Brain Injury Lawyer

Most people aren't aware of the main causes of traumatic brain injuries and who is most at risk. While there is a very diverse range of what can cause a traumatic brain injury, there are several very common causes of TBIs. The four most common causes of a traumatic brain injury are:

• 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

Last week, I wrote about the large number of previously undisclosed traumatic brain injuries being suffered by our troops in Iraq.  Department of Veteran’s Affairs officials have announced that all Iraq and Afghanistan war veterans receiving veterans’ medical care will be screened for hidden traumatic brain injuries beginning this spring.  The DVA also announced that they are creating a panel of outside experts to review how the VA detects and treats brain injuries that may not be readily apparent.

Looking for a silver lining in a dark cloud, maybe these unfortunate events will help people to understand that one can sustain a brain injury without loss of consciousness and with no visible sign of injury.

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.

The ideology of Chiari malformations is generally believed to be that the malformation is present at birth. [It has been suggested that during early embryo development of the brainstem and spinal cord, the malformation occurs.] While this condition may be asymptomatic in many people, it can, over time, become symptomatic. It is noteworthy that Chiari I malformation occurs more often in women than in men.

Chiari malformations are usually described as Type I which consists of a downward displacement of the cerebellar tonsils out of the inferior opening of the skull into the spinal canal or Type II malformations which have greater displacement of brain structures into the spinal canal. In addition to the cerebellar tonsils, there is also displacement of the inferior vermis.

It is not unusual for the Chiari malformations to have an associated accumulation of fluid within the interior of the spinal cord. This condition is called syringomyelia.

After having a conversation with a former client, I have decided to spend some time over the next few days to blog about a brain condition know as Chiari malformation. I hope to be able to share information about this developmental abnormality with the readers of my blog who are unaware of this issue, and what it means.

Chiari malformation is a developmental anomaly at the base of the brain which results in the downward displacement of some of the brain's structures into the spinal canal. The lower most part of the brain is the cerebellum and brainstem. This is the area just at the base of the skull which attaches to the spinal cord. This area is called the posterior fossa. The cerebellum is made up of three major lobes which are composed of nerve fibers connecting to the brainstem. There are two small portions of cerebellar tissue, called the cerebellar tonsils, which normally lie within the posterior fossa. A more detailed explination of the information above can be found here.