Personal Injury Blog

I once heard a comedian say that a “mild” heart attack is one that happens to somebody else.  Boy, isn’t that true!  Because when it happens to you it is anything but “mild”.

Does the same logic hold true for a brain injury? Does a “mild” brain injury only happen to somebody else? The answer is no.  But, surprisingly, you may not even know that you have a mid traumatic brain injury.  And, more surprisingly, the emergency room where you are seen may not be able to tell you that you have one.

Now, before we continue, we need to understand the difference between a “head” injury and a “brain” injury.  You may hear the terms used interchangeably, but they are very different.  A head injury is one that is clinically evident on physical examination – you can see it.  There are cuts, bumps, bruises, blood – visible evidence that an injury has occurred.  A brain injury, on the other hand, refers specifically to injury to the brain itself that cannot be seen by the naked eye on physical examination and is often not clinically evident.  The distinction between a head injury and a mild traumatic brain injury is critically important because when a brain injury goes undiagnosed 5% to 15% of patients may have compromised function one year or more after their injury.

Realizing that many mild traumatic brain injuries do go undiagnosed because there is no apparent head injury, The Centers for Disease Control (CDC) and the American College of Emergency Physicians (ACEP) convened a multidisciplinary panel to revise clinical diagnosis guidelines to help improve the diagnosis, treatment, and patient outcomes for mild traumatic brain injury patients.  With more than one million emergency department visits annually for brain injuries in the United States alone, the impact of an undiagnosed brain injury can be tremendous.  

Generally, the diagnosis of a mild traumatic brain injury can be made when at least one of the following criteria has been met:

1) Any period of loss of consciousness lasting 30 minutes or less
2) Any period of observed or self reported dysfunction of memory (amnesia) around the time of the injury
3) Any alteration of mental state at the time of the injury (feeling dazed, confused, disoriented)

The challenge of the emergency room physician and nursing staff is identifying which patients with a probable mild traumatic brain injury require extended diagnostic treatment to prevent further damage and which patients can be safely sent home.  The revised diagnostic guidelines answer the additional critical questions:

Which patients with mild traumatic brain injury should have a non-contrast head CT scan in the Emergency Department?
Is there a role for head MRI over non-contrast CT in the Emergency Department evaluation of a patient with acute mild traumatic brain injury?
In patients with mild traumatic brain injury, are brain-specific serum biomarkers predictive of an acute traumatic intracranial injury?
Can a patient with an isolated mild traumatic brain injury and a normal neurologic result be safely discharged from the Emergency Department if a non-contrast head CT sc an shows no evidence of intracranial injury?

It is widely believed that these new and enhanced guidelines will make a difference in the diagnosis and early treatment of brain injuries. For more information on the new guidelines, visit http://www.acep.org/practres.aspx?id=8814

A South Boston man who survived a traumatic brain injury returned with his family to the Virginia Commonwealth University Medical Center to present a $15,000 gift and to thank the doctors and health care providers who helped with his rehabilitation.

The donation was made in December at the annual holiday party for the Department of Physical Medicine and Rehabilitation.

On April 25, 1998, J.F. “Jeff” Gill was farming a piece of property in Lunenburg County when a cable that was towing machinery broke off, flew into the side of his head and left him with a traumatic brain injury.

Gill’s mother said surgeons at VCU Medical Center had to remove a fist-sized amount of damaged brain tissue, but the procedure saved her son’s life. Afterward he remained in a coma for six weeks. Barbara Gill said she expected her son would not be able to function independently, would never walk and would need a respirator for the rest of his life.

Gill endured more than four years of therapy and rehabilitation to beat the odds and regain a great deal of independence.

“He is walking, talking, dressing himself and has resumed farming,” said Barbara Gill. “Jeff operates machinery and even drives a tractor. We really are so grateful to Dr. Cifu and Dr. Kreutzer and everyone at VCU who was a part of his rehabilitation.”

Gill received a settlement from worker’s compensation, and his attorneys, Chip Kalbaugh and Brooke Anne Hunter, arranged to contribute a portion of his legal fees for the donation.

