"As heard on 1010 WINS radio"

Brain Injury

New York City Brain Injury Attorney

Frekhtman & Associates  New York City Brain Injury Attorney

The Center for Disease Control (CDC) reports that each year nearly 1.5 million people in the United States suffers a brain injury. The CDC also found that currently more than 5 million Americans have required prolonged hospitalization or long-term medical care because of traumatic brain injuries. Frekhtman & Associates represents victims of traumatic brain injuries, head injuries, and other types of personal injuries within New York City, Bronx, Brooklyn, and Queens.

Causes of Traumatic Brain Injuries

A traumatic brain injury (TBI) is often caused by a blunt force impact with some outside entity. A TBI can occur as a result of different types of accidents including: car accidents, construction accidents, trip and fall, ceiling collapse, and many others.

Mild Traumatic Brain Injury

Mild traumatic brain injury, or MTBI, usually refers to those injuries where loss of consciousness lasts less than thirty minutes. Symptoms of mild brain injury include headaches, difficulty concentrating or thinking, short-term memory loss, attention problems, irritability, depression, frustration, and sudden variations in mood. MTBI is often overlooked or not properly diagnosed.

Severe Traumatic Brain Injury

A serious or severe traumatic brain injury usually occurs when the individual has lost consciousness for a period greater than half an hour. This is often accompanied by memory loss for more than one day. The resultant symptoms range from decreased ability to think clearly and function, to a state of complete comatose. Survivors of a severe brain injury may have lost the ability to control body movement such as the use of their arms, legs, and the ability to speak clearly. Emotional distress, anger, and depression are additional symptoms.

How to Document Your Head Injury

One of the difficulties of prosecuting a “minor” closed head injury claim is the absence of traditional, objective, medical evidence. Frequently, in rear-end impacts or other types of deceleration trauma, there is a brief loss of consciousness, which may or may not be recalled by the claimant. It is not uncommon for the traditional diagnostic tests to be within normal limits.

In the absence of positive findings with the traditional diagnostic procedures, objective evidence of severe injury may be manifested in documentary evidence of life changes. The obvious examples are:

  • Employment records – A complete employment file with particular reference in performance reviews, pre and post trauma. Additional focus on the employment records as they reflect unscheduled absences, sick days, or other references to the failure to meet deadlines.
  • School records and transcripts – Complete transcripts from all educational institutions. Of particular significance is the reference to any standardized tests and the scoring on the same, both pre and post trauma.

Medical Examinations

The Glasgow Coma Scale (“GCS”) is a common test used by physicians to diagnose whether a brain injury is mild, medium, or severe. This scale helps doctors care for the brain injury patient, formulate a medical treatment plan, and more accurately predict the future prognosis and quality of recovery.

Several weeks later, another scale called Rancho Los Amigos is used. This scale of eight levels of brain injury is based on objective observations of the brain injury survivor’s reactions.

How is TBI diagnosed?

After people have survived major accidents that may have damaged their brains, they must then undergo a highly-detailed set of tests and procedures so their condition can be properly diagnosed. During this process, patients may need to be evaluated by one or more of the following: physicians, neuropsychologists, psychiatrists and neurosurgeons.

What makes this type of diagnosis so difficult is that even when all the most sophisticated tests currently available indicate that you do not have a traumatic brain injury (TBI) – you may be suffering from one. Furthermore, you may not know the full extent of your losses until your condition greatly worsens.

When trying to evaluate a potential TBI patient, doctors often look for some common symptoms. These are listed below, followed by a description of many of the diagnostic tests or exams administered to help determine of a person currently suffers from an easily documented TBI or other closed hear injury.

Frequently seen closed head and traumatic brain injury symptoms

  • Cognitive or thinking impairments
  • Significant changes in personality or behavior
  • Inability to concentrate easily
  • Difficulty accurately perceiving facts and circumstances
  • Bad headaches – many of them will not go away quickly
  • Problems with speech and basic articulation
  • Sleep problems
  • Vision changes that often include blurred vision
  • Memory problems
  • Inability to handle basic problem-solving tasks
  • Seizures
  • Coma

As your various doctors and other healthcare providers will tell you, it’s crucial to your long-term health to report any of these problems as soon as you become aware of them. Hopefully, family and friends may point them out to you – or your doctors will discern them based on tests results and interacting with you.

