Discerning a viable traumatic brain injury in a personal injury case is always an interesting challenge for a personal injury practitioner. When first analyzing a new case, we tend to triage the injuries as though we were member of an emergency response team. Customarily, we start by tallying the obvious and familiar injuries (back, neck, long bones, etc.) Head injuries can be subtle or hidden to all but the newest and most advanced technologies and certainly to the plaintiff's attorney who is not accustomed to prosecuting traumatic brain injury (TBI) claims. Furthermore, some head injuries may not manifest themselves for many years, if not decades, but there are ways to detect and account for these damages. We'll discuss those methods a bit here and in subsequent articles in greater detail.
Traumatic brain injury is often labeled as an invisible injury because it may easily be missed in ordinary diagnosis and treatment. As trial lawyers, we hope to inventory each new client for every injury that may exist. CT scanning is primarily ordered to rule out immediate life threatening bleeding of the brain that could prove fatal could prove fatal within twenty-four hours. However, routine Computed Tomography (CT) scans in hospitals rarely detect traumatic brain injury. The vast majority of traumatic brain injuries are also missed in Magnetic Resonance Imaging (MRI). Sadly, many acquired traumatic brain injuries missed by CT and MRIs may result in cognitive dysfunction, post-traumatic stress disorder, depression and suicide in many of its victims, among other damages such as lowered wage and career expectations.
As advocates, our first opportunity for ruling out acquired traumatic brain injury occurs during the initial interview process. Whenever possible, interview the client with a family member and/or close friend. If there are no obvious signs of head injury or none reported, ask whether there was a blow to the head. If not, or if the client does not recall, ask about loss of consciousness. Naturally, no one remembers being unconscious, so inquire whether the client recalls being dazed, confused, or a gap in memory. If not, for assurance, ask for a detailed chronological description of everything that happened based upon memory, not upon what someone else has told them. Explore with the client and family member(s) or friends, all the ways in which the client is different than before the incident. Be sure to inquire as to physical symptoms as well as mental and emotional ones. Try to be as specific as you can with this inquiry by asking leading questions which may show a specific example of loss of memory. For example, if the client enjoyed cooking, ask if he or she now ever omits ingredients in a recipe or leaves the house without turning off the stove.
Additionally, ascertain whether the injury involved rapid acceleration and/or deceleration. Often, the brain can become traumatically injured by a coup-contrecoup injury or sudden forceful acceleration or deceleration pushing against the inside of the skull. When the brain (which is composed of tissue similar to jello or oatmeal) slams against the inside of the skull it may bruise and/or shear axons.
Importantly, a concussive event may occur without a direct blow to the head. This is reason why so much traumatic brain injury goes undetected. The inside of the skull is quite different from the outside. For instance, the outer forehead has a smooth rounded feel to it, while the inner side adjacent to the frontal lobe of the brain consists of curved jagged ridges which protrude into the frontal lobe. Following a force strong enough, a coup/contrecoup event occurs. The damage may be in the form of axon shearing may not be detectible except by Diffusion Tensor Imaging (DTI). Even then, evidence of axon shearing may have a delayed onset, so repeated DTI screening may be recommended.
Here is a list of symptoms to watch for if you think you, your family, friend, or loved one has suffered a traumatic brain injury:
Temporary loss of consciousness
Headaches
Dizziness
Blurred vision
Problems with smell
Taste or hearing
Ringing in the ears
Slurred speech
Combativeness
Memory loss
Confusion
Depression
Dazed or groggy
Nausea or vomiting
Fatigue
Concentration or memory problems
Sleep disturbance
Personality changes or irritability
Traumatic brain injury cases are quite complex and it is critically important that your lawyer is skilled in this area of law. On the bright side, traumatic brain injury victims recently gained two credible allies in educating the courts and public of the dangers of traumatic brain injury. First, the recent attention given to rapidly exploding blast injuries to United States military personnel in Iraq and Afghanistan helps educate the public regarding traumatic brain injury. Second, the National Football League's intensified focus on rampant concussive syndrome which so infests the sport has helped draw attention to the problems associated with traumatic brain injury. Both the military and the NFL play a large role in educating our nation about the severity and frequency of traumatic brain injury. The attention they receive increases research, funding, and improves medical testing equipment, all of which have a downstream positive effect for traumatic brain injury victims.
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