Frequently Asked Questions About Traumatic Brain Injury Cases

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What Is a Traumatic Brain Injury? Are There Different Categories or Classifications?

A traumatic brain injury (“TBI”), sometimes called an “acquired brain injury,” is an injury that disrupts the normal function of the brain. A traumatic brain injury occurs when a sudden “external force” strikes the head or causes rapid movement with sudden deceleration. A TBI will obviously result from a penetrating injury to the brain, or when mechanical forces interact with the brain as a result of an explosion or blast. A TBI can be the product of a whiplash that causes the brain to move within the vault of the skull, followed by sudden deceleration of the head when the motion stops. A whiplash injury can cause damage to blood vessels, gray matter of the brain that makes up the cerebral cortex, and the white matter connections that permit the brain to function like complex electrical circuits.

A traumatic brain injury is distinguished from congenital brain damage (that occurs during gestation) and is distinguished from the type of acquired brain injury that occurs as a result of the stroke or a brain tumor.

Does the Location of an Injury in the Brain Affect the Severity?

It certainly can. The types of traumatic brain injuries that we see that are largely of a non-penetrating types, generally, but it really depends. The location of the injury will dictate the outcome in a large measure. There are different geographical regions of the brain, and trauma to any particular area will dictate the extent of loss of function or the types of functions that will be lost or impaired. In addition, the brain works in networks involving multiple structures. So performing certain tasks will likely implicate various functions from seeing and reading to decision making that involves executive function and responding or reacting that can involve other cognitive abilities. Simultaneously, the entire process is impacted by emotion that is regulated in the subcortical limbic system. A combination of macroscopic and/or microscopic damage to gray matter or white matter connections can cause one or more operations to perform poorly.

What Would Be Considered Primary or Secondary Injuries Resulting from a Traumatic Brain Injury?

When we talk about the distinction between “primary” and “secondary injury” and we talk about the traumatic event, the primary injury is the injury that is inflicted as a result of the blow to the skull or other interaction between physical force and the brain and the immediate aftermath of that injurious event. For example, if there were a motor vehicle crash, the primary injury would occur as a result of the blow to the skull during the acute period following the crash and would include the immediate aftermath, which might include a loss of consciousness or a period of amnesia and that period leading up to the initial visit to the hospital when there would be a display of symptomatology, say within a first hour or so after the crash. Medical intervention during that period would assess the acute injury that might or might not be quantifiable, based upon physical symptoms that have arisen as of the time of the injury. But not all manifestation of traumatic brain injury are manifest within the first few hours after the trauma. Some of the symptoms might be directly caused by or related to the initial trauma.

The secondary injury is a cascade of changes that are neurometabolic, electrical, chemical and structural changes that occur on a microscopic level within the brain. These secondary changes alter the way that the affected cells interact with each other and the way the brain functions as an integrated organ.

So, when you have grey matter or white matter cells that are damaged, that injury sets off the neurometabolic cascade releasing various substances that then have a toxic effect on adjoining cells. That toxic effect on adjoining cells, in turn, creates further cellular damage. That’s what is being referred to as the cascade – it’s essentially a snowballing effect.

The cascade of neurometabolic changes plays itself out over hours, days, weeks and perhaps even months. As a consequence, it is not uncommon for a brain injured client to experience a worsening of function for many weeks from the initial trauma. That’s why, contrary to the old wives’ tale that the brain injury condition is that condition that’s reflected in that first hour or so after the crash, TBI patients often experience a worsening of symptoms due to cellular damage. All the new peer reviewed scientific literature supports this concept of cascade.

With traumatic brain injury, it’s very difficult to actually measure or quantify precisely what’s going on because we don’t open up skulls and take tissue samples of people who are alive, and so there are a very limited number of systems that can actually monitor brain function following a closed head injury or concussion. Those measures that do exist have limited sensitivity. But in the proper hands, good clinicians do have the ability to look at converging evidence to arrive at a proper diagnosis and recommend the most effective treatment. In a large percentage of cases, a diagnosis of traumatic brain injury can only be made from a personal assessment of a good clinician.

If you have more questions regarding Traumatic Brain Injury Cases, call Stewart Casper at the law office of Casper & de Toledo LLC for a free initial consultation at (203) 325-8600 and get the information and legal representation you’re seeking.

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