Traumatic Brain Injury (TBI) is extraordinarily common in California. According to the California Department of Public Health, California emergency rooms treated 142,139 people for traumatic brain injuries in 2007. Of that, 29,354 were hospitalized, 7 percent of which died. The two leading causes for patients visiting the hospital with a traumatic brain injury are slip and falls and car accidents. A blow to the head or violent shaking of the brain within the skull can lead to a brain injury, both of which typically happen in slip and falls and car accidents.
These brain injuries can range from mild to severe. The most common type of brain injury in Orange County is a mild brain injury, also known as a concussion. Calling a brain injury “mild” is actually a misnomer though because they can be devastating for people and should be taken seriously.
If you have recently sustained a brain injury due to someone else’s negligence, you may be entitled to compensation. Contact our Orange County traumatic brain injury attorneys at the Crockett Law Group to learn about how we can help you maximize your settlement. Call (800) 900-9393 for a free consultation with an Orange County personal injury attorney.
What Is a Traumatic Brain Injury?
A traumatic brain injury (TBI) is defined by the CDC as a disruption in normal brain function as a result of a bump, blow, or jolt to the head. The severity of a TBI ranges from mild, moderate, to severe. A mild TBI is also known as a concussion.
How Do You Prove a Brain Injury?
Diagnosing a traumatic brain injury can be difficult because oftentimes the person does not show signs of physical injury, so they are often overlooked. A neurological exam is usually the first step, though. There are primarily two guidelines that are used, one published by the Department of Defense, and the other is called the Glasgow Coma Scale (GCS). If a TBI is suspected based on the results of these neurological exams, then brain imaging tests may be warranted.
Department of Defense Guidelines
The Department of Defense guidelines look at the duration of loss of consciousness (blacking out), post-traumatic amnesia (memory loss immediately following an injury), and altered mental status (confused or disoriented).
Mild concussion symptoms include:
- Loss of consciousness of fewer than 30 minutes; or
- Post-traumatic amnesia lasting less than 24 hours; or
- Altered mental status less than 24 hours. (Structural brain imaging is normal)
Moderate brain injury signs are:
- Loss of consciousness for more than 30 minutes but less than 24 hours; or
- Post-traumatic amnesia lasting more than 24 hours but less than 7 days; or
- Altered mental status lasting more than 24 hours. (Structural brain imaging may be normal or abnormal)
Severe injuries to the brain include:
- Loss of consciousness for more than 24 hours; or
- Post-traumatic amnesia lasting more than 7 days; or
- Altered mental status lasting more than 24 hours. (Structural brain imaging may be normal or abnormal)
Glasgow Coma Scale (GCS)
The Glasgow Coma Scale is a 15-point test that assesses patients based on their ability to move their eyes and limbs and follow directions. Each of the three categories is given an individual score that is then added up all together:
Eye Response (4)
- No eye opening
- Eye opening to pain
- Eye opening to sound
- Eyes open spontaneously
Verbal Response (5)
- No verbal response
- Incomprehensible sounds
- Inappropriate words
Motor Response (6)
- No motor response
- Abnormal extension to pain
- Abnormal flexion to pain
- Withdrawal from pain
- Localizing pain
- Obeys commands
A lower score indicates a more severe TBI, 3 being the lowest and 15 being the highest:
- Mild TBI/Concussion: GCS score of 13-15
- Mild TBI: GCS score of 9-12
- Severe TBI: GCS score of 3-8
Neuroimaging tests may be warranted if an emergency room patient presents with symptoms of a TBI based on the results of a neurological exam. There are primarily two neuroimaging tests used to diagnose a TBI: (1) CT Scans, and (2) MRI.
Computerized tomography (CT) scans are most commonly used by emergency room physicians who suspect a traumatic brain injury. A CT scanner uses a rotating X-ray machine to obtain images of brain tissue and brain structures. The scanners are capable of detecting blood clots (hematomas), brain bleed (hemorrhage), bruised brain tissue (contusion), and skull fractures. However, a CT scan will usually produce normal results for somebody with a mild TBI, such as a concussion.
