Brain Injury Lawyer

A number of years ago, the Brain Injury Association of America retained the Gallop Group to conduct a poll to gather information regarding the public’s awareness of traumatic brain injury.  One of the things learned from the polling results was that the public viewed the term “head injury” as being less serious than the term “traumatic brain injury.”
 
A recent study published in the journal Pediatrics confirmed that perception. Carol A. DeMatteo, M.S.c and her colleagues at McMaster University in Hamilton, Canada, conducted a study, the goal of which was to examine the clinical correlation of the concussion diagnosis and to identify the factors that lead to the use of this term in a regional pediatric center.
 
According to the abstract, the researchers collected data respectively from 434 children with traumatic brain injury who were admitted to a Canadian childrens hospital.  The researchers found that children with mild traumatic brain injuries have an increased frequency of receiving the concussion label, although the label may also be applied to children with more-severe injuries.  The study found the clinicians may use the concussion label because it is less alarming to parents then the term mild brain injury with the intent of implying that the injury is transient with no significant long-term health consequences.
 
In the study, the doctors followed children who had been given a diagnosis of either concussion or traumatic brain injury.  The study found that in the days following their injuries, those with a diagnosis of concussion were one and a half times as likely to be discharged from the hospital as those with a “mild tbi” diagnosis - even though there was significant overlap between the two groups in terms of the severity of their head injuries.  There was also a two and a half times greater likelihood that the children diagnosed with “concussion” would go back to school early as well.
 
Dr. DeMatteo, in an article published in the Los Angeles Times was quoted as stating “These children (the ones with a concussion diagnosis) may be sent back to school or allowed to return to activities sooner, and maybe sooner than they should.  This puts them at greater risk for a second injury, poor school performance, and wondering what is wrong with them.”

At present, the gold standard for objectively proving that an individual sustained a mild traumatic brain injury is through neuropsychological testing.  As we know, standard diagnostic testing such as CT scans, MRIs and EEGs, due to their lack of sensitivity, rarely if ever detect brain abnormalities in patients with mild traumatic brain injury.

However, advances in neuroimaging may soon eliminate the need for neuropsychological testing to diagnose brain damage.  Advances in FMRI and diffusion tensor imaging (DTI) will soon become the gold standard.

I recently read an article published in Brain entitled “Structural Dissociation of Attentional Control and Memory in Adults with and without Mild Traumatic Brain Injury”.  The article by S. N. Niogi et al, noted that executive function such as attention and memory are among the most significant human brain processes impacting overall cognitive function.  The study contained 43 patients prospectively recruited with mild TBI, (28 males, 15 females) who were imaged at least one month post injury and 23 healthy volunteers, (17 males, 6 females).  There was no significant difference in mean age, gender, handedness, or level of education between the mild TBI group and the control group.  Those with a prior history of TBI, a history of neurological or psychiatric illness were excluded.  All subjects underwent diffusion tensor imaging along with conventional MRI.  The study provided clear evidence that DTI may serve as a microstructural imaging biomarker for cognitive dysfunctions and variations within normal cognitive functions.  Hopefully, further research will confirm this finding.  DTI has already been accepted in our courts as a reliable neuroimaging mechanism to detect brain injury from trauma.  Further studies such as this will only strengthen its admissibility.

A new study states that prior to becoming homeless, more than one out of every three of Toronto, Canada’s homeless had suffered from a traumatic brain injury, which furthers past theories that mental health is linked to homelessness.

A paper published in the Canadian Medical Association Journal recently found that more than half of the homeless population of Toronto had experienced a severe brain injury, and 70% of those did so before ending up on the streets. The study surveyed roughly 900 people living in Toronto homeless shelters from 2004 – 2005. Traumatic brain injuries usually result in cognitive impairment, attention deficits and emotional instability.

You can read more on this story here.

 

• Falls - 28%
• Motor vehicle-traffic crashes - 20%
• Stuck by/against events - 19%
• Assaults - 11%

• Males are about 1.5 times as likely as females to suffer from a TBI
• The two age groups at highest risk for a TBI are 0-4 years of age, and 15-19 years of age
• Certain military duties (i.e. paratrooper) increase the risk of sustaining a TBI
• African Americans have the highest death rate from TBIs

I read an interesting article this morning on the Use of the Pediatric Glasgow Coma Scale in Pre-verbal Children with Blunt Head Trauma. James F. Holmes, M.D. MPH and his colleagues from the University of California, Davis, School of Medicine, investigated whether the accuracy of pediatric Glasgow Coma Scale score in pre-verbal children with blunt head trauma compared favorably with the standard glasgo coma scale score in older children. The authors perspectively enrolled children younger than 18 years with blunt head trauma.

According to the study, the patients were divided into cohorts of two years and younger and those older than two years. The authors assigned a pediatric GCS score to the younger cohort and the standard GSC score to the older cohort. The authors concluded that the pediatric Glasgow Coma Scale for children two years and younger compared favorably with the standard GCS in the evaluation of children with blunt head trauma. The Pediatric GCS was found to be particularly accurate in evaluating pre-verbal children with blunt head trauma with regard to the need for acute intervention. Acad Emerg Med Volume 12, Number 9 814-819 (2005).

Following up on earlier posts (here, here, here, here, here, here, and finally here) regarding seemingly minor injuries (a bump to the head or a fender bender) can actually be major events which sometimes may cause irreversible damage to the individual's health and personality.

When events such as a fall or minor car accident take place, many people "shake off the injury" and believe that no permanent damage has been done. As such, most do not go to their doctor or the hospital for treatment. Even those who do go to their doctor may be misdiagnosed since MRIs and CAT scans usually can not detect the damage done to blood vessels and tissues in the injured person's head.

Post-concussion syndrome refers to the changes in an injured person's brain processes that affect personality, mood, memory, social interaction and the ability to work and learn. Post-concussion syndrome can result in mental rigidity, inattention, swinging moods and shifting energy levels.

But doctors often miss the diagnosis of post-concussion syndrome, because it is not as recognizable as a broken bone or tumor. The patient may be as smart as ever, in fact. But he or she may have become "socially disabled" - impulsive, disinhibited, likely to say things out of context or inappropriately, unable to start a relationship or maintain one.

This can often be the basis for damage awards in a lawsuit, said Dr. Gerald Tramontano, whose NeuroRehab Institute includes a "forensic division," whose experts testify in court.

You can read more about Post-concussion syndrome here.

After one suffers a traumatic brain injury, many additional physical problems can occur as a result including vision problems. After traumatic brain injury, it is possible for the nerves or muscles that control eye movement to be injured. It is possible for the victim of a brain injury to experience a visual impairment such as double vision (diplopia), or the occurrence of two images at the same time. This condition can affect reading, walking, driving and other daily activities. In some cases, double vision isn't constant and the symptoms may only occur during certain settings.

There are two types of double vision: monocular and binocular. In monocular double vision, the vision problem affects only one eye and does not go away when looking in different directions. When the affected eye is covered, the double images disappear. Binocular double vision affects both eyes.

Today will be my fourth and final post on Chiari malformation.

While it is generally believed that Chiari malformation occurs at birth, recent scientific research has shown that this condition, which may be asymptomatic, can become symptomatic due to trauma. Also, there is a body of literature that recognizes that Chiari malformation may become acquired as opposed to congenital.