Brain Injury - Medical Malpractice Lawyers

Whilst most medical procedures are carried out satisfactorily by healthcare professionals there are times when things go wrong. Serious damage, with life threatening consequences, can occur as a result of negligent actions, poor skills, or delayed treatment for a traumatic brain injury. Where this occurs due to error our brain injury medical malpractice lawyers can help you to obtain a settlement for any damage that you or a loved one may have suffered. A brain injury medical malpractice lawyer will take a detailed statement after consideration of your medical records and will obtain medical opinions from experienced clinicians. No stone will be left unturned in our quest for justice to ensure that a fair settlement based on medical malpractice is obtained. Our brain injury lawyers charge no legal fees unless your claim is settled satisfactorily and you obtain a payment of damages. If you would like free advice from a brain injury medical malpractice compensation claim lawyer without further any obligation just contact our offices.

Description

There are several distinct types of brain injury. It should be noted that, without medical attention, every TBI category can cause permanent brain damage or death :

• Contusion: This is a bruise and means there is bleeding which can lead to swelling. Often a contusion will re-absorb and completely heal after some weeks, just like a bruise does on the rest of the body.


• Diffuse Axonal Injury: Each nerve in our brain has an axon. Axons are the long nerves that allow communication between the brain and the rest of the body – the “telephone lines” that connect the incoming and outgoing messages the body needs in order to function. They can become damaged or broken by such sudden motion-altering actions as vehicle accidents and violent shaking, resulting in a break or complete cessation of communication.


• Closed Head Injury: This occurs when there is no damage to the skull, but, due to an incident involving forceful deceleration, the brain has come into contact with the skull and become damaged. This type of injury does not necessarily require the head to come into contact with an object.


• Open Head Injury: An open head injury involves a breach of the skull, resulting in an injury to the meninges and/or the brain itself.


• Penetrating Trauma: A penetrating trauma occurs when a foreign object enters the brain. This includes bone fragments from a broken skull. Any solid object which is lodged in the brain can lead to secondary injury caused by inflammation, which can result in swelling of brain and/or brain cell injury. Severe brain damage or, even, death may follow. A penetrating object can also cause a brain haemorrhage (bleeding) by severing a vein or artery.

Causes and Symptoms

The causes of TBI can be many and varied. They are often the result of the sudden and intense interaction between a head and an unyielding object. It can also be caused by sudden head movement incidents.

Some examples of the causes of brain injury are:

• a fall where the head hits the ground or another object in its path;
• a sudden, violent and usually unexpected impact of the head against a solid object;
• a collision while in a motor vehicle, on a bicycle, skateboard or any other unsecured transportation vehicle;
• a punch or kick to the head;
• a violent blow from a solid projectile or anything that gives the arm extra leverage - (eg. a golf club or baseball bat);
• violent shaking of the head – this particularly affects the very young and the very old;
• impact from a bullet or other small, sharp projectile like glass or skull splinters.

Mild brain injury symptoms, often called a “concussion”, are not necessarily present at the time of the injury and, like the signs of severe brain injury, can manifest in the days, weeks and even months after the initial incident.

In those with a mild brain injury, the symptoms are easily missed, even by the person who suffered the injury. Therefore, any changes in behaviour, senses, memory, emotions or energy should be reported to medical authorities.

Symptoms to look for after any TBI include, but are not limited to:

• Frequent headaches
• Visual instability
• Memory loss or confusion
• Attention/concentration deficit
• Disturbed sleep
• Dizziness or trouble with balance
• Emotional turmoil
• Low energy
• Unfamiliar feelings of depression
• Convulsions
• Loss of the sense of smell
• Hypersensitivity to light and noise

Diagnosis

The diagnosis of a TBI should, at first glance, seem self-evident. But in real situations, the symptoms are often missed, especially if the patient has had other life-saving surgery or treatment involving other parts of the body. This is especially the case with a closed head injury. Therefore, the best form of diagnosis is awareness of symptoms after the event.

The most common scanning devices used to detect and identify a TBI are the MRI (Magnetic Resonance Imaging), CT (computed tomography) and PET (Positron Emission Tomography) scanning technologies. An alternative method of diagnosis can be obtained via neuropsychological testing protocols.

Mis-diagnosis or late diagnosis can give rise to a medical malpractice compensation claim.

Presentation

Severe traumatic brain injury can present a couple of ways. The first state is a coma in which the patient has little or no awareness of the outside world. The second state is called a persistent vegetative state, in which there is a limited sleep wake cycle, the eyes are open at times and there appears to be a limited state of awareness of the surroundings. This state can last as much as several years following the traumatic injury. The brain does not receive enough oxygen and the person is chronically or intermittently hypoxic.

