Everything You & Your Family Need To Know About Your Brain Injury Case

How Can a Brain Injury Attorney Help?

If you have suffered a traumatic brain injury, and you believe that it was caused by someone else’s negligence, then an experienced brain injury attorney is vital.  A brain injury attorney will be able to get you the monetary compensation you need to deal with your injury, from medical care and lost wages to pain and suffering damages.

Experienced brain injury attorneys, like the attorneys at D’Amore Personal Injury Law, know what to look for in a brain injury case.  Your attorney will carefully review the relevant medical records, review the evidence of how the injury was caused, and consult expert medical professionals in their network to understand the science behind your injuries.

Your brain injury attorney’s goal must be to establish the evidence needed to demonstrate that you suffer from a traumatic brain injury and that another person’s negligence was the cause of the injury.

The added value that D’Amore brain injury attorneys bring to your case is a nurturing of the client relationship.  At D’Amore we care deeply about our clients and will do whatever it takes to help. That means following up with you on whether you are receiving the appropriate course of medical treatment.  It means responding quickly to any questions or concerns. And it means being there to provide sound legal advice every step of the way.

Filing a Brain Injury Lawsuit

Filing a brain injury lawsuit begins with retaining the services of a trusted, well-established brain injury attorney.  After the first consultation, the attorney must commence a thorough investigation of your case, which includes a review of all the relevant medical records, factual evidence, and expert medical opinion information.

Once your attorney has gathered all the relevant evidence and can show that the negligent party caused your brain injury, the case can then be brought to court.

What is most important for you to know is that D’Amore Personal Injury Law works only on a contingency fee basis.  That means that you do not pay any fees or costs unless we recover a favorable settlement or verdict for you. Of course, that also means that your first consultation with us is also free.

Accordingly, if you believe that you may have suffered a traumatic brain injury, it is worth it for you to speak with our professionals at D’Amore, at no cost to you, to determine whether you should file a lawsuit.

Our Maryland Brain Injury Attorneys Are Here For You

We at D’Amore Personal Injury Law understand that suffering a traumatic brain injury can put you at the lowest point in your life, physically, mentally, and emotionally.  We know that you are dealing with the stress and anxiety just trying to put your life back together while dealing with the unfamiliar and frightening issues that come with brain injury, like memory loss and depression.

At D’Amore Personal Injury Law, our job is to worry about your legal case so you do not have to.  We will marshal our substantial resources to comprehensively investigate your case, and make sure that we can prove that the negligent party was responsible for your brain injury.  That way, you can focus on healing yourself and being there for your family. We invite you to contact us today at 410-324-2000 to learn about how we can help.

TRAUMATIC BRAIN INJURY (TBI)

Traumatic Brain Injury (TBI) is an alteration in brain function, or other evidence of brain pathology, caused by an external force.

ACQUIRED BRAIN INJURY

Acquired brain injuries are non traumatic. These include stroke, near drowning, hypoxic or anoxic brain injury, tumor, neurotoxins, electric shock or lightning strike.

CONCUSSION

• A concussion is caused when the brain receives trauma from an impact or a sudden momentum or movement change.
• A concussion is the most common type of traumatic brain injury.
• A concussion can be caused by direct blows to the head, gunshot wounds, violent shaking of the head, or force from a whiplash type injury.
• A person may or may not experience a brief loss of consciousness (not exceeding 20 minutes). A person may remain conscious, but feel “dazed” or “punch drunk”.
• A concussion may or may not show up on a diagnostic imaging test, such as a CAT Scan.
• Skull fracture, brain bleeding, or swelling may or may not be present. Therefore, concussion is sometimes defined by exclusion and is considered a complex neurobehavioral syndrome.
• concussion can cause diffuse axonal type injury resulting in permanent or temporary damage.
• It may take a few months to a few years for a concussion to heal.

