Traumatic Brain Injury - Diagnosis
Stamford, Connecticut, Brain Injury Attorneys
At Casper & de Toledo, Connecticut brain injury attorneys represent the victims and families throughout the state whose lives have been devastated due to an injury accident resulting in traumatic brain injury (TBI). Contact the traumatic brain injury lawyers group at our firm to schedule a free initial consultation with an experienced Connecticut Brain Injury Attorney (C.B.I.A.).
Who Needs a Qualified Lawyer for Representation in a Brain Injury Case?
Any person who sustains an injury to his or her head can benefit from qualified representation. There is scientific literature that confirms that a person who experiences a whiplash from a car crash, truck accident or any other type of accident can sustain a mild traumatic brain injury. Every patient diagnosed with a concussion has sustained a traumatic brain injury of some magnitude. The key is to know and understand the signs and symptoms that indicate that a whiplash or concussion has resulted in permanent damage to the brain. Sometimes the brain damage is microscopic, which means it exists on a cellular level and can produce damage to the neurons and axons in the brain.
Many physicians throughout the country (including in Connecticut) do not focus on the subtle changes that indicate that a brain injury is present, mainly because there is little, if any, treatment that can be afforded to this type of patient. In other cases, certain physicians are really not trained to recognize subtle forms of brain injury. Here at Casper & de Toledo we use checklists to review symptoms that are often associated with brain injury. Those check lists cover such items as reduced attention and concentration, memory problems, problems making decisions, depression, impaired judgment, dizziness/balance problems, blurred vision, ringing in ears (also know as tinnitus), alteration of sense of taste and/or smell, and many other indications. Often, these forms of deficits are only documented and recognized as a result of a specialized evaluation done by a neuropsychologist. In other cases, documentations of subtle forms of brain damage may be identified with specialized imaging techniques known as PET scans, SPECT scans, functional MRI evaluations (FMRI), or the latest technology available (including the use of an extra strength MRI magnet, known as a 3.0 Tesla, together with Diffusion Tensor Imaging).
Diagnostic Tests and Traumatic Brain Injury
These types of injuries will not be discernible on most diagnostic tests that are performed in an emergency department setting. Some MRI (magnetic resonance imaging) evaluations may reflect mild traumatic brain injury, but other tests may be relied upon to corroborate suspected brain injury, including:
PET scan-assesses metabolic function in the brain
SPECT scan-assesses blood perfusion (or blood flow/spreading) in the brain.
Functional MRI (fMRI) - brain mapping that correlates structures within the brain with cognitive function
MR Spectroscopy - identifies metabolic changes in the brain tissue
Electroencephalogram (EEG) - Assesses abnormal electrical activity in the brain including seizure activity
Our traumatic brain injury lawyers help residents in Stamford and other areas of Connecticut use the results of these tests to seek compensation from the parties who are responsible for the injury.
The Role of Neuropsychology in Evaluation of Head Injuries
Complete evaluation of the consequences of traumatic brain injury most often requires a neuropsychological evaluation. Neuropsychology is a specialized field within the field of psychology. A neuropsychologist administers a battery of standardized tests of cognitive function. Most of the tests have been thoroughly researched and normed so that an opinion can be developed as to whether or not the patient has experienced any decrease in the type of functions that are sensitive to a brain injury. In this fashion, a neuropsychologist, often working in conjunction with a neurologist or physiatrist (doctor of physical medicine and rehabilitation) can determine if the neuropsychological findings are consistent with the injuries and losses of which the patient complains.
In some situations, neuropsychologists might use improper tests that have not been properly validated for corroborating acquired brain injury. One such test is the Minnesota Multiphasic Personality Inventory - 2 ("MMPI-2") which was not normed on the traumatic brain injury population. In particular, the so-called "Fake Bad" Scale ("FBS") within the MMPI-2 has been the subject of much scientific criticism insofar as some psychologists attempt to use it to identify malingerers - patients who are intentionally faking their condition. The American Psychological Association has expressed severe reservations about the use of the FBS and several courts around the country have excluded the use of the Fake Bad Scale because it is scientifically unreliable and is inherently biased against patients suffering from traumatic brain injury and women in particular. Stewart Casper was interviewed by the "Connecticut Law Tribune" concerning the Fake Bad Scale in September 2008. The Fake Bad Scale is comprised of forty-three of the five hundred sixty-seven items contained in the MMPI-2. Each item is answered "True" or "False". If a patient's responses to the FBS items results in a score of twenty-six or higher, the patient is identified as a malingerer. Yet the items in the FBS consist of complaints and symptoms common to people who have suffered serious injury including acquired brain injury. Therefore, it is important for an accident lawyer to be capable of recognizing the limitations of the test.
