Jul 27, 2020

What are the Types of Brain Injuries?

Human Brain Injury Anatomy.

Brain X-ray
X-ray image of the brain computed tomography.

The brain weighs a lot. The average brain weight is between two to five pounds. Your brain's matter consists of a gray, jelly-like substance, called cerebrospinal fluid. And this liquid contains millions of microscopic fibers. And this is the transmitter our brain uses to send electrically charged neurochemical signals around the different lobes responsible for things like emotions, coordination, speech, hearing, and balance, etc. These electrical signals travel through axonal-dendric connections. Physicians call these signals to be "synapses."

So if a jolt or strike impacts human brain tissue, your axonal-dendric connections could break apart. Or they may become severely damaged. Although we are not brain surgeons, we do work with brain injury medical experts regularly. Here, attorney Michael Ehline tells us all what we must know to identify and treat a brain injury


Most Common Causes of Brain Damage.

Vehicular accidents involving passenger automobiles are the most significant cause of skull, head, and brain injuries. Harm can happen due to blow or strike to the head. And this could be an impact from falling off a bicycle and hitting the asphalt with force. Or it could be from a spill on a motorcycle.

Often it results from crashing into a windshield during a car accident. Even without an impact, the G-forces of an impact can cause your brain to go from sudden acceleration to sudden deceleration. And precisely, this is what occurs in a whiplash event.

So even without blunt trauma to your head, you can still suffer a head injury. Also, many brain injuries are directly related to the bleeding and swelling of the brain. So many times, they remain unrelated to a hit on the head. The whiplash event can cause the brain to bleed.

It can create bruising and twisting of brain matter. And all this could happen during the impact, or later as the brain matter and tissue swell. Afterward, you think you’re beautiful, but then you’re not.

What Are the Various Parts of the Brain?

Science has discovered that your brain consists of three principal organs.

These are called the:

  1. cerebellum.
  2. cortex.
  3. the brain stem, or diencephalon.
  • Your cerebellum remains responsible for balance and coordination.

Your brain stem connects your spinal cord to your mind. So, in turn, it sends signals to your vital organs like your heart and lungs. But it magnificently controls natural survival functions, from adrenaline, heartbeat, urination, breathing, consciousness, fear, and hunger.

Although your skull and the fluid therein helps protect your brain, the skull is not extremely thick and un-padded on the inside. Just the opposite remains true. The interior of your head has internal ribs with bony structures.

So if a sudden back and forth or side to side movement happens, your brain can bang or collide into the skull's ribbing. Depending upon how the jolting event took place, it could ruin lives. Also, bruised lobes might sustain long-term damage.

What Are Some Other Medically Important Aspects of the Brain?

  • The Cortex Controls The Majority of Thought.

Connected to these lobes is the internal cortex. This tender area in the middle of your brain controls the majority of thoughts and analysis. Particularly pertinent, four lobes travel to your cortex, along with two hemispheres: the right and the left.

Intentional, voluntary activities like mixed martial arts can damage the brain lobes. Or damages can arise from unintentional events like motor vehicle collisions, discussed above.

Left Brain is What Helps You Write, Read, and Calculate Numbers.

Your left hemisphere is typically the most dominant portion of your brain. Mainly it controls your ability to talk, read, write, or do mathematical calculations.

The right side of your brain is responsible for visual-spatial functions like musical rhythm. It is also responsible for the ability to draw and other visual memories associated with computing, programming, and drawing things.

Frontal Lobe is Number One Injury From Car Crashes?

True. Your frontal lobe is often the one injured from motor vehicle accidents. Most of all, this is due to most crashes being rear-enders. So this is what results in the front and rear cars pushing forward with force and stopping rapidly. Hence, this banging and snapping effect can drive an internal impact right into the front of your skull. Furthermore, this holds regardless of whether or not the head itself makes contact with an immovable, external object.

  • Frontal Lobe is About Personality and Emotions.

The frontal lobe is the part of the body that controls emotions and characteristics, such as your real personality. It is easy to see how a belted occupant in the forward vehicle can sustain a bad injury that alters his or her nature and harms their emotional health.

