What to Do if You Have Been Affected by a Traumatic Brain Injury

Traumatic brain injury (TBI) is a leading cause of fatality and disability amongst children and young adults in the United States. In a given year, roughly 1.5 million Americans endure a traumatic brain injury. Of these injuries, about 230,000 individuals are hospitalized and live, 50,000 individuals die, and between 80-90,000 individuals experience life-long disabilities.

Traumatic brain injury is defined as any kind of trauma that influences how the mind works. Usually, a traumatic brain injury is the outcome of a violent strike to the head or body. Objects that break through the brain tissue, like a shattered piece of a person's skull or even a bullet, can also cause traumatic brain injury.

There are three primary types of traumatic brain injuries. Mild, Moderate, and Severe traumatic brain injury. Each of these is graded on a scale known as the Glasgow Coma Scale (GCS) to determine the severity.

Mild Traumatic Brain Injury

A mild traumatic brain injury is a relatively new finding that can happen in anyone's daily life. Any kind of force to the head area can trigger a mild TBI, which should never be ignored. For example, concussions: these sorts of head injuries have come to be regular events in the lives of active people, especially collegiate and professional athletes. Before they discovered the seriousness of concussions, athletes that endured concussions were frequently told to return to the game or rest for a brief amount of time. Nonetheless, we now understand that mild traumatic brain injuries like concussions can progressively accumulate and impact how a person's brain functions long-term.

Additionally, mild traumatic brain injuries can be the result of sudden motion. A good example would be traveling in a moving vehicle and suddenly slamming on the brakes. This inertia-driven force can legitimately bounce the brain against the skull cavity, causing a mild traumatic brain injury. The result could be swelling, bruising, and sometimes even bleeding of the brain, classifying it as a traumatic brain injury.

Moderate to Severe Traumatic Brain Injury

Moderate to severe traumatic brain injuries are a step above a mild traumatic brain injury on the GCS measuring scale. Just like mild traumatic brain injuries, moderate to severe traumatic brain injuries can result after force to the head area or by a piercing injury like a gunshot wound to the head. Moderate to severe traumatic brain injuries threaten the lives of individuals each year and need to be taken seriously. Gunshots, car accidents, assault cases, and even falls by the elderly all add to the leading sources of moderate to severe traumatic brain injuries.

Before we detail the steps you should take when you or a loved one has suffered a traumatic brain injury as the outcome of another individual or party’s negligence, it is essential to understand the details of TBIs. Below you will find the types of TBI there are, signs and symptoms associated with traumatic brain injuries, diagnosis, prevention, and the treatments that are readily available for patients that have endured a TBI.

Types of Traumatic Brain Injuries

Although traumatic brain injuries are usually described as individual injuries, many people who suffer a TBI are more likely to have a combination of the following injuries, each of which has a different level of severity.

• Concussion: a mild head injury that can cause a momentary loss of consciousness and usually does not cause lasting brain injury.
• Contusion: a bruise to a specific area of the brain caused by impact to the head; also referred to as coup or contrecoup injuries. In coup injuries, the brain is injured directly under the area that was impacted, whereas, in contrecoup injuries, it is injured on the side opposite of the impact. 
• Diffuse Axonal Injury: (DAI): the shearing and stretching of the nerve cells at the cellular level. This happens when the brain rapidly moves back and forth inside of the skull, leading to tearing and damaging of the nerve axons. Axons are what connect one nerve cell to another throughout the brain, similar to telephone wires. An extensive axonal injury disturbs the brain’s normal transfer of information and can result in substantial changes in a person’s alertness.
• Traumatic Subarachnoid Hemorrhage (tSAH): bleeding into the space surrounding the brain. This space is typically filled with something called cerebrospinal fluid (CSF), which behaves like a floating cushion to protect the brain. tSAH occurs when small arteries tear during the initial injury. This, in turn, spreads blood all over the surface of the brain, which causes widespread effects.
• Hematoma: a blood clot that forms when a blood vessel bursts. Blood that breaks free from the normal bloodstream starts to thicken and clot. Clotting is the body’s natural way of stopping the bleeding. A hematoma can be relatively small, or it could possibly grow large and even compress the brain. Your symptoms will vary depending on the location of the clot. There are three important types of hematoma that affect the brain: epidural hematoma, intracerebral hematoma, and subdural hematoma. An epidural hematoma is a clot that forms between the skull and dura lining of the brain.  A subdural hematoma is a clot that forms between the brain and the dura actual. An intracerebral hematoma is a clot that forms deep within the brain tissue itself. Over time your body will reabsorb clots, but sometimes surgery is needed to remove larger clots.

