“He just doesn’t seem the same.  It looks like my husband, even sounds like him, but he’s just different.  I can’t really explain it, he just feels different to me.”

When we hear these words, as personal injury attorneys experienced in handling traumatic brain injury claims, our hearts drop.  We know that in our office we have a client who has just described a traumatic brain injury but does not yet realize how catastrophically her husband is hurt or how profoundly her life will be altered. 

At Cutler Rader, whether our client was injured in an auto accident, fall or other incident, we commonly see obvious injuries: broken bones, torn ligaments, amputations and paralysis. But some of the most severely injured come to us with the most subtle of findings such as:

Changes in personality- more angry or violent, more docile, loss of sense of humor, erratic behavior- the kinds of things that you can’t necessarily describe, you just know them to be true;

Changes in senses- a smell, taste or feel that he can’t get out of his head, or the absence of a sense;

Slurred speech or difficulty remembering words;

Difficulty with executive function such as impulse control, emotional control, flexible thinking, working memory, self-monitoring, planning and prioritizing, task initiation and organization.

Needless to say, traumatic brain injury can manifest in an alteration in just about everything that makes us…human. 

That eight-pound organ protected within our skull is the most complicated and enigmatic object in the universe.  We revel in the wonders it fulfills in us such as feeling emotions, consciousness or that most mysterious and inspiring capability, unique to humans, of being able to fathom the existence of something that doesn’t exist- imagination.  It was Imagination that conceived War and Peace, the Mona Lisa and Beethoven’s Ninth Symphony.  Our brain is what figures out how to get us to the store, how to build our business and how to find a mate.

It is small wonder why something as complex as the brain can manifest injury in un-namable ways.  Yet it is these injuries that can be the most damaging and life altering, not just for injury victim, but also for his family. 

Traumatic brain injuries come in two varieties- penetrating and non-penetrating.  Penetrating injuries arise when an object outside the head pierces the skull and dura, the membrane that holds the brain.  Stabbings and gunshots are penetrating injuries, as is a blunt force that shatters the skull, causing skull fragments to penetrate the dura.  Penetrating injuries are usually fatal not only because of the obvious damage to the brain and the propensity of the brain to bleed, but also because of the introduction of toxins and infectious agents.

Nonpenetrating, or closed head, injuries do not involve a breach of the skull and dura.  Rather, these injuries involve bruising, shearing (axonal injury) and bleeding. Often, nonpenetrating injuries are not easily observable or apparent immediately following the traumatic event. For example, in a rear end collision, the head is whipped back and forth, causing the brain to slam against the front (coup) and back of the skull (contrecoup).  This generally may result in, at a minimum, a concussion, or mild traumatic brain injury, which is often overlooked or undiagnosed following such a crash.  While diagnosing a closed head injury is often a challenge, emergency medical providers and medical practitioners have developed some key assessment tools to help quantify the existence and severity of a traumatic brain injury. There are five primary methods for the measurement of the severity of a closed head injury:

  1. Loss of consciousness (LOC)– Length of LOC
    1. Mild:  0-30 mins;
    1. Moderate: 30 mins to 24 hours;
    1. Severe: >24 hours
  • Glasgow Coma Scale-Depth of LOC
    • Eye opening:  none, upon pain, upon command, spontaneous (0-4);
    • Verbal:  none, sounds, words, confused, normal (0-5);
    • Motor: none, decerebrate posturing (arms and legs straight out, toes pointed downward, head and neck arched backward, muscles tight), decorticate posturing (body stiff, arms bent, fists clenched, legs straight, arms bent toward the body and wrists and fingers are bent and held on the chest), withdrawal, localizing, obeys commands (0-6).

Mild 13-15;

Moderate:  9-12;

Severe: 3-8.

  • Posttraumatic Amnesia:  the longer the amnesia, the more severe the injury:
    • Mild: >24 hours;
    • Moderate: 1-7 days;
    • Severe: <7 days.
  • Presence of visible intracranial injury on imaging.

CT, MRI (contrast, flair, DTI, qDTI), SPECT, PET:  show skull fractures, presence of blood, midline shift, swelling, intracranial pressure.  Different types and strengths of MRI’s can demonstrate different injuries.

  • Neuropsychological Evaluation:  through neurological testing and extensive psychological testing, assessments can be made of executive functioning, memory, cognition and other areas of brain performance.

At Cutler Rader we not only understand the anatomy and severity of our clients’ injuries, but also the level of care that they will require going forward. We understand the impact these injuries will have not only upon our injured clients, but also upon their families. Our job is to make sure these injured people have access to the best medical care and other resources such as vocational rehabilitation specialists, who can help these injury victims find meaningful employment again. We also know what it takes to be able to fully explain these injuries, and the resulting needs, to an adverse insurance company or ultimately to a jury.  If you believe that you or a loved one suffered a traumatic brain injury, contact the experienced trial attorneys at Cutler Rader today.