Treatment

Neurosurgical intervention is the most urgent and potentially life-saving treatment for TBI, but the milder conditions can sometimes be treated with non-invasive methods, such as the use of anti-inflammatory and, later, anti-convulsant drugs.

Constant monitoring for symptoms by both the sufferer and the medical professionals can result in early intervention and, thus, the restoration of normal function.

Negligent Treatment can give rise to a medical malpractice compensation claim.

Mild TBI

Mild TBI is the most common type of brain injury and it can occur in many and varied ways to all age group. The initial injury occurs when the brain “bounces” briefly, squeezing the layers containing cerebrospinal fluid, and allowing the skull to come into direct contact with the brain. This causes bruising, which can lead to swelling of the brain and typical symptoms of brain injury for some time after the incident.

The causes can be related to any kind of sudden stopping, such as head contact with a solid object or a moving object meeting with the head. It can also be as a result of a fall or any other condition where severe head shaking occurs.

Many people who have suffered a mild TBI feel “normal” afterwards and, therefore, do not seek medical assistance. In truth, often there are no further symptoms. However, people around the sufferer should remain vigilant in the days and even weeks after the initial incident as symptoms which can produce more serious brain damaging conditions can go unnoticed.

These include :

From a medical perspective, mild TBI is often undiagnosed because the sufferer may not attend a medical facility. This may be because there was no loss of consciousness, so the person does not realize they have experienced a TBI. Another common reason for not seeking medical diagnosis - or a diagnosis of TBI not being concluded by attending medical staff - is there are often no symptoms to identify at the time of the injury.

However, should symptoms arouse suspicion of a mild TBI in the days or weeks after the incident, positive identification can be made using an MRI (magnetic resonance imaging) or CT (computed tomography) scanning technologies.

Mis-diagnosis or late diagnosis can give rise to a medical malpractice compensation claim.

Severe TBI

The difference between a mild traumatic brain injury and a severe traumatic brain injury is the level of loss of consciousness and the persistence of neurological findings in those with severe injuries. Those with severe traumatic brain injuries almost always have a prolonged period of loss of consciousness or even a coma that can persist for weeks following the injury. There is often brain swelling and bleeding within the brain with severe disability and death is not uncommon, especially if a person is in a prolonged coma. An awakening coma patient can appear relatively normal or can have evidence of severe cognitive deficit.

The main symptoms of severe traumatic brain injury are coma or other loss of consciousness. Severe cognitive deficits occur upon awakening and the person has difficulty with memory attention and can be affected with tinnitus or ringing in the ears can be noted. Taste and smell can be lost. Many people with traumatic brain injuries have prolonged and frequent seizures. There can be paralysis and chronic problems with bowel and bladder function. Sleep can be impaired and there can be a change in appetite. Personal, emotional and social changes are too common and the victim can be aggressive, irritable, depressed and can have dependent behaviors.

A severe traumatic brain injury may cause a severe deficit in the way the victim interacts with loved ones. There can be difficulty with memory and concentration often associated with confusion or impulsive behavior. Vision and hearing may be affected and there may be problems with seizures. Different parts of the body can be paralyzed and there may be bowel and bladder dysfunction. Personality can change and a victim may develop irritability depression, denial or aggressive behavior. The treatment of severe traumatic brain disorder is primarily supportive of vital signs, followed by aggressive physical and occupational therapy so the patient gradually improves.

There can be two different states of consciousness associated with severe traumatic brain injury. You can be in a coma—completely unaware of your surroundings with closed eyes as if sleeping. This lasts up to four weeks following a traumatic brain injury. On the other hand, you can be in a vegetative state. Your eyes open and close and you have sleep/wake cycles. Even so, you are unaware of your surroundings and can be in this state for at least a year following the brain injury. There can be a shorter length of a persistent vegetative state if it was due to a hypoxic-anoxic injury to the brain.

In a vegetative state, the awareness of the surrounding area is minimal and the person can recover enough to be able to follow simple commands and partake in simple gestures. They may be able to indicate a yes or no response and has a sleep wake cycle, unlike in comas when the patient is always asleep.

• Unusual feelings of tiredness
• Uncharacteristic headaches
• Dizziness
• Sensitivity to noise and light
• Becoming lost often and feeling confused
• Nausea
• Trouble with concentration
• Sluggish thinking capacity
• Mood fluctuations
• Troubled sleep

TBI Surgery

There are many types of brain injuries—ranging from minor contusions to the brain, concussions, bleeding in the brain and severe pressure to the brain. There can be skull fractures with shards of bone lacerating what otherwise would be normal issue. The cause of a head injury can be sports injury, motor vehicle accident, severe fall or a motor vehicle accident. Some of these injuries get better by watchful waiting and physical therapy. Others will not get better unless surgery is done on the brain. Fractures of the skull often need surgery to remove debris and fragments of bone.