And this remains another reason why people in any vehicle wreck should seek medical care fast. You must rule out brain tears or bruised lobes at a minimum.

What is a Traumatic Brain Injury?

First, there are two medically classified types of brain injuries:

  • Traumatic.
  • Mild Traumatic.

Traumatic Brain Injury.

Traumatic brain injury (“TBI”) may significantly cause damages one’s cognitive, physical, mental, and psychological skills. Physical deficits can include ambulation, loss of balance, coordination, fine motor skills, strength, and endurance.

Cognitive deficits of language and communication, information processing, memory, and loss of perceptual skills are common. Psychological status often changes as well. People with TBI frequently encounter adjustments to disability issues.

IMPORTANT: TBI Brain injuries can occur in many ways.

TBI typically results from accidents in which the head strikes an object. This is the most common type of traumatic brain injury. However, others, such as those caused by insufficient oxygen, poisoning, or infection, can cause similar deficits. Attorneys need to pin down who caused this exposure and why. This process includes finding the liable parties.

Research Shows Pituitary Damage Frequently Follows TBIs.

As if the effects of brain injury aren't enough. Researchers determined that traumatic brain injury does even more damage to the human body than previously believed. The brain's fragile and vital interaction with the pituitary gland is critical to bodily function. Injuries cause interruption or change to the regular communication between the two.

This is where personal injury attorneys need to keep their medical knowledge current. The Ehline Law Firm APLC is the leading TBI law office in California. This is partially due to our own research and partly due to partnerships with leading physicians and researchers. With medical science expanding quickly, it is vital to be ahead of the curve.

Also, there are several key factors at play. One is the well being of our clients. The newest medical knowledge allows us a better understanding of their medical challenges. Furthermore, it also allows our firm to estimate their future needs better.

TBIs And Emerging Science Regarding Pituitary Injuries.

Pituitary injuries are nothing to sneeze at. In fact, coupled with TBIs, they are often devastating to families. A 2015 article printed by the National Institute of Health shows the incredible effects on the human body. Up to 20% of TBI victims develop chronic hypopituitarism.

Imagine the numbers. Two hundred thirty-five thousand people are hospitalized due to TBIs, and many more do not seek treatment. There are thousands of people suffering from the effects of sports injuries, work accidents, and car accidents. These medical issues can cause severe pain, hematomas, and severe blood and energy issues.

All of this means tens of thousands to millions of dollars of needed future care, depending on the client. Clients, firms, and courts need to know this vital information.

For more information about the future of thyroid issues and traumatic brain injuries, keep it tuned here. The Ehline Law Firm writes about the future of medicine and how it affects law firms and our clients.

What is a Mild Traumatic Brain Injury?

So this is where it gets interesting. Just because it is mild, makes it no less traumatic.

A Mild Traumatic Brain Injury (“MTBI”) is medically classified with the following symptoms:

  • Loss of awareness.
  • Loss of one’s memory right before or after brain injury.
  • Any alteration in mental state at the time of the accident.
  • Focal neurological deficits. (Read more here).

In many MTBI cases, a person may seem just fine on the surface. But sadly, they continue to endure chronic functional problems. Some people suffer long-term effects of MTBI. Doctors call this post-concussion syndrome. (“PCS”). Persons suffering from PCS can experience significant changes in cognition and personality.

In addition, nothing proves "mild" about any "traumatic" brain damage. In contrast, this remains a medical term and should be used in this context. "Mild" can still mean the victim is a vegetable for life.

Brain Ricochets

Most traumatic brain injuries cause widespread damage to the brain. Contrast this with mild brain injury. In the latter case, the injury stays in a localized area. Because the brain ricochets inside the human skull, it gets bruised.

This factor remains common during a jarring and jolting auto collision. Furthermore, a diffuse axonal injury occurs when the nerve cells are torn apart. Localized damage may arise from the brain bouncing into the inner the skull.

The brain stem, frontal lobe, and temporal lobes are vulnerable. Similarly, they are located near bony protrusions inside the skull. So they become bruised most natural. Also, their location near the front of the cranium means a higher chance of forward or backward motion impacts.

