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WHEN IS A BUMP ON THE HEAD MORE THAN JUST A "BUMP" ON THE HEAD?

By David Wood, Esq.

Closed-head brain injuries are potentially very devastating injuries. Yet, they are frequently misunderstood by the victims of such injuries. The families of these victims often observe the symptoms of such injuries, yet do not realize that the victim is actually demonstrating classical symptoms of a closed-head brain injury.

Worse yet, in spite of efforts by the victim's attorney and expert witnesses, closed-head brain injuries are more often than not misunderstood by jurors sitting on cases involving these injuries. This frequently is a product of the use of the term "mild traumatic brain injury" to describe such a condition. "Mild" in this context is a comparative term as opposed to a "serious" traumatic brain injury which invariably involves an actual cracking or physical insult to the skull itself. Nevertheless, jurors and insurance companies often improperly rely on the word "mild" to denigrate the seriousness of the injury.

Many times the symptoms of a closed-head brain injury do not appear until sometime after the initial injury and, thus, the "bump on the head" that was not considered to be serious at first, in fact, can be a serious and life changing injury

A "closed-head brain injury" occurs when the brain, being encased in the skull and basically "floating" in fluid is severely jolted from rapid movement of the skull. This can occur from the most obvious source - a traumatic blow to the head, or it can occur from a more subtle source - a whip-lash movement of the skull causing the head to go backwards and then forwards in quick succession.

In closed head brain injury cases, brain damage typically occurs in two stages. First, the brain inside the skull is impacted on the inside of the skull where the original trauma takes place. It is then thrown against the inside of the skull on the opposite side of the skull from which the original trauma took place - literally bouncing back and forth inside the skull. Frequently, depending on the source of the original trauma, the brain can suffer a rotational motion from the trauma. This is the primary injury that results at the time of impact.

The secondary injury occurs and develops later and gives rise to physiological and psychological symptoms from the effects that the primary injury has set in motion. In other words - the bump on the head, or the headache you get after the bump, may only be the beginning of the problems.

Symptoms observed as the result of a "closed-head brain injury" usually fall into three categories. Not every case will include all of these symptoms.

First, there are the "behavioral symptoms." These include personality changes exhibiting irritability, anxiety, depression, fatigue, emotional lability, and social isolation.

Next, there are the "physical (somatic) symptoms." These include headaches, dizziness or vertigo, fatigue, sleep disturbances or problems, sensitivity to light or noise, and nausea.

And, finally, there are the "cognitive (thought) symptoms." These include, memory problems, attention problems, concentration problems, slowing of information processing, and decision making (executive) functions.

Many times the victims themselves are not aware that they are demonstrating these symptoms. This is especially true with the behavioral or cognitive symptoms. The most valuable, and often the most reliable witnesses to the existence of the injury are family members, friends, employers, and co-workers. They are able to describe what the victim does not realize exists. An underlying realization that something is wrong, that something is different, may be held by the victim, but because of the injury itself they are not capable of describing or comprehending what is wrong and what has changed.

One of the main problems with obtaining adequate compensation for these types of injuries usually lies with the physical appearance of the victim. These injuries are subtle and are not manifested for the world to see at a quick glance. Different from a broken leg or a cracked skull, just looking at the victim in a courtroom does not necessarily demonstrate the injury. The victim often appears to be perfectly normal and without distress. Thus, skeptical jurors often send such victims of closed-head brain injuries away with no compensation for their injuries. Insurance companies, are well aware of this fact. Thus, getting a settlement before a trial for a closed-head brain injury is a very difficult proposition.

Even a skilled and experienced lawyer who has utilized the best expert witnesses to document his client's injury will have trouble with this type of case. The experts utilized will invariably include a neurologist, a neuro-psychiatrist, and a neuro-psychologist. The neurologist frequently will not be able to contribute anything objective since signs of this injury more often than not will show nothing out of the ordinary on an MRI, a CAT Scan, or an EEG. But, the neurologist's testimony is necessary to describe the physiological nature of the injury. The neuro-psychiatrist will be a valuable witness to establish the existence of the injury and the future treatment that will be required. The neuropsychiatrist usually will rely heavily on the neuropsychological testing administered and evaluated by the neuropsychologist.

                                         Last modified: June 9, 2005     

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