Secondary brain juries can also take place as the result of the body’s inflammatory response to the primary injury. Extra fluids and nutrients will accumulate to try to heal the injury. In certain areas of the body, this is good and is expected to help the body heal; however, inflammation of the brain can be dangerous in some cases due to the firm skull limiting the available space for extra fluid and nutrients. Swelling of the brain increases pressure in the head, which can also cause injury to parts of the brain that were not primarily injured. Swelling will happen gradually and can happen up to 5 days after the injury occurs. 

Symptoms of Traumatic Brain Injuries

It is necessary to remember that the type and location of your injury are going to determine your signs and symptoms. Symptoms can consist of:

• Vomiting
• Headaches
• Problems with vision
• Disturbed sleep
• Tiredness
• Memory loss
• Amnesia
• Confusion and disorientation
• Reduced attention span/concentration
• Dizziness
• Loss of balance
• Feelings of being depressed
• Irritability

Injuries such as concussions or diffuse axonal injury (diffuse injuries) will usually create decreased levels of consciousness. Focal injuries such as ICH or a contusion will have symptoms based on which component of the brain is affected. Each patient impacted by a traumatic brain injury is distinctive, and some injuries will include more than one area or part of a section, making it tough to foresee symptoms that an individual will encounter.

How Are Diagnoses Made?

When somebody has suffered a head injury and is transported to a hospital, physicians will take in as much as they can, as fast as they can, concerning the patient's symptoms and how the injury took place. The state the individual's brain is in will be promptly assessed to identify the extent of the injury. Physicians will utilize the Glasgow Coma Scale to grade the individual's level of consciousness; this scale varies from 1-15. Doctors analyze the person's capacity to 1) open their eyes, 2) respond appropriately to concerns like "What is your name? What is your birthdate? What is the date today?" as well as 3) follow commands like "Put up three fingers or give a thumbs up." If a patient is unconscious or is unable to follow the commands that were given, their response to painful stimulation will be examined. After this, a number will be taken from each category and added together to get the overall GSC score.

To comprehend what part of the brain the injury impacted, diagnostic imaging tests will be taken. There are three different types of imaging scans that can be taken:

• Computed Tomography (CT) is an X-ray that is noninvasive, that provides detailed images of the anatomical structures of the brain. A CT scan is typically taken when the injury happens to quickly identify fractures, any bleeding that has taken place in the brain, blood clots (hematomas), and the overall severity of the injury. CT scans will continue to be used throughout the recovery of a patient to determine the progress of the injury and help make decisions on the patient’s care. 
• Magnetic Resonance Imaging (MRI) is another noninvasive test that uses a magnetic field and radiofrequency wave to give detailed images of the soft tissues of the brain. Sometimes a contrast agent (dye) will be injected into the bloodstream of the patient to help detect minute changes in the brain that a CT scan cannot show.
• Magnetic Resonance Spectroscopy (MRS) gives information about the metabolism of a brain. The numbers generated from this type of scan will give a general prognosis about how well the patient will be able to recover from the injury. 

Can a TBI Be Prevented or Avoided?

Although accidents always happen, and they are just that, accidents, there are a few things that you can do to lower your risk for a TBI. You should:

• Do not drive under the influence of drugs or alcohol
• Avoid dangerous sports and activities
• Always wear a seatbelt in the car
• Make sure to wear a helmet when engaging in sports and activities such as skiing/snowboarding, horse riding, biking, and skating
• Make living areas for seniors safe
• Use child car seats the way they are intended to be used and always buckle your young child into a car seat before driving

What Treatments Are Available for TBIs?

Traumatic brain injuries are serious scenarios and more than likely need instant attention. As specified above, treatment will depend on the type, location, and seriousness of the injury.

If you have experienced a mild traumatic brain injury, treatment will probably consist of great deals of rest. Medication may also be needed in order to ease the headache connected with the injury. This medication can be over-the-counter pain medicine.