David X. Cifu, M.D., chair of Physical Medicine and Rehabilitation, announced that the department would match the $15,000 gift to establish the J.F. Gill, Jr. Lecture each year to promote public awareness of traumatic brain injury.

“We already host an annual three-day conference on traumatic brain injury and I think this new lecture can be a signature item to bring attention to the rehabilitation needs of people with brain injury,” Cifu said.

“Jeff and his family never gave up and that is a big piece of it,” he said.

The VCU Department of Physical Medicine and Rehabilitation is ranked among the top 20 programs in the country by U.S. News and World Report. The department has grant funded research investigating traumatic brain injury, spinal cord injury, return-to-work for people with disabilities and pain management. Other department programs focus on stroke, neural tumors, pediatric disability, pulmonary rehabilitation, limb deficiency and sports medicine.

(via vcu.edu)

Traumatic brain injuries can have devastating consequences for its victims and their families.  The severity of brain injuries can vary greatly ranging from very severe brain injuries causing coma or even death to mild traumatic brain injuries or concussions that may result in temporary symptoms of short-term memory loss or problems with focus and attention.  Although some traumatic brain injuries are classified as "mild," they can actually have significant, and sometimes permanent, effects.  The problem is that many symptoms associated with MTBI are subtle and therefore, many people who have suffered this type of brain injury go undiagnosed.  Typically, people who have suffered from a MTBI or concussion will have very short periods of a loss of consciousness or no loss of consciousness at all.  In addition, traditional diagnostic testing such as CAT scans and MRI's will generally not show the subtle changes of the brain that occur with MTBI's. Because there is frequently no "objective" medical evidence of a MTBI, brain injury litigation most often centers around cases where a victim suffers a MTBI rather than a more severe and obviously debilitating brain injury.  

Many people with mild brain injury may suffer from a multitude of symptoms including short-term memory loss, loss of focus and attention, depression, irritability, anxiety, headaches, problems with hearing, problems with language, confusion, balance difficulties and other physical, cognitive and behavioral changes.  These symptoms can cause people to lose the ability to function normally, both from a professional and a social perspective.  Because of the possible devastating effects of such an injury, and the difficulty in "proving" during the course of brain injury litigation that a very real injury exists, it is important to obtain thorough evaluations, treatment plans and rehabilitation from a variety of health care providers with different areas of specialty.  Typically, plaintiffs who have suffered mild traumatic brain injuries will be evaluated by a neuropsychologist who will do a battery of tests to determine the areas of cognitive and psychological deficits.  Plaintiffs will also be evaluated by medical doctors such as physiatrists, neurologists or neuropsychiatrists who can diagnose the injury, determine the effects of the brain injury and develop an appropriate treatment plan.  Plaintiffs also may need the assistance of physical therapists, occupational therapists, speech therapists, audiologists, vocational counselors and others depending on the extent of the deficits and the symptomatology.  Many of these experts will be needed to provide opinions and testimony at trial in order to establish the existence of the injury, the effects of the injury and the cause of the brain injury.  It is also very important to show how the plaintiff has changed as a result of the brain injury.  This can be established through the testimony of friends, family members and co-workers who have noted changes in the plaintiff's behavior since the injury.  

During the course of brain injury litigation, defense counsel will thoroughly investigate the plaintiff's injury claims by delving into the plaintiff's prior medical and psychological history, academic background, employment background, etc.  Defense counsel will also hire their own experts to examine and evaluate the plaintiff and to provide opinions as to the nature and extent of the plaintiff's injuries.  The plaintiff may have to submit to one or more lengthy evaluations by a neuropsychologist, neurologist, psychiatrist, or other medical doctor or doctors.  The plaintiff may also need to be interviewed by vocational counselors regarding his or her capacity to work.  

Brain injury litigation is complex and can sometimes be very time consuming, stressful and expensive.  However, given the severity of the potential consequences of such an injury, it is important to have an experienced brain injury attorney who is familiar with the medical and legal issues involved in brain injury litigation to assist an injured victim in getting the appropriate treatment he or she needs and in thoroughly preparing the case to ensure that the victim obtains the recovery that he or she deserves.