Magnetic resonance imaging (MRI) is most commonly used when symptoms persist following the acute period of a TBI. An MRI machine uses a magnetic field and radio waves to create images of your brain. These machines are particularly good at detecting injury to nerve fibers (diffuse axonal injury) according to the Journal of Affective Disorders. MRIs are also useful diagnostic tools as far as diagnosing a cerebral microbleed (microhemorrhage) and bruised brain tissue (contusion).
It’s important to note that neuroimaging tests, such as CT scans and MRI, oftentimes show “normal” results. However, “normal” does not mean a person did not sustain a TBI. These tests typically only detect large abnormalities and fail to detect other signs of brain injury.
What Are the Different Types of Brain Injuries?
The term “brain injury” can be vague because there are so many different types, and each type is associated with a different outcome. With that being said, brain injuries typically fall within one of three categories: (1) open head injury; (2) closed head injury; and (3) skull fracture.
Open Head Injury
An open head injury, also known as a penetrating brain injury, occurs when an object pierces the skull and enters the brain tissue.
Closed Head Injury
A closed head injury is a brain injury caused by an external impact that moves the brain within the skull but does not break the skull. A concussion is one type of closed head injury and the most common type we see from accidents in Orange County, CA.
A concussion is a brain injury that results in a temporary loss of normal brain function. Note, though, that a person doesn’t have to lose consciousness to sustain a concussion. A concussion is caused by either a blow to the head or a violent shaking of the head. Imaging studies, such as CT scans and MRIs, do not help diagnose a concussion; the diagnosis is clinical in nature.
Epidural Hematoma (EDH)
An epidural hematoma refers to bleeding between the inside of the skull and the outer covering of the brain (called the dura). The leaking blood forms a hematoma (mass of blood) that puts pressure on the brain tissue.
Subdural Hematoma (SDH)
A subdural hematoma refers to bleeding between the outer covering of the brain (dura) and the surface of the brain. The leaking blood forms a hematoma that puts pressure on the brain tissue.
Intracerebral Hemorrhage (ICH)
An intracerebral hemorrhage refers to bleeding that occurs within the brain tissue.
A cerebral contusion refers to a bruise on the brain’s surface, which causes bleeding and swelling inside the brain. In other words, a brain contusion often results in an intracerebral hemorrhage.
Diffuse Axonal Injury (DAI)
A diffuse axonal injury refers to widespread damage of nerve axons throughout the brain, which disrupts nerve communication. Car accidents are the most common cause of DAI.
A skull fracture refers to a break in the skull bone. There are 3 types of skull fracture that are particularly relevant to accidents:
Linear Skull Fracture
A linear skull fracture refers to a break in the skull with a single fracture line. This is the most common type of skull fracture.
Depressed Skull Fracture
This refers to a fracture in the skull with pieces of bone being pushed inwards towards the brain.
Basilar Skull Fracture
A basilar fracture is located at the base of the skull. This is the most serious type of skull fracture.
Can You Get Brain Damage From a Car Accident?
You can absolutely get brain damage from a car accident. In fact, the CDC says that car accidents are the second leading cause of all TBI hospitalizations, only second behind falls. There are several other causes of brain injury as well, such as motorcycle crashes, bicycle crashes, and pedestrian accidents.
As for car accidents, brain damage can happen in one of two ways: either from a direct blow to the head or from a violent movement of the head. Let’s take a look at both ways.
A car crash can cause an occupant’s head to strike an object (e.g., dashboard, roof, steering wheel, or window) or an object to strike an occupant’s head (airbag, glass, or metal sheared from the car). This area of direct impact is called a “coup” injury. If the brain subsequently moves to the opposite side and strikes the skull again, it’s called a “contrecoup” injury. Coup-contrecoup injuries are responsible for every type of brain injury there is, including open head injuries and skull fractures.