Keep in mind that you must try to spend time around other people who care about you after enduring most significant head injuries because new complications can suddenly appear – often when you may just think you’re getting a bit sleepy or simply feeling odd. Should you be alone and no symptoms on the list above appear – or even others not noted there – you must contact your doctor or return to the nearest emergency room right away.

Common test or exams run to help physicians diagnose serious head injuries

The most common tests you may be asked to undergo include: X-rays, EEGs, CTs or CAT Scans, and one or more MRIs (Magnetic Resonance Imaging) tests. These tests are further described below, following by a second list of additional tests or exams often used.

  • X-rays: These are basically pictures taken by a very sophisticated camera or machine to get an accurate view of the bones in your head (or other parts of the body). Once the fully developed film or pictures are produced, your doctors can review them, looking for specific signs of various conditions or changes. In some cases, X-rays are also used to help medical workers determine if they are properly inserting feeding tubes or other devices in the body during your treatment or recovery;
  • EEGs (Electroencephalograms): This test involves placing small metal discs known as electrodes to your scalp, so that your brain waves can be recorded on paper and then evaluated by your doctors. It is most often run to detect seizure activity or other abnormal brain activity;
  • CTs or CAT Scans (Computed Tomography Scans): This imaging test helps your doctors determine if you are currently experience any internal bleeding in your brain – or if you have developed blood clots, swelling or other brain abnormalities. A CAT Scan is also useful for carefully examining the various structures within the brain – while also indicating any fractures or other problems in the facial bones or skull;
  • MRI (Magnetic Resonance Imaging): This test produces some of the most detailed and sophisticated views of various brain structures. For example, a doctor might want to use this test if she suspects you have damaged your brain stem or cerebellum, based on your current symptoms.

While these are the more common tests run after someone endures a suspected closed head or traumatic brain injury – they are often given in conjunction with other tests.

Additional tests often given to head injury patients

  • Arterial blood gas measurements: These are most commonly run to examine your overall lung functions – and your “acid/base” balance. You’ll often hear your doctor mention running these if you are experiencing breathing problems – or if you’re known to be suffering from asthma, chronic pulmonary disease (COPD) – or even some type of electrolyte imbalance. An MRI can also help doctors determine specific problems you’re battling due to kidney or heart failure, a drug overdose, deadly infections – or complications with your diabetes;
  • Electrolyte balance exams: Commonly run in emergency rooms, this test helps doctors look at the degree of trouble you may be having with your heart, lungs, or kidneys. It’s always critical for any patient who may have just suffered a serious closed head or traumatic brain injury to have their electrolytes balanced as quickly as possible since the brain is one of the first organs that can be seriously affected if this isn’t immediately addressed. Patients suffering from any form of dehydration also need to have this test run;
  • A neurological exam: There are many specific types of neurological tests that may be run. They are usually conducted to see how well your central nervous system is functioning, how well you’re mentally functioning and if you’re able to be fully cooperative – and if your motor activity, coordination, and various reflexes are intact;
  • A SPECT scan: This acronym stands for “single-photon emission computerized tomography.” This nuclear imaging tests lets your doctor gain an in-depth idea of how well your various organs are working. It involves the use of a radioactive substance and its 3-D camera produces highly-specialized pictures;
  • A Glasgow Coma Scale: When your doctor runs this test, he is trying to determine the basic severity of your head injury – more specifically – your level of consciousness. You’ll be asked to try and respond to commands asking you to move your eyes and various limbs. The person conducting the test will also be evaluating your verbal responses to various questions;
  • The Rancho Los Amigos Scale: If this test is administered to you, the doctors will be trying to look at how well you can hopefully progress while responding to simple questions or commands. You’ll be asked to open and shut your eyes in specific ways and to move your body in certain ways. Doctors also look to see how frustrated or cooperative you’re acting – since agitated patients may be suffering deeply from specific brain deficits. Efforts will also be made to determine how much pain you’re currently enduring and if you seem confused regarding your current condition.


