Traumatic Brain Injuries

A traumatic brain injury (“TBI”) is sudden damage to a person’s brain caused by a blunt or penetrating trauma to the head. Common causes include car accidents, motorcycle accidents, bike accidents, and falls. During the impact of an accident, the brain crashes back and forth inside the skull, causing bruising, bleeding, and tearing of nerve fibers. If you or a loved one has suffered a TBI, it is important to contact a qualified traumatic brain injury attorney in Colorado.  

TYPES OF TRAUMATIC BRAIN INJURIES

• Concussion: a mild head injury that can cause a brief loss of consciousness and usually does not cause permanent brain injury.
• Contusion: a bruise to a specific area of the brain caused by an impact to the head. This is also referred to as coup or contrecoup injuries. In coup injuries, the brain is injured directly under the area of impact, while in contrecoup injuries, the brain is injured on the side opposite the impact.
• Diffuse Axonal Injury (“DAI”): a shearing and stretching of the nerve cells at the cellular level. DAI occurs when the brain quickly moves back and forth inside the skull, tearing and damaging the nerve axons connected throughout the brain like telephone wires. Widespread axonal injury disrupts the brain’s normal transmission of information and can result in substantial changes in a person’s wakefulness.
• Traumatic Subarachnoid Hemorrhage (“Traumatic SAH”): bleeding into the space that surrounds the brain normally filled with cerebrospinal fluid, which acts as a floating cushion to protect the brain. Traumatic SAH occurs when small arteries tear during the initial injury. The blood spreads over the surface of the brain, causing widespread effects.
• Hematoma: a blood clot that forms when a blood vessel ruptures. Blood that escapes the normal bloodstream will thicken and clot. Clotting is the body’s natural way to stop the bleeding. A hematoma may be small or it may grow large and compress the brain. Symptoms vary depending on the location of the clot. A clot that forms between the skull and the dura lining of the brain is called an epidural hematoma. A clot that forms between the brain and the dura is called a subdural hematoma. A clot that forms deep within the brain tissue itself is called an intracerebral hematoma. Over time, the body reabsorbs the clot. Sometimes surgery is performed to remove large clots.

SYMPTOMS OF TRAUMATIC BRAIN INJURIES

The human brain is comprised of three main parts, including the brainstem, cerebellum, and cerebrum. The three parts are further divided into lobes. Depending on the type and location of the injury, a person’s symptoms may include:

• Loss of consciousness
• Confusion
• Disorientation
• Memory loss
• Fatigue
• Headaches
• Visual problems
• Poor attention
• Sleep disturbances
• Dizziness 
• Loss of balance
• Irritability
• Depression
• Anxiety
• Seizures
• Vomiting
• Emotional disturbances

DIAGNOSING A TRAUMATIC BRAIN INJURY 

Following an accident, injured parties are often transported to the emergency room, where on-staff physicians evaluate the patient to determine as much as possible about his or her symptoms. The patient’s condition is assessed relatively quickly at the emergency room by using the Glasgow Coma Score (“GCS”), a 15-point test used to grade a patient’s level of consciousness. Doctors assess the patient’s ability to (1) open his or her eyes, (2) respond appropriately to orientation questions, (name, date, etc.), and (3) follow commands (blink twice, give a thumbs up, etc.). If a patient is unconscious or unable to follow commands, his or her response to painful stimulation is checked. A number is taken from each category and added together to get the total GCS score. The score ranges from 3 to 15 and helps doctors classify an injury as mild, moderate, or severe. Mild TBI has a score of 13-15. Moderate TBI has a score of 9-12, and severe TBI has a score of 8 and below.

In addition to utilizing the GCS, physicians have access to an array of diagnostic tools to help diagnose a TBI.

• Computed Tomography (CT): is a noninvasive X-ray that provides detailed images of anatomical structures within the brain. A CT scan of the head is taken at the time of injury to quickly identify fractures, bleeding in the brain, blood clots (hematomas) and the extent of injury. CT scans are also used throughout recovery to evaluate the evolution of the injury and to help guide decision-making about the patient’s care.
• Magnetic Resonance Imaging (MRI): is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of the brain. A dye (contrast agent) may be injected into the patient’s bloodstream. MRI can detect subtle changes in the brain that cannot be seen on a CT scan.
• Magnetic Resonance Spectroscopy (MRS): gives information about the metabolism of the brain. The numbers generated from this scan provide a general prognosis about the patient’s ability to recover from the injury.

