Traumatic Brain Injury (TBI) is a serious, debilitating, and deadly injury resulting from trauma to the head. Often resulting from trips, slips, falls, automobile, motorcycle, and trucking accidents, TBIs are not always easy to identify. For example, if one suffers a fractured skull, a brain bleed, or a coma due to an impact to the head, it is obvious one has suffered a severe TBI. However, one can also suffer a mild brain injury, which despite its name, should be taken as seriously as a severe TBI. These often occur during automobile, motorcycle, and trucking accidents, and although they are not life threatening, they can have serious effects on one’s physical, cognitive, and emotional abilities. It is important to take these seriously because if left untreated or ignored, the injury could get worse and symptoms can intensify over time.
Keep in mind that over 1 Million Americans are afflicted by a traumatic brain injury each year and over 70,000 experience a long-term disability as a result.
A diagnosis of MTBI is considered valid when one or more of the following conditions occur after am injury to the brain.
The most common myth surrounding TBI’s is that one must be struck on the head or knocked unconscious in order to receive or have suffered an injury to the brain. However, a recent study done by Ezriel Kornel, M.D., F.A.C.S., and Michael Freeman, Ph.D, found that whiplash, often experienced in automobile and motorcycle accidents, caused brain injury in over 20 percent of cases presented in the study. The brain injury often found in the study manifests as a hernia in the brain known as a Chiari Malformation, in which the bottom part of the brain protrudes through the base of the skull.
One can also suffer a brain injury as a result from whiplash as well. The rapid acceleration/deceleration forces sustained to the skull in a rear end car accident can cause the brain to impact the opposite side of the skull.
Axonal tears often go unrecognized by emergency responders, doctors, and personal injury attorneys since they can also occur in a low impact accident where there is no impact of the head or loss of consciousness. This is one of the worst brain injuries that can be suffered, and insurance companies will try dismissing it and labeling the accident in which it happened as a “minor impact accident.” This is certainly not the case, and it is very important to be examined by a doctor who is well-versed in the area of TBIs and all of the science that goes behind it.
As a traumatic brain injury lawyer, I have personally heard these myths, either from clients or from other brain injury lawyers. Let’s go over some of the more common myths:
The human brain has the consistency of jello. In a car accident, the brain can move rapidly though the course of a rigid skull lined with numerous bony protrusions. The brain can bounce off the skull and hit the opposite end of the skull resulting in a coup-countrecoup injury.
This myth is also disproven in instances akin to a whiplash mechanism of injury wherein the head jerks forward and the movement suddenly ceases. Whiplash has been shown in certain cases to cause a disruption in the nerve cells of the brain, responsible for sending messages.
Diagnostic testing has greatly advanced over the past twenty years. However, microscopic lesions in the brain and damage to the neurons can often be missed on an MRI. This fallacy pushed by insurance adjusters must be countered immediately. Neurologists will rely on the medical history of the patient and their clinical presentation. In fact, it is quite common to have a negative MRI yet manifest with cognitive or functional impairment during neurological or neuropsychological testing.
Claims adjusters and insurance defense lawyers often attempt to minimize the extent of a brain injury by alleging that the ailment is minor and the claimant will quickly recover. Some symptoms of brain injury are minor and subtle such as memory issues. “At one year after injury, 10-15% of mild TBI patients have not recovered. Many are more symptomatic than even immediately after the injury. Some have had persistence of one particularly troubling symptom usually headache, neck pain or dizziness. Most have persistence and even worsening of the entire symptom complex. Both groups are at a high risk of permanent symptomatic persistent post-concussive syndrome.”
The prognosis for many brain injury victims may be favorable but that unfortunately does not hold true for everyone. In fact, some take longer than others to recover, while a minority of individuals, simply do not get better despite the passage of time.
The most common type of brain trauma, both closed and open head injuries can result in concussions. They are often caused by impacts to the head, violent shaking of the head, or whiplash type movements. A concussion often results in post-concussion syndrome; a very serious disorder which can last for months and even in excess of a year. Concussions are often referred to as a mild traumatic brain injury (MTBI).
A concussion must never be ignored and warrants immediate medical attention. Post-concussion syndrome can greatly inhibit your ability to perform tasks and may interfere with your job functions. We often see the incidence of concussion either ignored or overlooked by attorneys and physicians who opt to focus on the more obvious and readily apparent orthopedic injuries.
Most individuals with concussions recover after a short to moderate period of time aided by rest. Neurologists often play a crucial role in assisting a patient with post-concussive syndrome in both the evaluation and treatment of minor mental health and cognitive issues. Diagnosis of post-concussion syndrome is based on the patient’s history of head trauma, results of both a physical and neurological examination and perhaps other diagnostic tests to rule out the presence of a more serious brain injury. Risk factors for post-concussive syndrome are increased by age of the patient and history of prior concussions.