Brain Stem Facts.

The brain stem begins at the base of the brain. Furthermore, your brain stem regulates essential arousal and regulatory functions. And the brain stem helps people to remain attentive. Short-term memory is connected to the brain stem as well. Trauma to this area leads to disorientation, frustration, and anger. Most noteworthy, our attorneys work to identify the part of the brain harmed.

That way we can work to identify and mitigate damages for you. All this helps later when we argue damages on your behalf — the limbic system, higher up in the brain than the brain stem. Hence, this helps regulate emotions. Connected to the limbic system are the temporal lobes. Likewise, these are associated with many cognitive skills such as memory and language.

Lobe Damage

Damage to the temporal lobe or seizures causes many behavioral disorders. However, the frontal lobe gets injured the most. Doctors consider all of this our emotional and personality control center. As a result, damage to these parts causes poor judgment and increased impulsivity.

Learn more Here About Diagnosing an MTBI.

A person with MTBI has a traumphysiological disruption of brain function.

This is usually manifested by at least one of the following:

  • loss of consciousness.
  • loss of memory for events right before or after the accident.
  • alterations in one’s mental state at the time of the injury or collision (e.g., seeing stars, lethargy, or confused).
  • neurological deficit(s) that may be transient but the severity of the injury doesn’t exceed the following:
loss of alertness of around 30 minutes or less; b. after 30 minutes, a preliminary Glasgow Coma Scale (GCS) of 13-15; and c. post-traumatic amnesia (“PTA”) not greater than 24 hours.

What to Look For in General When Diagnosing an MTBI.

  • Determine whether or not alertness was lost.
  • Determine the length of unconsciousness.
  • Research if there was an alteration of alertness.
  • Determine the duration of altered alertness.
  • Classify the specifics of how the injury occurred.
  • In addition, determine the history of previous head injuries or concussion by an interview with the patient and family.
  • Find about former alcohol use.
  • Determine former substance use.
  • Thus, determine former vocational pursuits, positions, and durations.
  • Determine former leisure pursuits, to include hobbies, athletics, and other recreational pursuits.
  • As a result, if possible, obtain academic record and rule out pre-existence of attention deficit disorder or learning disabilities.
  • Determine social/legal history.

MTBI Medical Issues.

  • Determine one’s current sleep patterns, time to bed, time to sleep, times to wake up, activities during wakefulness, rise time, and relaxed state upon awakening.
  • Determine one’s dietary habits.
  • Research one’s exercise routine.
  • Determine one’s caffeine usage and outline any changes since the injury.
  • Read past medical history.
  • Determine family medical history.
  • Discover his past medications.
  • Determine his current medication; chronicle changes in medications.
  • Correlate his symptomatology with medications. Look at side effects. Determine the use of over-the-counter medications/vitamins/supplements.
  • Review the EEG’s.
  • Research the CT scans of the head.
  • Review the skull x-rays.
  • Review the cervical x-rays, CT’s, and MRI’s.
  • Read the headache history. List headaches to look for sinusitis, tension. TMJ dysfunction, medication/substance withdrawal, migraine. Headaches should be fully characterized and described completely.
  • Describe all one’s vision complaints. Know the difference between blurred vision and diplopia. Evaluate the visual fields and one’s ocular motor skills. Determine if there is the presence of photophobia, image suppression, image persistence in the patient.
  • Define and describe all the patient's pain complaints as well as past/current treatments for the same.
  • Define the patient's complaints of dizziness, imbalance, and disco-ordination.
  • Appraise patients’ balance by single-foot standing, Romberg, star-march.
  • Appraise the patient’s history of balance in low-light conditions.
  • Determine the patient’s perilymphatic fistula, cupulolithiasis, and cervical dizziness.
  • Appraise the patient’s cardiac status and serum glucose levels as possibly contributory to dizziness. * The term “concussion” should be avoided and replaced with the term “mild traumatic brain injury.”

