Traumatic Brain Injuries

Traumatic brain injuries are a class of injuries that result from a violent blow or jolt to the head or body, or is sustained from the penetration of the brain tissue by a foreign object. A traumatic brain injury can be catastrophic causing instant death, or it can be classified as mild if the loss of consciousness or confusion and disorientation is shorter than 30 minutes.

TBIs are one of the most common causes of disability and death in adults. Traumatic brain injuries are a severe public health problem and has come to the forefront of the collective consciousness with news of concussions in veterans and professional athletes in the NFL, NHL, the NBA and even professional soccer. Many of these repeated sports-related injuries are mild TBIs that can result in cumulative neurological and cognitive deficits.

Although some TBIs are severe a vast majority of the injuries, about 75 percent, are mild and affect brain cells temporarily causing a brief change in mental status or consciousness. More-serious TBIs can result in an extended period of unconsciousness or amnesia after the injury and cause physical damage including bruising and bleeding, or torn tissues, in the brain.

What are the Types Brain Injuries?

Brain injuries are classified by how the damage occurs. A closed brain injury occurs when there is a nonpenetrating injury to the brain and no break in the skull. A closed brain injury occurs when a rapid motion of the head causes the brain to shake inside the skull. This type of injury can cause bruising and tearing of brain tissue and blood vessels. Closed brain injuries are caused by car accidents, falls, and in sports. Shaking a baby can also result in this type of injury, called shaken baby syndrome.

A penetrating brain injury or open head injury occurs when there is a break in the skull, such as when a bullet pierces the brain.

There are also two types of brain injuries that occur following an incident. The first is the sudden and profound injury to the brain that occurs at the time of impact; this is the primary brain injury. The brain injury that evolves over a period of hours or days after the initial impact is referred to as the secondary brain injury and can include a series of steps or stages of cellular, chemical, tissue, or blood vessel damage in the brain that contribute to further destruction of brain tissue.

What are Possible Results of a TBI?

Some mild brain injuries have symptoms that disappear over time. Other TBIs are more severe and can result in permanent disability.

Effects of a brain injury may include, cognitive effects including confusion, shortened attention span, memory problems and amnesia, difficulty in problem-solving and challenges with judgment, an inability to understand abstract concepts, spatial and temporal issues, or a decreased awareness of self and others.

TBI victims may also suffer motor deficits including paralysis or weakness, spasticity (tightening and shortening of the muscles), poor balance, decreased endurance, inability to plan motor movements, tremors, swallowing problems and poor coordination.

Perceptual or sensory deficits resulting from TBIs can include changes in hearing, vision, taste, smell, and touch, loss of sensation or heightened sensation of body parts, difficulty understanding where limbs are in relation to the body and vision problems, including double vision, lack of visual acuity, or limited range of vision.

Some TBI sufferers include communication and language deficits including difficulty speaking and understanding speech, trouble choosing the right words to say, difficulty reading or writing and problems identifying objects and their function. Functional deficits resulting from a TBI can include impaired ability with activities of daily living, such as dressing, bathing, and eating, problems with organization, shopping, or paying bills or the inability to drive a car or operate machinery.

TBI sufferers may also have social difficulties like impaired social capacity resulting in difficult interpersonal relationships such as understanding and responding to the nuances of social interaction and challenges in making and keeping friends. Physically TBI victims suffer fatigue, changes in sleep patterns and eating habits, dizziness, headaches and in some cases loss of bowel and bladder control.

TBI victims may also suffer personality or psychiatric changes including apathy, decreased motivation, irritability, anxiety, and depression or disinhibition, including temper flare-ups, aggression, cursing, lowered frustration tolerance, and inappropriate sexual behavior.

In some extreme cases, a TBI can lead to traumatic epilepsy that generally occurs immediately after the injury, or within the first year, but it is also possible for epilepsy to surface years later. These can be tough cases to litigate because the jurors are so skeptical that someone could manifest symptoms so long after the crash. The key is educating the jury on the irrefutable science of these injuries.

What is a Shearing Injury to the Brain?

A shearing injury happens when there is a jarring of the brain against a side of the skull. A shearing injury is also known as diffuse axonal injury (DAI), which is caused by the shearing or tearing of the brain's long connecting nerve fibers, known as axons, which happens when the brain is injured as it shifts and rotates inside the skull. A diffuse axonal injury or diffuse axonal sheer is usually caused by some sort of acceleration/deceleration injury. This can happen from a blunt head injury, sharp head injury, or a penetrating brain injury.

So DAI is the result of traumatic shearing forces that occur when the head is rapidly accelerated and decelerated. The major cause of damage in DAI is disruption of the axons or white matter. These are the pieces of the brain that facilitate communication between neurons.

A shearing injury or DAI usually causes injury to multiple parts of the brain and leads to loss of consciousness or even a coma. A shearing injury causes microscopic injuries that may not be evident on computed tomography (CT scans) or magnetic resonance imaging (MRI) scans.

What is Axonal Damage?

The brain is made up billions of nerve cells with trillions of connections that occur through cellular structures known as axons. These are long projections of a nerve cell that navigate the body's electrical impulses away from the nerve cell body.

Axons transmit electrical pulses that travel between neurons and to muscles, organs, and glands. Axons are particularly susceptible to mechanical injury due to its viscoelastic attributes - a property of axons that allows it to exhibit both viscous and elastic characteristics - and their highly organized structure in white matter tracts. Under normal conditions axons are supple but, they become very brittle when exposed forces that result in the rapid deformations associated with brain trauma. The rapid stretching or twisting of axons in the brain during a traumatic event can cause damage the axonal cytoskeleton, resulting in a loss of elasticity and impairment of the axon's ability to transport their electronic transport mechanisms.

