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.
What Are 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, 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.
What is a 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.
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.
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.
Diagnostic Testing For Traumatic Brain Injury (TBI)
A number of diagnostic tests can identify and help treat traumatic brain injury and head injury. In a hospital, a basic neurological exam is performed and sometimes a CT scan is ordered. Unless someone presents with a clear injury such as a skull fracture, usually most patients are treated and released without any full medical workup that can find a neurological disorder. A hospital usually does very basic tests for memory loss, level of consciousness, blood clots, closed head injury, examines some risk factors, and checks on prior mental health issues. If a patient’s symptoms do not subside, they may see a treating physician who will refer them to a specialist for more comprehensive neurological testing. Often after trauma, an injury victim may be going to a regular doctor, a physical therapy or sports medicine practice, and not know they need to see a neurologist for an action plan.
A 3T MRI (Magnetic Resonance Imaging) can be given in a large medical center or neuroradiology practice. It has a stronger T or Tesla magnetic field compared to a standard 1.5T MRI. A 3T MRI is the gold standard in the medical community when diagnosing and treating head injuries in the human brain.
A 3T MRI returns higher-quality images in a shorter amount of time allowing for quicker patient examinations. The higher resolution and better image clarity enable neuro-radiologists to see smaller lesions that may not be visible on a regular MRI brain scan.
Susceptibility Weighted Imaging (SWI)
These are brain scans that show veins in the brain. SWI scans look at brain function and can help show diffuse axonal injury. The scan shows venous blood, hemorrhages in the brain, and iron storage. The imaging of blood in the brains’ veins is a blood oxygen level-dependent (BOLD) technique. SWI imaging was originally called BOLD venographic imaging. It is important to contact a health care provider familiar with 3T MRIs, SWI imaging, computed tomography, and other specialized care for brain injury.
the arrows point to micro-bleeds. Figure (A) shows micro-bleeds in the temporal lobe. Figure (B) shows deep micro-bleeds in the right putamen.
Diffusion Tensor Imaging (DTI)
Diffusion tensor imaging (DTI) is an MRI scan that employs anisotropic diffusion to estimate the white matter organization of the brain. It shows cables or fiber bundles traveling in different directions. DTI can show up to six different directions of travel which is much greater than a standard MRI. DTI shows how water travels along the white matter tracts in the brain. Areas of missing cables confirm brain injury especially since these studies are compared to normal scans. Data collection and projects nation and world wide will improve the reliability of DTI testing. If axon cables are scattered in all directions, it is like chaos in the brain. It is important to follow up with a positive finding on a DTI scan with neuropsychological testing that can examine brain function and executive function. By having both neuro-radiology diagnostic testing as well as neuro-psych testing a patient is improving their chances of recovery. This treatment is often followed by occupational therapy.
Arterial Spin Labeling (ASL)
ASL is a non-invasive MRI for measuring blood flow also known as tissue perfusion. It is a non-ionizing test. ASL uses the water molecules already circulating throughout the brain along with a radiofrequency pulse to track the blood water as it travels throughout the brain. It is often used as a follow-up test after DTI. Once the blood travels and circulates through the brain, which takes just microseconds, label images is taken.
Videonystagmography (VNG) testing
VNG testing is a series of four exams that test an individual’s ability to follow objects with their eyes. VNG examines how well someone’s eyes respond to information from the vestibular system located in the inner ear responsible for balance. The test examines whether an issue with a person’s vestibular system may be the reason they experience dizziness, blurred vision, or balance problems. The VNG test is comprised of
ocular mobility – you will be asked to have your eyes follow objects that jump around, stand still, or move smoothly. The examiner will look for slow responses or inabilities to follow the moving objects.
optokinetic nystagmus – you will be asked to look at a large visual image that is continuously moving. The test determines if your eyes can track the movements and will similarly look for slow responses or inaccurate following of the object.
Positional Nystagmus – the examiner will move your head and body into various positions to confirm there is no nystagmus or inappropriate eye movements.
Caloric Testing – the examiner will stimulate each of your inner ears, one at a time, with warm and then cold air. The test tracks your eye movement with goggles to confirm both of your inner ears can sense this stimulation and that your vestibular system is working properly.
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.
The 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.
Frekhtman & Associates charges no fee unless we first recover money for our clients. We pay for all expenses while prosecuting a brain injury lawsuit through the courts. Our firm’s trial lawyers have been successful in winning some of the top verdicts and settlements in New York as is reflected on our Verdicts page.
Feel free to call New York Traumatic Brain Injury Attorney at (866) ATTY LAW or fill out the online contact form on this page.