The diagnosis and treatment of traumatic brain injuries is a rapidly developing and fluid field of both medicine and the law. So this is an ever-evolving area of medicine concerning closed head injuries and traumatic brain injuries. And tests such as these are affecting plaintiff lawyers who seek to demonstrate such injuries to juries throughout the State of California. We recently published a study on diffuse tensor imaging (DTI) and susceptibility-weighted imaging. As diagnostic studies that can detect diffuse axonal injuries and other brain-related trauma, these are helpful tools in proving the plaintiff's burden.

DTI and SWI have become attractive options to both medical practitioners and brain injury lawyers as they often illustrate pathology unseen on a plan static brain MRI. Functional MRI’s take the diagnosis of brain trauma and closed head injuries one step further. In fact, functional MRI’s (hereinafter referred to as “FMRI”) provide the unique perspective of displaying brain activity while performing specific activities as compared to at rest.

When an individual performs certain cognitive tasks, this triggers the flow of blood to specific areas of the brain. In turn, this helps create a map of the brain’s activity and enables Radiologists and Neurologists to determine which areas of the brain are damaged and to what extent. Further, this allows the physician to obtain a stronger grasp of the patients’ clinical presentation. It is one thing to identify pathology in a diagnostic study. In contrast, FMRI allows the medical practitioner to see how the pathology affects the patient while performing objective tests. The potential for this diagnostic study is exciting.

As traumatic brain injury attorneys, it remains our job to illustrate the nature and extent of our client’s injuries. When representing a victim of a brain injury, it is essential that we readily display to the jury the “hidden injury” our client has sustained. In other words, our clients who have suffered a traumatic brain injury often appear completely healthy. They can often walk and talk with ease and the symptoms may be very subtle in nature.

However, even very subtle changes in the structure of the brain including but not limited to a diffuse axonal injury can cause substantial changes to the victim’s personality. People close to them often complain about cognitive changes as well that may manifest with difficulty staying on task, memory loss, irritability among many other conditions. Our attorneys make sure you have access to the best imaging systems.

MTBI Vocational.

  • Completely describe the patient's vocational history.
  • Completely describe the person’s current job description. Include whether or not the work is full-time, part-time, seasonal.
  • Determine for the presence or absence of a supplemental disability insurance income.
  • Find out workers’ compensation TD payment level.
  • Determine the presence of a salary agreement.
  • Thus, determine if there is a status vs. wage loss compensation.

MTB Victim’s Psychosocial.

  • Evaluate injury patient for anxiety, depression, panic attacks, somatization, hypochondriasis, malingering.
  • Determine injury patient for issues of secondary gain.
  • Evaluate the injury victim for family system adaptation/adjustment.
  • Differentiate victim’s psychiatric symptoms from iatrogenic or seizure-induced symptoms.
  • Physical Therapy.
  • Evaluate the injury victim for overall fitness and conditioning, muscular strength, the range of motion, sensation, proprioception.
  • Define the injury victim’s pain complaints.
  • Balance/coordination diagnostics.

MTBI Testing?

MTBI Tests to Consider:

Firstly, many doctors consider the Wide Range Achievement Test highly. Also, the Motor Free Visual Perception Test. Don't forget about the Test of Visual Perception Skills. In addition, look at the Santa Clara Valley Perceptual Motor Evaluation MMPI-II. Beck’s Depression Inventory is also valuable in this regard. Furthermore, reading the famous Taylor-Johnson Temperament Analysis proves valuable. Equally important is the FIRO-B, and Woodcock-Johnson Psychoeducational Battery.

More recently the Detroit Tests of Learning Aptitudes have proven beneficial in the overall analysis. Even more, experts generally quote from the Booklet Category Test, and Wisconsin Card Sort. (Trails-A, B Neuropsychological Battery). All of these above tests assist patients.

What is An Anoxic Brain Injury?

An anoxic brain injury means the patient will have interrupted blood flow to and from the brain. Lack of oxygen to the brain is sometimes the cause of this damage. Examples of

  • Causes Of Anoxic Brain Injuries Include:

Ex 1: Patrial drowning in an unsupervised pool can cause swelling or bleeding of the brain tissues. Mostly, side to side impacts often associated with an impact on a person's head.