A car crash can cause an occupant’s head to jerk backward and then forwards where it abruptly stops, meanwhile their brain still has forward momentum and winds up striking the inside of their skull. Acceleration/deceleration injuries are responsible for concussions, brain contusions, hemorrhages, and diffuse axonal injuries.
What Are Brain Damage Symptoms?
Symptoms of a brain injury might be noticed right away, or they might not appear at all until several days or weeks later. Sometimes people don’t even realize they are experiencing symptoms of a TBI until others bring it to their attention. TBI symptoms fall into one of these three categories: (1) cognitive, (2) emotional, and (3) physical.
Decreased attention and concentration, difficulty processing and understanding information, language and communication problems, planning and organizing problems, problems learning and remembering new information, and problems with reasoning/problem solving/judgment.
Anger, anxiety or nervousness, depression, impulsiveness, mood swings, and irritability.
Blurry vision, diminished sense of smell (anosmia), dizzy, fatigued, headaches, lethargy, nauseous, poor balance, poor coordination, reduced sense of taste, ringing in the ears (tinnitus), seizure, sensitivity to light (photophobia), sensitivity to sound (phonophobia), sleep disturbance, and vomiting.
These symptoms are a part of the normal recovery process for a brain injury. They can be expected to resolve within about 3 to 6 months for a majority of people.
Can TBI Symptoms Get Worse Over Time?
TBI symptoms can get worse over time, but how long those symptoms persist depends on the type of TBI you sustain. As you can probably imagine, people with a moderate or severe TBI can generally expect symptoms for a longer period of time than people with a mild TBI (i.e., a concussion).
TBI symptoms do resolve fairly quickly for a majority of people who sustain a mild traumatic brain injury. However, for about 20% of people they don’t. When TBI symptoms continue to persist for months or years after an injury, it’s referred to as a post-concussion syndrome.
According to the VA, a certain percentage of people with head injuries can be expected to experience the following symptoms of post-concussion syndrome at some point in their recovery:
- Sleep difficulties: 80 percent
- Poor concentration: 71 percent
- Irritability: 66 percent
- Fatigue: 65 percent
- Depression: 63 percent
- Memory problems: 59 percent
- Headaches: 59 percent
- Anxiety: 58 percent
- Trouble thinking: 57 percent
- Dizziness: 52 percent
- Blurry or double vision: 45 percent
- Sensitivity to bright light: 40 percent
These symptoms of post-concussion syndrome tend to gradually dissipate over time. Like any other injured body part, your brain needs time to heal itself through rest and relaxation. You wouldn’t go for a run the day after spraining your ankle, would you? The brain is no different. It also needs time to recover.
People who give their brain sufficient time to rest before jumping back into their normal routine experience these symptoms for a shorter period of time than those who don’t. Rest assured, these symptoms will likely go away within 3 to 6 months without any formal treatment. If your symptoms are getting worse, this is a sign you need to cut back on your work and responsibilities so you’re under less stress.
Chronic Traumatic Encephalopathy (CTE)
CTE refers to a degenerative brain condition caused by repetitive mild traumatic brain injuries. According to the Concussion Legacy Foundation, a single mild TBI won’t necessarily cause CTE. Rather, evidence suggests that people with multiple mild traumatic brain injuries have a greater risk of developing CTE, which is a type of dementia.
Repeated hits to the head cause a buildup of the protein called “tau,” which has been linked to the death of brain cells. Damage to brain cells that are necessary for healthy brain function causes neurological changes, such as: aggression, changes in personality, confusion, depression, difficulty with balance and movement, impulsive behavior, and memory loss.
These symptoms of CTE may not appear until many years or decades later. And unfortunately, a definitive diagnosis of CTE can only be made after death during an autopsy.
TBI symptoms can persist long-term, sometimes even life-long, for people who sustain a moderate or severe traumatic brain injury. These people may require extensive rehabilitation for persistent cognitive, emotional, and physical symptoms. Let’s take a look at some of the long-term consequences.