Axons within the brain may extend across different layers of the brain. For example, axons in the cerebral cortex - gray matter on the outside of the brain - may connect to the subcortical region - white matter deep inside the brain. As a result of the different densities of the matter in the brain, a traumatic event can cause varying forces on the different areas. As these different layers of the brain have different densities and locations of varying distances from the center of a given rotation, they will be accelerated and decelerated at different speeds when a whiplash mechanism occurs. This action results in different layers of the brain, sliding across each other, which can put unnatural stress on the axons, which extend across these layers.

What is a Diffuse Brain Injury?

BrainDiffuse axonal injury (DAI) is a brain injury in which extensive lesions in white matter tracts that occur over a widespread area in the brain. DAI is one of the most common and devastating types of traumatic brain injury.

A diffuse axonal injury is not dependent on a direct impact on the head, as it requires only the condition of rapid acceleration/deceleration such as takes place in whiplash injuries causing the brain to strike the inside of the skull.

Diffuse axonal injury is the result of traumatic shearing forces when the head rapidly accelerates or decelerates. This happens in car accidents, falls, and assaults. Our lawyers see a lot of diffuse axonal injuries in car and truck accidents. You see it on the news in child abuse cases as well.

DAI is one of the most common and devastating types of traumatic brain injuries our attorney see. The acceleration and deceleration forces typical in vehicle crash traumatic brain injury cause shearing or tearing of the axons of the white matter at the junction of the white matter and grey matter. This is a brutal trauma for the brain. The white matter and grey matter slide over one another at varying velocities. This causes damage to precious white matter.

What is a Diffuse Traumatic Brain Injury?

There are two ways to classify TBIs: focal and diffuse. A focal injury occurs in a specific location of the brain while diffuse injury occurs over a more widespread area of brain matter. It is common for both focal and diffuse damage to occur as the result of the same event.

Commonly, focal injuries occur when the head strikes an object or when an object strikes the head. Diffuse injuries often found in acceleration and deceleration injuries, and there does not necessarily have to be a head strike associated with the event to cause a diffuse brain injury.

What is a Diffuse Axonal Injury of the Brain?

A diffuse axonal injury is a severe TBI generally caused by widespread damage to the white matter of the brain resulting from acceleration or deceleration type injuries. Diffuse axonal injuries may also be the result of hypoxia, meningitis, and damage to blood vessels. DAI can cause harm to any part of the brain, and the chief symptom of DAI is the loss of consciousness. Usually, this occurrence lasts six or more hours. If the DAI is mild, then people might remain conscious but display other signs of brain damage.

Unlike focal injuries, diffuse injuries may be difficult to detect and define as often much of the damage is microscopic and can be difficult to identify using CT or MRI scans.

What is a Closed Head Injury?

According to Wikipedia, "a closed head injury is a type of traumatic brain injury in which the skull and dura mater remains intact". Closed-head injuries can range from mild injuries to severe TBI that can lead to severe brain damage or death.

Common closed-head injuries include concussion, intracranial hematoma, which can cause an increase in pressure on the brain, cerebral contusions or bruising to the brain tissue, or even diffuse axonal injuries that can lead to comas or vegetative states.

Common symptoms of closed head injuries include a headache, dizziness, nausea, vomiting, slurred speech, and severe injuries can lead to comas, seizures or loss of consciousness. Because the brain swelling associated with a closed head injury is often a slow process, symptoms may not surface for days to weeks after the injury.

More than 50 percent of patients who suffer from a traumatic brain injury will develop psychiatric disturbances including anxiety, and changes in sensory perception, depression, personality changes, and cognitive disabilities.

What is Diffusion Tensor Imaging?

Diffusion tensor imaging is a type of MRI that is utilized to detect white matter injuries in the brain. DTI does this by measuring the restricted diffusion of water in tissue. As defense lawyers are quick to point out, diffusion tensor imaging cannot by itself confirm a brain injury. What it can do is find white matter abnormalities in the brain that are consistent with a traumatic brain injury.

What are Axonal Degeneration and Axonal Loss?

Axonal degeneration is a type of nerve damage that occurs as the result of a traumatic event. Axonal degeneration generally results in axon death with the subsequent breakdown of the myelin sheath caused by focal injury to peripheral nerve fibers. This process is referred to as Wallerian degeneration and is a process that results when a nerve fiber is cut or crushed, and the part of the axon farthest from the cell body degenerates.

Wallerian degeneration occurs after axonal injury in both the peripheral nervous system - the nervous system outside the brain - and the spinal cord and central nervous system. Following an injury, the axonal skeleton disintegrates, and the axonal membrane breaks apart. The axonal degeneration is followed by degradation of the myelin sheath, - a lipid-rich substance that surrounds the axon of some nerve cells, forming an electrically insulating layer - and infiltration by macrophages.

Wallerian degeneration occurs after axonal injury in both the peripheral nervous system (PNS) and central nervous system (CNS). Wallerian degeneration occurs in the axon stump situated away from the center of the body or the point of attachment of a site of the injury and usually begins within 24-36 hours of an injury.

Before degeneration, distal axon stumps tend to remain electrically excitable. After an injury, the axonal skeleton disintegrates, and the axonal membrane breaks apart. The axonal degeneration is followed by degradation of the myelin sheath and infiltration by macrophages.

Hiring a Lawyer for a Brain Injury Claim

Hiring a lawyer for a brain injury case is different from hiring a lawyer for a general, garden variety personal injury case. You need a law firm that has handled these claims and has tried those cases to a successful verdict. Miller & Zois is that firm. If you have a case in Maryland and you want someone who knows the science of these cases and how to take them to trial, call 800-553-8082 or get a free online consultation here.

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