The A To Z Basics Of Proving Closed Head Injury

These are some of our toughest cases to convince insurance companies and juries to accept. The problem in the past has been that these cases turn on the believability of the plaintiff, their families and their co-workers. Anyone handling such claims must first start by referring to the injury as a Traumatic Brain Injury (TBI) with all parties concerned, including the expert witnesses.

To effectively work these cases, one must understand the new diagnostics available and how they coincide with the Client’s complaints. To do this, you must have your radiologist (nuclear or neuro) talking and working hand in hand with your clinical expert. Clinical experts should be a neurologist, neuropsychiatrist, psychiatrist or psychologist. Some of the modern diagnostic tools we have used in our TBI case include SPECT (single photon emission tomography) scans and PET (positron emission tomography) scans.

Finding a radiologist who understands the injuries and can diagnose coup contrecoup (CCC) and brain shear is critical. CCC is when the brain moves forward to back or side to side, suddenly and forcefully, damaging two sides of the brain. Brain shear is the movement of the brain’s grey matter over from the white matter due to centrifugal force. When this happens, the delicate blood supply and neuron connections are severed.

During your trial, when using PET or SPECT scanning, you must have your radiologist review how both diagnostic studies are used, not only for TBI, but also for other problems or diseases unrelated to trauma, for example, heart disease. Your radiologist must get down from the witness stand and show and explain your client’s diagnostic study and compare it to a normal PET or SPECT scan, in front of the jury. Lastly, go into great detail as to either or both tests being recognized as authoritative by the American Radiology Association.

Please be aware that the technology for diagnosing TBI is advancing daily. Some of the best diagnostic studies involve MRI (magnetic resonance imaging). Three and seven tesla MRI magnets show much improved imaging for detecting micro hemorrhages or other subtle injuries to the brain. You must talk to your radiologist about focal (contusions and hematomas) versus diffuse (diffuse axonal injury and diffuse microvascular damage) injuries. There are several different MRI tests that can be used to better detect TBIs. The first is SWI (susceptibility weighted imaging). SWI is sensitive to iron, so it is a great tool to reveal even the smallest hemorrhages. fMRI (functional magnetic resonance imaging) can also be used to reveal hemorrhages. Another excellent study, used to detect ischemia, is DWI (diffusion weighted imaging) that measures ADC (apparent diffusion coefficient). DTI (diffusion tensor imaging) is used to detect and reveal axon injuries. Last, MR Spectroscopy is used to detect altered biochemistry in the brain. Going into the exact science behind these diagnostic studies goes beyond the scope of this article, but they must be discussed, prior to any testing, with your radiology expert. As you can see, TBIs are now easier to detect and prove with modern technological advances in diagnostic studies.

Please keep in mind that TBI cases are some of our toughest cases to prove. You should understand that time consuming efforts by the attorney, on behalf of the client, is required in every one of these cases. The attorney must be interactive in correlating the diagnostic imaging findings with the clinical findings. Therefore, a meeting or phone conference among the attorney, clinical physician (neurologist, psychiatrist, neuropsychiatrist, and or neuropsychologist), and the radiology expert (nuclear or neuro) at every phase of the workup of the case is necessary. Finally, your experts need to be able to discuss the long term development and effect on the brain from a TBI. You should have your experts discuss and show diagnostic findings of patients many years after suffering a similar head injury. Also, have your experts talk about beta alkaloids that begin to form on and in the brain as the body’s response to the injury to the brain. Beta alkaloids are often found in the brains of patients with Alzheimer’s disease.  Excellent research and expert opinion testimony is being developed by the attorney pursuing claims on behalf of the NFL Football Players.  The experts and research used by these attorneys are helping all of us in our representation of TBI victims.  Please do not hesitate to contact us with any questions about your TBI cases.


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