If a second concussion occurs prior to the symptoms resolving from the initial concussion; second impact syndrome (SIS) can occur. An occurrence of second impact syndrome; is marked by rapid swelling of the brain, which may prove fatal. Even a minor concussion can cause secondary impact syndrome. Secondary impact syndrome often proves to be fatal and will result in a debilitating condition at a minimum.
A contusion is a direct result of an impact to the head resulting in severe bruising or bleeding of the brain. A cerebral contusion by definition is a bruise to the brain tissue. Large contusions often require surgery. Keep in mind that a cerebral contusion can be related to blood vessel leaks and microhemorrhages. Contusions generally occur in the cortical tissue under the site of where the impact took place. Contusions with edema (swelling) often require surgery to reduce intracranial pressure which can be life threatening or result in permanent brain damage. Contusion related symptoms depend both on the location (sphere of the brain) of the pathology and obviously the severity of such. In moderate to severe contusions, the swelling is usually greatest at five to six days following the trauma. This is due to swelling of the brain tissue surrounding the site of the impact. Additionally, toxins are released due to the contusion increasing the rate of swelling.
This is a result of two contusions on both sides of the brain. The first contusion is a result of the initial impact to the head. The second contusion is a result of the head being hit with such force that the brain slams against the other side of the skull. A coup injury occurs directly under the area of impact. A contracoup injury occurs on the side directly opposite the impact. In a coup-contrecoup brain injury, both sides of the brain are damaged.
This occurs when the brain lags behind movement of the skull, thus tearing parts of the brain. This often is a result of an intense shaking or twisting of the head, such as a car accident. A diffuse axonal injury to the brain can cause severe problems and even death. Diffuse axonal injury is caused by shearing forces such as an acceleration deceleration mechanism of injury akin to whiplash. This occurs when the head moves forward in a rapid manner (acceleration) and then backwards or a sudden stop (deceleration). Individuals with diffuse axonal injury typically lose consciousness at the time of trauma. The back and forth movement of the brain disrupts the nerve cells and inhibits the ability of the cells to transmit messages.
An injury that forces matter from the skull into the brain. It is a result of a gunshot wound, stabbing wound, or any other sharp object. Often these types of brain injuries can result in death.
A mass of blood or pronounced swelling between the skull and the brain. In some cases, the swelling or mass of blood occurs inside the brain.
The most popular professional sports league in America, the N.F.L., has been making headlines lately for settling with a group of former players. The suit will provide them with compensation for medical bills and other needs if a player currently suffers, or later develops, a severe neurological condition as a result of repeated TBIs.
These unfortunate former football players are experiencing, for the first time, the severe effects of untreated or misdiagnosed, repeated closed head injuries. The repeated injuries have resulted in dementia, Alzheimer’s disease, Lou Gehrig’s disease, severe depression. It is tragic that the suffering of our former gridiron heroes is what finally made the public pay attention to severity of closed head injuries.
In the event of a possible head trauma, one is often rushed to the nearest emergency room. Hopefully the emergency room doctor runs all the standard procedures and tests in place to diagnose a TBI. Even so, MRIs and CT scans will not always provide the conclusive evidence needed to confidently diagnose a TBI.
As Clearwater traumatic brain injury attorneys, we are up to date on the best technologies and tests for TBIs available in Florida, and will ensure that you receive the proper care and treatment when dealing with TBI.
The Dolman Law Group, consistently deals with insurance adjusters, Florida insurance defense lawyers, and even physicians who are unfamiliar with TBI and the relationship between a potential closed head injury and whiplash. Many practitioners are mistakenly under the assumption that the head must strike an object to cause trauma to the brain. It is essential to retain a Florida injury law attorney who is not only familiar with TBIs but also the latest science in this rapidly evolving area of medicine.
The brain injury law attorneys at Dolman Law Group, are experienced with the tactics employed by insurance carriers and defense lawyers in combating such claims. We have clients who have suffered significant brain injury and did not suffer any impact to the head or even lose consciousness. An insurance carrier would try to discredit an injury in that type of situation. We will not let that happen to someone who has suffered a serious injury.
Dolman Law Group, is a Pinellas County and Manatee County personal injury law firm that routinely handles claims and litigates cases involving closed head injuries as a result of an automobile accident or motorcycle accident. We actively litigate auto accident and motorcycle accident related cases in Pinellas County, Hillsborough County, Sarasota County, Manatee County and Pasco County. Located in central Pinellas County (Clearwater), Dolman Law Group, is easily accessible to injury victims in St. Petersburg, Tampa, Palm Harbor, Dunedin, Safety Harbor, New Port Richey, Pinellas Park, Largo and Kenneth City.
1. Alexander, M.P., Mild Traumatic Brain Injury: Pathophysiology Natural History and Clinical Management, 45 Neurology 1256, 1256 (1995)