Ex 2: Other examples could include professional boxers hitting a person with their fist. There is an impact, which can cause external damage, and a snapping motion causing internal damage.

Ex 3: Another example would be the whipping motion to a stopped vehicle occupants head upon being hit in the rear by another vehicle. And that is the classic rear-end car accident that causes so many cases of whiplash, depending on the impacting vehicle's speed. So, of course, this can result in a head and neck injury risk to the patient, coma, or death.

What is Contrecoup Brain Injury?

Contrecoup injuries take place as a result of the jarring side to side impact. These types of damages strike people walking in public cross-walks. In some cases, such as the front end of an oncoming car hitting a pedestrian, jarring internally causes the brain to propel against both sides of your skull. The brain rebounds and crashes into the opposite sides of the head. A contrecoup injury is the ultimate result of precisely this type of event.

What is an Epidural Hematoma.

An epidural hematoma is from a blood clot forming between your skull and the inner, upper lining of your brain known as your “dura.” A blood clot in that area of your head causes many pressure changes in your brain. This clot can result in the medical necessity of emergency surgery to effectuate emergency repairs and eliminate the clotting.

This clotting is a common injury a senior will suffer as a patient in hospitalized environments. This can often be the nexus of an elder abuse lawsuit. Care providers can often mitigate or eliminate the risks of clotting in many dependent patients.

What Is A Contusion or Concussion?

Contusions and concussions take place when your external skull, and brain bruises. This is usually a result of the brain hitting and impacting on the inside of your cranium. This jarring type of injury creates many symptoms. These can range from dizziness, seeing stars, mild headaches, severe headaches, loss, or lack of memory and loss of concentration.

A simple concussion can even create lifetime consequences that could require lifetime medical care. An example would be a helmeted motorcyclist who falls from his bike. He slams his head into the curb, breaking open his padded helmet.

Although he may survive, the impact could still be enough to damage the brain. This impact is also a problem with bad sports injuries. Examples are common in boxing and the hard tackles of pro-U.S. football.

As a general rule, if you are struck in the head, see stars, or feel vertigo, stabilize yourself, and get to the hospital. You must mitigate your injuries to the best of your abilities. Act reasonably and seek professional help. Rule out things like potential blood clots that could kill you.

What is A Diffuse Axonal Injury (DAI)?

Diffuse Axonal Injury is a brain injury associated most closely with the rotation and disruption of your brain within the cranium. This rotation can cut away, shear, or sever the brain axons, which are connecting nerve fibers. Damage such as this is typically difficult to analyze. It is also accompanied by microscopic tears that are difficult to locate from the get-go.

If doctors diagnose your case as a “mild brain injury,” you may notice that thus the wounds heal over time. But often, a DAI results in permanent disabilities from loss of consciousness to lifetime coma. Eventually, a fatality could be the nexus of a future wrongful death claim in civil court and even a murder case in criminal court.

Many physicians and lawyers are confident that modern advances in science will be able to treat and slow down or stop the injury from progressing. These people believe that medications and other therapy and surgery will cure or minimize the damage. So far, we have seen some success stories as science and medicine advances.

We hear remarkable stories about Scorpion Venom and other new treatments for damaged brains all the time. For now, however, an ounce of prevention is still worth a pound of cure. So be careful out there.

About Skull Fractures.

Skull fractures often result from when the bone in your head, or skull, fractures. As discussed here, this is similar to cracks in an eggshell. A skull fracture usually mends itself over time. Also, this is often due to injury or damage to the fracture zone. And this will typically require surgery to repair the fractured armor.

What is a Subdural Hematoma?

Causes of Subdural hematomas are blood clots forming in between your brain tissue and your dura. A hematoma can happen in many ways. It could arise slowly over a few weeks or days. Clinically, this latency makes this "subdural" hematoma. 

What is an Acute Hematoma?

On the other side of the coin, the rapid onset of a hematoma will be classified medically as an acute subdural hematoma. As with all sufferers of blood clots, you could easily be a candidate for emergency surgery as a corrective measure. So it is essential to discuss these issues with your doctor to choose a course of action. These decisions often are life or death.

Feel free to browse our educational brain injury materials.