The Centers for Disease Control describe a concussion as: A type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. Most modern treatises do not require a loss of consciousness in order to diagnose a concussion.
As a personal injury trial lawyer, I was exposed to brain injury cases early in my career. I immediately developed a passion for working on these cases. This passion developed on two fronts.
The first and most important was the utter devastation these cases caused to the brain injured victim and their family. Motivated to help, I began to study the brain and brain injury litigation. The second part of the passion piece was how interesting the anatomy of the brain is and how wondrous a structure it is (and how easily it can be injured).
Brain injuries are generally categorized by severe, moderate or minor. Severe and moderate brain injury is usually fairly apparent. Minor traumatic brain injury (or MTBI) on the other hand, can be anything but minor. “MTBI is a medical classification and is not meant to imply the injury is minor (But jurors and claims adjuster can easily think that because of the name).
Many people are familiar with the fact that in the old days, there were jokes in cartoons about how a character got a funny bop on the head and the victim cutely saw stars and was then 100% healed. Modernly, after seeing football players have their lives ruined from concussions (Just another name for a TBI), society and the medical establishment began to take notice and are taking these cases more seriously.
Problems with these cases can start at the scene of the collision or trauma. Ambulance personnel and hospitals will often use the Glasgow Coma Scale (GCS) to determine if somebody has suffered a concussion. That scale is as follows:
Best eye response (4)
- No eye opening
- Eye opening to pain
- Eye opening to sound
- Eyes open spontaneously
Best verbal response (5)
- No verbal response
- Incomprehensible sounds
- Inappropriate words
- Confused
- Orientated
Best motor response (6)
- No motor response.
- Abnormal extension to pain
- Abnormal flexion to pain
- Withdrawal from pain
- Localizing pain
- Obeys commands
The highest score (generally indicating no concussion) is a 15. The problem here is that most MTBI injury victims will get a score of 15. Why is this? First off, even if the victim is knocked unconscious, by the time ambulance personnel arrive, the victim will have regained consciousness and be walking and talking. Being conscious and talking is basically all you need to get a 15 in most situations. In virtually 100% of my MTBI cases, my client was given a GCS at the scene of 15 (I.E. Normal); even in cases that totally devastated the clients life, including career loss and more.
The problem often continues when the patient presents to the emergency room (and many will just go home to rest and do not see a doctor until the next day or longer).
For example, a University of Washington study found that 56 percent of mild traumatic brain injuries went undiagnosed in emergency room visits. According to the study, as many as 80 percent of all adults with a traumatic brain injury are discharged the same day without being admitted to the hospital.
If the client does not promptly seek medical treatment or the ambulance or hospital fail to diagnose a concussion, the case already has one barrier to proper compensation. The insurance company will argue if there was a concussion, the ambulance or hospital would have caught it. To combat this argument, we scour the medical records, including nursing notes, for any symptoms that might be consistent with a concussion, including headaches, confusion, a spacey feeling, etc. We contact witnesses who may have seen the client at the scene, acting confused or strange.
Even if the hospital listens to a concussion complaint, the usual check is a CT Scan of the head. CT Scan is a great tool, but it generally only visualizes frank bleeding of blood in the brain, midline shift or a more dramatic finding. The microscopic structures that can be damaged in the brain (Neurons, dendrites, axons for example) can be too small to visualize on the CT Scan. (A negative CT Scan of the head does not mean there was not a TBI).
I remember taking my first brain injury case to trial in the 1990’s. This was the “pre-PowerPoint years”. We had a negative CT Scan and no other imaging. We had a Neurologist and Neuropsychologist who competently testified that my client had suffered a TBI. We brought in family and friends as witnesses who testified to the differences in my client from before the car crash contrasted with after the car crash. We got a good verdict in my clients favor, but I was dismayed that in many ways we could not show the brain injury to the jury. (There had to be a better way). The case proof was basically that we know TBI is real and even though you cannot see it, you should believe our client. (A broken arm for example, we can image the x-ray in the court room and actually show the break and 100% prove the injury).