DIFFUSE AXONAL INJURY

• A Diffuse Axonal Injury is a “shearing” injury to brain tissues and structures.
• It can be caused by shaking or strong rotation of the head, as with Shaken Baby Syndrome, or by rotational forces, such as with a car accident.
• Injury occurs because the unmoving brain lags behind the movement of the skull, causing brain structures to tear.
• The tearing of the nerve tissue disrupts the brain’s regular communication and chemical processes.
• This disturbance in the brain can produce temporary or permanent widespread brain damage, coma, or death.
• A person with a diffuse axonal injury could present a variety of functional impairments depending on where the shearing (tears) occurred in the brain.

CONTUSION

• A contusion can be the result of a direct impact to the head.
• A contusion is a bruise (bleeding) on the brain.
• Large contusions may need to be surgically removed.

COUP-CONTRECOUP INJURY

• Coup-Contrecoup Injury describes contusions that are both at the site of the impact and on the complete opposite side of the brain.
• This occurs when the force impacting the head is not only great enough to cause a contusion at the site of impact, but also is able to move the brain and cause it to slam into the opposite side of the skull, which causes the additional contusion.

SECOND IMPACT SYNDROME “RECURRENT TRAUMATIC BRAIN INJURY”

• Second Impact Syndrome, also termed “recurrent traumatic brain injury,” can occur when a person sustains a second traumatic brain injury before the symptoms of the first traumatic brain injury have healed. The second injury may occur from days to weeks following the first. Loss of consciousness is not required. The second impact is more likely to cause brain swelling and widespread damage.
• Because death can occur rapidly, emergency medical treatment is needed as soon as possible.
• The long-term effects of recurrent brain injury can be muscle spasms, increased muscle tone, rapidly changing emotions, hallucinations, and difficulty thinking and learning.

PENETRATING INJURY

• Penetrating injury to the brain occurs from the impact of a bullet, knife or other sharp object that forces hair, skin, bone and fragments from the object into the brain.
• Objects traveling at a low rate of speed through the skull and brain can ricochet within the skull, which widens the area of damage.
• A “through-and-through” injury occurs if an object enters the skull, goes through the brain, and exits the skull. Through-and-through traumatic brain injuries include the effects of penetration injuries, plus additional shearing, stretching and rupture of brain tissue.
• The devastating traumatic brain injuries caused by bullet wounds result in a 91% firearm-related death rate overall.
• Firearms are the single largest cause of death from traumatic brain injury.

Sources: Brumback R. Oklahoma Notes: Neurology and Clinical Neuroscience. (2nd ed.). New York: Springer; 2006. and Center for Disease Control and Injury Prevention.

SHAKEN BABY SYNDROME

• Shaken Baby Syndrome is a violent criminal act that causes traumatic brain injury. Shaken Baby Syndrome occurs when the perpetrator aggressively shakes a baby or young child. The forceful whiplash-like motion causes the brain to be injured.
• Blood vessels between the brain and skull rupture and bleed.
• The accumulation of blood causes the brain tissue to compress while the injury causes the brain to swell. This damages the brain cells.
• Shaken Baby Syndrome can cause seizures, lifelong disability, coma, and death.
• Irritability, changes in eating patterns, tiredness, difficulty breathing, dilated pupils, seizures, and vomiting are signs of Shaken Baby Syndrome. A baby experiencing such symptoms needs immediate emergency medical attention.

Source: National Center on Shaken Baby Syndrome

LOCKED IN SYNDROME

• Locked in Syndrome is a rare neurological condition in which a person cannot physically move any part of the body except the eyes.
• The person is conscious and able to think.
• Vertical eye movements and eye blinking can be used to communicate with others and operate environmental controls.

ANOXIC BRAIN INJURY

• Anoxic Brain Injury occurs when the brain does not receive oxygen. Cells in the brain need oxygen to survive and function. Types of Anoxic Brain Injury:
  • Anoxic Anoxia – Brain injury from no oxygen supplied to the brain
  • Anemic Anoxia – Brain injury from blood that does not carry enough oxygen
  • Toxic Anoxia – Brain injury from toxins or metabolites that block oxygen in the blood from being used

Source: Zasler, N. Brain Injury Source, Volume 3, Issue 3, Ask the Doctor

HYPOXIC BRAIN INJURY

• Hypoxic Brain Injury results when the brain receives some, but not enough, oxygen. A Hypoxic Ischemic Brain Injury, also called Stagnant Hypoxia or Ischemic Insult, occurs because of a critical reduction in blood flow or low blood pressure leading to a lack of blood flow to the brain.