What should I do after a concussion?

We see concussions happen in sports and other physical activities on a somewhat regular basis. Often a concussion is dismissed as a temporary and relatively mild injury with no permanent ramifications. In reality, a concussion can have a serious and lasting damages.

After a concussion, you may feel foggy and tired. You may experience vomiting, nausea, dizziness, headaches, and a general feeling of frustration. It is important to recuperate from your injuries by resting after getting a full medical check up. This will allow the head injury to enter the healing process. The brain injury lawyers at Frekhtman & Associates can handle all aspects of your traumatic brain injury “TBI” litigation while you recover.

Following a concussion, it is important to:

  • avoid strenuous or physical activity
  • avoid executive functions or stressful mental situations
  • obtain rest through some relaxation to allow your brain to heal and recuperate from the injury
  • do not use handheld electronic devices or other stimuli such as cell phones, televisions, and video games.
  • seek out medical care including a neurologist or other doctor
  • resume normal day to day activities slowly and gradually
  • avoid alcohol

Diffuse Axonal Brain Injury

The human brain contains billions of nerve cells. These cells communicate with each other via axons which are long fibers and comprise the white matter in the brain. Traumatic events that happen in an accident can damage these axons resulting in diffuse axonal injury to the brain. Diffuse Axonal Brain Injury (“DAI”) is also known as acquired brain injury, axonal shearing, or a head injury.

Examples of how DAI can occur include:

  • whiplash injury or acceleration / deceleration can result in traumatic twisting of the axons
  • An impact to the head can cut, stretch, twist, or otherwise injure the axon fibers

Often damage to the axons cannot be visualized on diagnostic imaging such as MRI or CT scans. However, a sheared axonal fiber can result in brain cell death.

The axon fiber can no longer serve as a pathway for communication between brain cells thereby cutting off flow to a brain cell which causes it to wither and die.

What causes diffuse axonal brain injury ?

Diffuse Axonal Injury (DAI) is one of the most common traumatic brain injuries. It occurs in about fifty percent of head trauma accidents. Car Accidents especially whiplash type sudden acceleration / deceleration injury are the most common causes of DAI. Other types of accidents that cause DAI include falls, assaults, and shaken baby syndrome.

Diagnosis of DAI

A regular MRI may not show diffuse axonal injury due to the microscopic nature of the injury such as a tear in tiny axon fibers. However, newer technology including Diffusion Tensor Imaging (DTI) can show damage to the white matter indicative of axonal injury.

An example of DTI brain imaging:

DAI symptoms may not appear immediately after an accident. The injury to the axon fibers prevents brain cells from communicating with each other and over time the death of brain cells will manifest symptoms.

Symptoms of DAI

Common patient symptoms after a diffuse axonal injury include:

  • loss of consciousness during the accident or traumatic event
  • Inability to concentrate / loss of focus
  • Concussion
  • Coma
  • Loss of memory
  • High blood pressue
  • Increased sweating
  • Fever
  • Decreased vision or loss of eyesight

How to Win a Traumatic Brain Injury Case

It is necessary to orient the lay jury into the gross and microscopic anatomy of the brain, the surrounding structures, and the brain itself. This gives the lay jury an understanding of how the trauma involved in a closed head injury case has resulted in the psychological behavior changes manifested by the plaintiff. The use of medical illustrations depicts both the anatomy of the skull, brain, and the mechanism of closed head injury.

Our Services

The New York City brain injury lawyers at Frekhtman & Associates develop each client matter as a medical legal team that includes attorneys, neuropsychologists, neurologists, neuro-radiologists, and other top brain injury specialists. Speak with us today (866) ATTY-LAW.