impairment after a traumatic brain injury then do younger patients. Elderly patients who sustain traumatic brain injuries are generally at risk for a higher mortality as well as poor cognitive and functional outcomes.
Age-related cerebral atrophy leads to a decrease in brain volume per year after the age of 60. The aging brain may be less able to mount an effective regenerative response to brain trauma. Age-related changes also lead to a reduction in the flow of blood to the brain. The cerebral atrophy leads to brain shrinkage. Shrinkage increases the distance between the brain and skull. Changing velocities within the skull when involved in a car accident may stretch and tear small bridging veins which run to the surface of the brain. This type of injury is more common in the elderly given the shrinkage of the brain.
Types of Traumatic Brain Injury
A closed head injury results from a blow to the head for example when the head strikes the windshield or dashboard. This can result in a skull fracture, bruising of the brain, bleeding of the brain, laceration or tearing of the brain as well as nerve damage.
In addition to the primary brain damage associated with a closed head injury, secondary damage may occur. This includes swelling of the brain which may result in movement of the brain from the mid-line. A shift from the mid-line found on a CT scan may indicate a poor prognosis. The displacement of the brain from the mid-line can cause compression and inadequate flow of blood and oxygen to the brain. Brain compression may also cause sugar depletion to brain cells and may impair brain cell function and cause permanent neuronal damage.
Traumatic brain injury can also give rise to neurochemical changes in the brain including increased excitatory amino acids which can cause swelling and neuronal death as well as an influx of calcium which can cause further brain damage. Secondary brain damage can also include increased intracranial pressure, infection, low or high blood pressure and cardiac changes.
Cases involving traumatic brain injury are often complex and will typically involve issues which should be discussed with a personal injury attorney.
A concussion is the most common and least serious type of traumatic brain injury. Concussion typically involves temporary impairment of neurological function. Imaging of the brain such as a CT scan normally shows no structural change to the brain as a result of a concussion. According to the National Institute for Health and Clinical Excellence, concussion may involve physical disruption of the brains synapses. A headache is the most common symptom of a concussion. A person who has suffered a concussion may also experience dizziness, vomiting, nausea, confusion, motor problems and difficulties with balance.
The American Academy of Neurology has developed guidelines for the grading of a concussion. A Grade I concussion involves confusion and symptoms that last less than 15 minutes with no loss of consciousness. A Grade II concussion involves symptoms that last greater than 15 minutes with no loss of consciousness. A Grade III concussion includes the loss of consciousness.
Some patients who suffered a concussion develop post-concussion syndrome. Post-concussion syndrome involves symptoms of a concussion which lasts for weeks, months or years. Post-concussion syndrome may occur in mild traumatic brain injuries or more moderate and severe cases.
Prognosis of a patient with a traumatic brain injury
Most traumatic brain injuries are mild and do not cause permanent or long-term disability. However, even a mild traumatic brain injury has the potential to cause significant long-lasting damage. Patients with even mild traumatic brain injury may experience cognitive and social impairment which can continue over the course of their lives.
At Dwyer & McDevitt, we have experience representing young and elderly clients who have suffered anywhere from mild to severe traumatic brain injury as the result of trauma. For example, we represented a 74-year old woman who suffered multiple facial fractures and post-traumatic dementia as a result of being hit by a box truck. A variety of complex issues including her medical history, the amount of brain damage initially diagnosed and a period of months in which she did not require medical care presented challenges in proving the extent of her injury. The case was eventually resolved by way of settlement at mediation for the sum of $2,350,000.00.