Your Concussion Is a Brain Injury
Health care professionals, including academics, have been at odds for years about the methodologies for classifying concussions. Needless to say, uniformity in descriptors has been elusive. In 1966, the Congress of Neurological Surgeons defined concussion to be a "clinical syndrome characterized by immediate and transient posttraumatic impairment of neural function, such as alteration of consciousness, disturbance of vision, equilibrium, etc. due to brain stem involvement." Other researchers have defined concussion by distinguishing between a "mild concussion", a "moderate concussion" and a "severe concussion" relating severity to the extent of loss of consciousness ("LOC") with Mild = to "no LOC"; Moderate = brief LOC plus retrograde amnesia; and Severe = LOC for 5 minutes or more. Another researcher (Cantu 1986) developed definitions for concussion differentiating between Grade 1, 2 and 3. Grade 1 would be a concussion with no LOC and less than 30 minutes of post traumatic amnesia; Grade 2 would be LOC for less than 5 minutes or post traumatic amnesia lasting longer than 30 minutes but less than 24 hours; and Grade 3 concussion would refer to injuries accompanied by a LOC of greater than 30 minutes or post traumatic amnesia lasting longer than 24 hours. Cantu later revised his concussion criteria in 2001 to combine Grades with duration of symptoms of Post Concussion Syndrome ("PCS") using the signs or symptoms of PCS that can be verified by neuropsychological tests. Another widely used guideline for rating concussions are the Practice Parameters for Concussion Severity adopted by the American Academy of Neurology ("AAN"). The AAN likewise uses three grades for concussion ranking severity as follows: Grade 1 (mild): "Transient confusion; symptoms or mental status abnormalities on examination resolve in less than 15 minutes and no LOC". Grade 2 (moderate): "Transient confusion; symptoms or mental status abnormalities on examination last longer than 15 minutes and no LOC". Grade 3 (severe): "Any LOC either brief (seconds) or prolonged (minutes)".
Often, accident victims experience a direct blow to the head or even a severe shaking of the head, which can occur in a rear-end collision and whiplash type of injury. This is also known as a hyper flexion-hyperextension injury. The common feature of both types of injuries is the sudden movement of the skull that causes the brain, with a gelatinous-like consistency, to bounce around inside the skull. The inside of the skull contains a number of rough and jagged bony ridges that can cause injury to the brain. Furthermore, the forces, including rotational forces, can cause damage within the brain.
Most often, any damage inflicted in these types of events cannot be seen on CT Scans or MRIs. Yet the history combined with the constellation of symptoms leaves little doubt that blows to the head, often dismissed as simple concussions, are in fact brain injuries that may have permanent adverse consequences. Moreover, very often a patient is discharged from a hospital emergency room after having a CT Scan and being evaluated. Discharge does not mean there is no brain injury. One should not get a false sense of security.
Find Help from a Skilled Brain Injury Attorney
No other law firm in the state of Connecticut provides you with the type of background we offer in dealing with brain injury cases. Senior Partner Stewart Casper and his Connecticut brain injury team are members of a select group of lawyers throughout the nation who attend advanced seminars on the specifics in the areas of brain imaging, neuropsychology, life care planning, and retention of experts. He and partner Andy Savvaides have attended these advanced educational programs for lawyers, and Mr. Casper has also taught at several of the programs. Recently, he attended a special program on "Advanced Techniques in Neuroimaging" that included subjects on CT Scans, Magnetic Resonance Imaging, MR Spectroscopy, Functional MRI, Diffusion Tensor Imaging, PET Scans and SPECT Scans.
If you, or a loved one, has suffered a concussion in an accident and things are not returning to normal from a cognitive standpoint, the Connecticut Brain Injury Attorneys (C.B.I.A.) at Casper & de Toledo are equipped with just the right combination of scientific and legal knowledge to advise you about your legal rights and treatment alternatives so that your rights will be protected. Contact us to schedule a free initial consultation today.