Moderate to severe traumatic brain injuries are associated with an increased risk of developing dementia. Older adults who sustain a moderate TBI have a 2.3 times greater risk of developing Alzheimer’s disease, which is a type of dementia; those with a severe TBI have a 4.5 times greater risk according to the Alzheimer’s Association.
Seizures occur when the brain has a sudden surge of electrical activity. These electrical disturbances in the brain can happen to 1 to 5 out of every 10 people who sustain a traumatic brain injury according to the Archives of Physical Medicine and Rehabilitation. The risk of having one of these seizures increases with the severity of the TBI. For example, seizures may affect as much as 50 percent of penetrating brain injury patients, 25-30 percent of severe TBI patients, and 5-10 percent mild to moderate TBI patients.
Traumatic brain injuries are associated with increased mortality. People with a moderate to severe TBI who undergone inpatient rehabilitation are 2.2 times more likely to die as compared to the general population and have a reduced life expectancy of 6.6 years on average according to the Journal of Neurotrauma.
What Is the Best Treatment for Traumatic Brain Injuries?
Recovery from a traumatic brain injury varies quite a bit depending upon the severity of the injury. With that being said, every TBI patient will require rest so the brain can heal, and probably require medication to relieve headaches, like Neurontin.
If you sustain a TBI and go the emergency room, you won’t be discharged from the hospital until your condition has stabilized. In fact, you might even be admitted to Neurocritical Care, which is the ICU for people with a life-threatening brain injury. There are several devices that physicians will use to monitor the condition of your brain injury.
An EEG test uses small, metal discs called electrodes that attach to your scalp to detect abnormal brain waves.
Intracranial Pressure (ICP) monitor: An ICP uses a microsensor that is inserted through a small hole drilled in your skull in order to measure pressure around the brain.
Depending on the type of TBI you sustain, surgery may be necessary to relieve pressure on the brain caused by bleeding and swelling.
A craniotomy is used primarily to treat a hematoma putting pressure on the brain after head trauma. It involves removing a part of the skull called the bone flap in order to access the brain. Once the surgeon drains the hematoma using suction and irrigation, the bone flap back is secured back to the skull with plates and screws.
A craniectomy is preferred over a craniotomy when the swelling in the brain is significantly great. Just like a craniotomy, the surgeon removes a part of the skull called the bone flap to access the brain. But unlike a craniotomy, the surgeon doesn’t immediately secure the bone flap back to the skull. Instead, the bone flap is stored in a freezer for 1 to 3 months while the swelling in the brain continues to go down. Once the patient stabilizes, the surgeon performs a second surgery to secure the bone flap back to the skull again with plates and screws.
Luckily, the brain is capable of repairing itself by creating new brain cells to replace damaged ones. This ability of the brain to physiologically change and adapt after an injury is referred to as neuroplasticity. Neuroplasticity is at the heart of recovery from a brain injury, but it requires rest and time for the brain to create these new connections.
Although the brain is remarkable in its ability to self-heal, therapy can help speed your recovery process along. You might undergo inpatient rehabilitation before you’re discharged from the hospital, or after you’ve been released, or both.
A neuropsychologist is a licensed psychologist who administers tests that measure the degree of cognitive impairment caused by a brain injury. The results of this test will help guide treatment and rehabilitation for problems with behaviors, emotions, thinking, and memory.
An occupational therapist teaches TBI patients how to function in day-to-day activities, such as bathing, cooking, dressing, eating, grooming, home maintenance, toileting, and work.
A physical therapist helps TBI patients improve balance, coordination, endurance, and strength so they can function at work and at home.
A speech-language pathologist helps TBI patients improve language, speech, and swallowing skills so they can eventually return to work or school.
Review Your Injury Claim With an Orange County Traumatic Brain Injury Attorney
As brain injury lawyers, we regularly represent the interests of victims who have been treated unfairly by an insurance company. We are committed to handling your brain injury claim from start to finish and will fight to make sure that you receive the money you deserve. If you have sustained a brain injury as a result of someone else’s negligence, contact the Crockett Law Group at (800) 900-9393 to schedule a free consultation.