TREATMENT FOR A TRAUMATIC BRAIN INJURY

The goal of treatment is to resuscitate and support the critically ill patient, minimize secondary brain injury and complications, and facilitate the patient’s transition to a recovery environment. Despite significant research, doctors only have measures to control brain swelling, but do not have a way to eliminate swelling from occurring. In addition, treatment will depend on the severity of the brain injury. Mild TBI usually requires rest and medication to relieve headache. Moderate to severe TBI require intensive care in a hospital. Bleeding and swelling in the brain can become an emergency that requires surgery. However, there are times when a patient does not require surgery and can be safely monitored by nurses and physicians in the neuroscience intensive care unit (NSICU).

Medication is another form of treatment that may be necessary for those with brain injuries. After a head injury, it may be necessary to keep the patient sedated with medications to keep them comfortable. Alternatively, a patient may require medication to control intracranial pressure. Hypertonic saline is a medication used to control pressure within the brain. It works by drawing the extra water out of the brain cells into the blood vessels and allowing the kidneys to filter it out of the blood. Other patients may require medication to prevent seizures or infections. 

Regardless of the severity, victims of brain injuries may require neurocritical care, the intensive care of patients who suffered a life-threatening brain injury. Many patients with severe TBI are comatose or paralyzed, oftentimes with injuries in other parts of the body. Their care is overseen by a neurointensivist, a specialty-trained physician who coordinates the patient’s complex neurological and medical care. Patients are monitored and awakened every hour for nursing assessments of their mental status or brain function.

Surgery is sometimes necessary to repair skull fractures, repair bleeding vessels, or remove large blood clots. Surgery is also performed to relieve extremely high intracranial pressure. 

• Craniotomy involves cutting a hole in the skull to remove a bone flap so that the surgeon can access the brain. The surgeon then repairs the damage (e.g., skull fracture, bleeding vessel, remove large blood clots). The bone flap is replaced in its normal position and secured to the skull with plates and screws.
• Decompressive craniectomy involves removing a large section of bone so that the brain can swell and expand. This is typically performed when extremely high intracranial pressure becomes life threatening. At that time the patient is taken to the operating room where a large portion of the skull is removed to give the brain more room to swell (Fig. 6). A special biologic tissue is placed on top of the exposed brain and the skin is closed. The bone flap is stored in a freezer. One to 3 months after the swelling has resolved and the patient has stabilized from the injury, the bone flap is replaced in another surgery, called cranioplasty.
• Tracheotomy involves making a small incision in the neck to insert the breathing tube directly into the windpipe. The ventilator will then be connected to this new location on the neck and the old tube is removed from the mouth.
• Percutaneous Endoscopic Gastrostomy Tube (PEG) is a feeding tube inserted directly into the stomach through the abdominal wall. A small camera is placed down the patient’s throat into the stomach to aid with the procedure and to ensure correct placement of the PEG tube (see Surgical Procedures for Accelerated Recovery).

Contact a Colorado Traumatic Brain Injury Attorney

At Bowman Law LLC, we are frequently presented with cases that include traumatic brain injuries. In our experience, these types of injuries are often identified as an “invisible injury” because they cannot be seen like a broken arm or a fracture. However, brain injuries require proper assessment and treatment by trained health care professionals. Moreover, the victims of an accident who suffered a traumatic brain injury deserve to be made whole through a personal injury settlement or verdict.

Brain injury cases can be challenging and there are many attorneys practicing who do not understand these types of cases. Traumatic brain injuries are some of the most difficult and complex injuries to handle. It is important to retain a personal injury law firm that truly understands traumatic brain injuries. Bowman Law LLC has handled thousands of cases with trauma to the brain. We have been successful in presenting brain injury cases to insurance companies and jurors. 

If you have suffered a traumatic brain injury, contact the qualified attorneys at Bowman Law LLC today for a free consultation. Call Bowman Law LLC today at 720.863.6904 or email us for your free consultation.