Delays in brain surgery can be deadly. As the brain swell s from internal bleeding, the pressure within the brain builds up and can result in herniation of the brain into the spinal cord area and ultimate death. With rapid surgery, the pressure can be relieved from the brain and, in some situations, bleeding can be stopped permanently. A burr hole can be put the side of the head so as to decrease pressure immediately. When more complicated surgery is required, doctors do a craniotomy—remove a section of bone—and manipulate the damaged areas of the brain, removing dead brain and doing surgery on the bleeding blood vessels so they don’t bleed any more.

Pressure

In some cases a bolt is placed into the skull with a device that measures the intracranial pressure. Doctors use drugs that shrink the swelling of the brain and It may be possible to avoid further surgery altogether. Mannitol is relatively specific to brain swelling and can shrink swelling when surgery can’t be done or when a bolt an intracellular pressure monitor is used.

Burr Hole

Burr holes are reserved for more severe cases. When a burr hole is used, a small hole is drilled overlying the bleeding area. Blood is drained out and the pressure within the brain is diminished. Sometimes a burr hole is placed on both sides of the skull. The doctor can also remove tiny blood clots that have formed beneath the burr hole.

Hematoma

Large hematomas, fractures and increased pressure within the brain require that a doctor perform a craniotomy. In a craniotomy, a larger section of brain is cut away and lifted off the brain. The swelling is drastically reduced and the area is freed up to cauterize bleeding areas so the pressure further goes down. The craniotomy is considered the more severe of the procedures done to the brain. The brain cap is then set gently on the brain and allowed to rise and fall, depending on the pressure. This is called floating the segment. If there is a hematoma, this is removed via the craniotomy procedure.

Consequences of TBI

Those who suffer a traumatic brain injury (TBI) usually have to live with the consequences for the rest of their lives. While there are cases where recovery is complete, there are many who never recuperate fully and still others who are left with permanent disabilities in varying degrees.

The first indication of how long it may take a person to recover from a traumatic brain injury is the length of time the patient was unconscious. The estimate is carried out using methods like the Glasgow Coma Scale. This is a measure by which the patient is assessed by responses to motor function and verbal capabilities. This 15 point scale is used to asses every level of coma over 20 minutes in duration. (It should be noted that there are other methods of assessment used, but the Glasgow Coma Scale is the most widely used in the Western medical system).

Mild

It would be inaccurate to state all people who suffer mild traumatic brain injury will make a full recovery, as there is evidence there are those who suffer long term cognitive, psychological and physiological problems long after they sustained a concussion. The medical term for this category of sufferers is Post Concussion Syndrome or “PCS”.

Severe

The more severe forms of TBI can result in long term complications like constant fatigue, clumsiness, changes in sensory function (loss of hearing, appetite changes and light sensitivity). Sensory loss has been reported up to ten years after the initial injury.

Cognitive functions after TBI can involve reduced processing speed, spelling and math capabilities, word processing skills, planning abilities and lack of ability to concentrate. Psychiatric changes can be anything from mood alteration, depression, loss of the sense of “self” and post traumatic stress syndrome.

The list of ongoing challenges suffered by those who have sustained a severe TBI encompasses every area of life:

Studies have shown that, in the long term, people who have suffered TBI at some time in their lives have a propensity to develop Alzheimer’s disease and Parkinson’s disease.

• Seizures – medication may need to continue anywhere from numerous weeks to several years.


• Hydrocephalus – the cerebrospinal fluid (CSF) around the brain can increase after a TBI and cause a build-up of pressure under the skull with resultant loss of balance and bladder control. This can commence within the first year after the injury. Trapped CSF can also leak out from the ears and nose which can lead to an infection – a serious and life-threatening complication.


• Damage to blood vessels – Even though surgery can repair torn and damaged blood vessels at the time of the injury, the consequential weakness of blood vessels can cause the bleeding to resume at any time and, if not detected immediately, can be fatal.


• Damage to cranial nerves – this is the most common nerve damage after a TBI and may induce partial or full facial paralysis. It can sometimes be surgically repaired or it can heal by itself.


• Pain – The most intense and common pain felt by TBI sufferers is severe headaches. Mostly the intensity wears off over time and pain becomes more manageable.


• Ongoing sensory difficulties – There is a tendency for TBI sufferers to have ongoing sensory issues, such as tinnitus (ringing in the ears), a bitter taste in the mouth and, most especially, reduced eyesight where recognising items is a problem.


• Emotional and behavioural after-effects – Family members bear the brunt of this very common post TBI challenge. The negative emotions include depression, anger, paranoia, frustration, aggression, impulsiveness, childish behaviour and other emotional outbursts.

The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here