Because of the lack of diagnostic technology to properly show the “subtle findings” of TBI, proving TBI cases has historically posed significant challenges due to the invisible nature of many brain injuries. However, advancements in medical technology are transforming our ability to diagnose and document these injuries with greater precision than ever before. In this article, we explore some of the latest imaging tools and technologies that are revolutionizing the way traumatic brain injuries are detected and proven in legal cases.
Diffuse Tensor Imaging (DTI)
Diffuse Tensor Imaging (DTI) is a cutting-edge imaging technique that is particularly effective in identifying and visualizing microscopic brain injuries, such as axonal injuries that are common in TBIs. Unlike traditional MRI scans, DTI measures the movement of water molecules in brain tissue. This allows for the mapping of the brain's white matter tracts and can reveal disruptions or abnormalities that indicate traumatic brain injury. DTI has proven invaluable in cases where conventional imaging methods might show no apparent damage, yet the patient exhibits symptoms of TBI.
Quantitative EEG (qEEG)
Quantitative EEG (qEEG) is another emerging tool that provides objective data about brain function and connectivity. By analyzing the brain's electrical activity, qEEG can detect abnormalities associated with traumatic brain injuries, including changes in brain wave patterns and connectivity disruptions. This technology not only aids in diagnosis but can also demonstrate the physiological impact of a TBI in a way that is tangible and compelling for legal proceedings.
Functional MRI (fMRI)
Functional MRI (fMRI) is not entirely new but continues to evolve and improve. This imaging method measures brain activity by detecting changes in blood flow, allowing for the mapping of specific brain functions and networks. In TBI cases, fMRI can illustrate alterations in brain activity that correlate with cognitive impairments or other symptoms of traumatic brain injury. This can be crucial in establishing a direct link between an accident and the resulting brain damage.
QMENTA Platform
QMENTA is an advanced cloud-based platform that integrates various neuroimaging technologies and data analysis tools. It enables the processing and interpretation of complex imaging data, making it easier to identify subtle brain injuries and track changes over time. The platform's machine learning algorithms can enhance the sensitivity and specificity of imaging findings, aiding both clinicians and legal professionals in understanding the full scope of a traumatic brain injury.
Biomarkers and Blood Tests
Beyond imaging technologies, biomarkers and blood tests are emerging as promising tools for diagnosing and documenting traumatic brain injuries. Specific biomarkers associated with brain trauma, such as tau proteins or glial fibrillary acidic protein (GFAP), can be detected in blood samples following an injury. These biomarkers not only confirm the presence of brain damage but also provide insight into the severity and progression of the injury.
Implications for Legal Cases
The integration of these advanced imaging tools and technologies into the legal landscape has profound implications for traumatic brain injury cases. By harnessing objective data from DTI, qEEG, fMRI, and other innovative methods, personal injury lawyers can present compelling evidence of brain injury in court. This evidence is instrumental in establishing liability, quantifying damages, and securing just compensation for TBI victims.
In conclusion, the newest tools for proving traumatic brain injury cases represent a paradigm shift in personal injury law. With technologies like DTI, qEEG, fMRI, and platforms like QMENTA, lawyers and medical experts have unprecedented capabilities to identify, diagnose, and document traumatic brain injuries with precision and objectivity. These tools empower legal professionals to advocate effectively for TBI victims and ensure that justice is served in cases involving these often-invisible injuries.
At the Law Office of Adam Sorrells, we handle all types of serious injury cases, including TBI. We have access to many of these advanced tools; giving your case an edge and improving the odds that your case will have a successful outcome.
Contact us online or give us a call at 530-899-9900 to speak with a Chico personal injury attorney from our firm to learn how we can assist you in your case.
Law Office of Adam Sorrells
60 Independence Circle, Suite 100
530-893-9900
Chico, CA 95973
www.chicopersonalinjury.com