Traumatic Brain Injuries

We Help Clients With Long-Term Recoveries

A traumatic brain injury (TBI) is an alteration in brain function, or other evidence of brain pathology that is caused by an external force. TBI most often occurs when an external force acts on the brain.  The external force may be a direct trauma to the head, such as a head being struck by an object, or an object penetrating the brain. The external force may also occur in the absence of direct trauma to the head by an external object, such as a rapid acceleration/deceleration of the head which may result from a violent auto collision, shaken baby syndrome, a fall, or similar event. Traumatic brain injuries can also occur from outside forces acting on the body, such as a shockwave from a blast or explosion.  While radiological imaging sometimes shows evidence of TBI, a person can have a TBI even if the radiologic imaging is normal.

Historically, traumatic brain injuries have been graded in severity ranging from mild traumatic brain injury (mTBI) to moderate traumatic brain injury, up to severe traumatic brain injury. The severity grades can be misleading though, because any brain injury is serious to those who suffer from it. Doctors might describe a brain injury as “mild” because it is not life threatening, but even mild traumatic brain injuries can have devastating lifelong consequences for survivors.

Due to recent rapid advances in diagnostic medicine, traumatic brain injuries are being caught more often than ever before. Nevertheless, traumatic brain injuries remain, for the most part, a “silent” epidemic in the United States, where each year an estimated 2 million Americans suffer some form of a traumatic brain injury. Most of these traumatic brain injury survivors struggle to understand the changes they experience, and many end-up with some form of long-lasting disability.

What happens when a traumatic brain injury occurs?

The pathophysiology of a traumatic brain injury can be divided into two separate categories: 1) Primary Brain Injury; and 2) Secondary Brain Injury.

Primary brain injury occurs at the time of trauma and causes damage that can include a combination of brain contusions, brain bleeding, shearing of white matter tracts (also known as a diffuse axonal injury) and edema. The edema (swelling) can be focused or global.

Generally speaking, diffuse axonal injuries (DAI) are seen most often at the gray-white junction of the brain, where the anatomy of the brain makes it most susceptible to injury. Sometimes these injuries can be visualized on imaging studies, such as magnetic resonance imaging (MRI), although damage at the cellular level is beyond the ability of even the most modern imaging equipment to detect.

Other primary injuries, such as torn blood vessels, hematomas, and hemorrhages can be easier to visualize on imaging studies due to the presence of pooled blood within the brain.

White matter tract disruption can be seen in the left panel in Diffusion Tensor Imaging (DTI), which can be correlated with a lesion in the gray-white junction of the brain in the MRI image as seen in the right panel.

Secondary Injury occurs in what has become known as the “metabolic cascade” that occurs in the hours and days following a traumatic brain injury. During this metabolic cascade, an initial release of neurotransmitter chemicals shifts the brain into a state of high energy demand and metabolic crisis. As the metabolic cascade continues, electrolyte imbalances can occur, which when coupled with reduced cerebral bloodflow can result in cellular death (apoptosis) and secondary ischemic injuries.

Flowchart of the metabolic cascade occurring as the secondary injury in a TBI.

Signs and Symptoms of a Traumatic Brain Injury

Any loss of consciousness following an external force acting on the head is a clear and unmistakable sign of a traumatic brain injury, however brain injuries often occur without loss of consciousness. Even an altered state of consciousness, when coupled with an external force acting on the brain can be an indication of a traumatic brain injury.

Common indications of a traumatic brain injury include:

The Right Attorneys

Traumatic brain injuries can cause lifelong consequences for a survivor and his or her family. Survivors of traumatic brain injuries may find their lives altered in ways they never imagined, and in some cases a lifetime of medical care and support may be necessary. Many of the problems they now face are invisible to casual observers and can be difficult to prove without the right attorneys and supporting expert witnesses.

Insurance companies often dispute whether a person has suffered a TBI, and if so, what future treatment will be required. At Rapoport, Weisberg & Sims P.C. our legal team works on the cutting edge of medicine and science in representing individuals who have suffered brain injuries. We know what is necessary to prove that our client has suffered a TBI, to prove the past and future consequences of our client’s TBI, and to prove the amount of compensation that will be required for future medical care and support. Brain injury survivors have never been through this before, but we have helped guide the way in obtaining understanding and justice for countless survivors of traumatic brain injury. We treat our clients with compassion and care to help them through the legal process, and to help them build the strongest possible case to prove their injury.