If you have a moderate to severe injury, treatment will probably call for intensive treatment at a healthcare facility. Hemorrhaging and swelling in the brain usually become an emergency situation that calls for surgical treatment. Nonetheless, there are times when an individual will not require surgery and can be safely monitored by a physician in the ICU. Most times, doctors will begin by maintaining the patient's injury. This will involve getting oxygen to your body and brain, maintaining your blood flow, and managing your blood pressure. These safety measures are required to help stop any type of further damages. The objective of treatment is always to resuscitate and sustain the critically ill patient, decrease additional brain injuries and problems, and help the patient shift to a recovery environment (such as rehabilitation).

If a person's injury is severe, it is possible that therapy will consist of numerous monitors, such as brain oxygen and intracranial pressure monitors, ventilators, feeding tubes, and seizure and EFG surveillance. Medication will probably be given as well to assist with controlling intracranial pressure, pain, sedation, as well as preventing seizures and infection.

If surgery is needed, it is normally to fix skull fractures, repair any kind of bleeding vessels, remove large hematomas, or alleviate very high intracranial pressure. Surgical procedures could include:

• Craniotomy: cuts a hole in the skull in order to remove a bone flap so that the surgeon can access the brain. The surgeon then repairs the damage, and the bone flap is replaced to its normal position and secured back to the skull with plates and screws.
• Decompressive craniectomy: Removes a large section of bone so the brain can swell and expand. This is usually performed when very high intracranial pressure builds up and becomes life-threatening. This helps leave room for the brain to swell more, and a special biological tissue is placed on top of the brain that is exposed, and then the skin is closed. The bone flap is stored in a freezer, and one to three months after the swelling has stopped and the patient is stable, the bone flap is replaced, called a cranioplasty.  

Other surgeries that can be done to help aid in the patient’s recovery include:

• Tracheotomy: Makes a small incision in the neck so a breathing tube can be inserted directly into the windpipe. A ventilator is then inserted into this new location, and the tube that was in the mouth is removed (these tubes are used to help a patient breathe).
• Percutaneous Endoscopic Gastronomy Tube (PEG): a feeding tube inserted directly into the stomach. When a patient has a breathing tube, they cannot eat, so this is to help them get the nutrients they need while recovering. 

What Should I Do If I’ve Suffered a TBI?

If you think that you have suffered a traumatic brain injury due to the negligence of another, you are going to want to file a legal suit. Even if you are already negotiating with an insurance company, in the midst of making a workers' compensation claim, or applying for various other benefits, the first thing you should do is get in touch with a legal professional that specializes in brain injuries. Brain injury lawsuits are really complicated, both medically and legally, so it is important to consult an experienced and qualified attorney.

Understanding the legal concept on which your case will be based is important because what you will have to prove in order to win your claim is determined by this. It will additionally assist you in compiling together all of the evidence that you will need for your case.

Most brain injury cases are built on negligence, which states that someone (usually a medical professional in a brain injury case but could be somebody else) acted wrongfully and was the reason for your injury. In order to have a basis for a negligence claim, the patient (complainant) must be able to prove that the party they are taking legal action against (the accused) is legally responsible for their injury.

Showing that a brain injury occurred and linking that injury to a defendant's actions can be extremely helpful in a suit. Traumatic brain injuries are a lot more times than not complicated and tough to identify than any other type of accident. This results from the large quantity of evidence that needs to be collected in regards to the nature of the brain injury and the accident. The more information you have on these two points, the less complicated it will be to confirm your negligence claim.

When preparing your case, the lawyer of your choice will ask numerous questions about how your brain injury happened. They will likely ask you to keep in mind what you can of the accident, such as how it took place, where you were and also who you were with, what you were doing at the time of the accident, and the medical treatment that you obtained after the injury. As memory loss is common with brain injury patients, it is okay if you cannot remember certain information about your accident. The important thing is to just be honest with your attorney and help collect as much information as you can from various other sources such as witnesses, police records, and even newspaper articles.

Although a traumatic brain injury case can seem complicated, specifically during memory loss and various other pain and sufferings, the right experienced lawyer will help navigate you through the complicated legal process to the best of their ability. Contact an experienced personal injury attorney about your traumatic brain injury today.