Source: Zasler, N. Brain Injury Source, Volume 3, Issue 3, Ask the Doctor Column

OPEN HEAD INJURY

The following are terms used to describe types of skull fractures that can occur with open head injuries:

• Depressed Skull Fracture – The broken piece of skull bone moves in towards the brain.
• Compound Skull Fracture – The scalp is cut and the skull is fractured.
• Basilar Skull Fracture:
  • The skull fracture is located at the base of the skull (neck area) and may include the opening at the base of the skull.
  • Can cause damage to the nerves and blood vessels that pass through the opening at the base of the skull.

• Battle’s Sign
  • The skull fracture is located at the ear’s petrous bone.
  • This produces large “black and blue mark” looking areas below the ear, on the jaw and neck.
  • It may include damage to the nerve for hearing.
  • Blood or cerebral spinal fluid may leak out of the ear. This is termed “CSF Oterrhea.”

• Racoon Eyes
  • The skull fracture is located in the anterior cranial fossa.
  • This produces “black and blue” mark looking areas around the eyes.
  • Cerebral spinal fluid may leak into the sinuses. This is termed “CSF Rhinorrhea.”
  • Nerve damage for the sense of smell or eye functions may occur.

• Diastatic Skull Fracture
  • The skull of infants and children are not completely solid until they grow older.
  • The skull is composed of jigsaw-like segments (cranial fissures) which are connected together by cranial sutures.
  • Skull fractures that separate the cranial sutures in children prior to the closing of the cranial fissures are termed “diastatic skull fractures.”

• Cribiform Plate Fracture
  • The cribiform plate is a thin structure located behind the nose area.
  • If the cribiform plate is fractured, cerebral spinal fluid can leak from the brain area out the nose

CLOSED HEAD INJURY

When a person receives an impact to the head from an outside force, but the skull does not fracture or displace this condition is termed a “closed head injury”. Again, separate terminology is added to describe the brain injury. For example, a person may have a closed head injury with a severe traumatic brain injury.

• With a closed head injury, when the brain swells, the brain has no place to expand. This can cause an increase in intracranial pressure, which is the pressure within the skull.
• If the brain swells and has no place to expand, this can cause brain tissues to compress, causing further injury.
• As the brain swells, it may expand through any available opening in the skull, including the eye sockets.When the brain expands through the eye sockets, it can compress and impair the functions of the eye nerves. For instance, if an eye nerve, Cranial Nerve III, is compressed, a person’s pupil (the dark center part of the eye) will appear dilated (big). This is one reason why medical personal may monitor a person’s pupil size and intracranial pressure.

Outcomes After Brain Injury

Brain injury can result in a range of outcomes:

• 52,000 die;
• 280,000 are hospitalized; and
• 2.2 million are treated and released from an emergency department.

Among children ages 0 to 14 years, TBI results in an estimated

• 2,685 deaths;
• 37,000 hospitalizations; and
• 435,000 emergency department visits.

The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.

Source: Centers for Disease Control and Injury Prevention

Severity of Brain Injury

Emergency personnel typically determine the severity of a brain injury by using an assessment called the Glasgow Coma Scale (GCS). The terms Mild Brain Injury, Moderate Brain Injury, and Severe Brain Injury are used to describe the level of initial injury in relation to the neurological severity caused to the brain. There may be no correlation between the initial Glasgow Coma Scale score and the initial level of brain injury and a person’s short or long term recovery, or functional abilities. Keep in mind that there is nothing “Mild” about a brain injury—the term “Mild” Brain injury is used to describe a level of neurological injury. Any injury to the brain is a real and serious medical condition. There is additional information about mild brain injury on our mild brain injury page.

Glasgow Coma Scale (GCS)

The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person). A GCS score of 13-15 is considered a “mild” injury; a score of 9-12 is considered a moderate injury; and 8 or below is considered a severe brain injury.

Mild Traumatic Brain Injury (GCS of 13-15)

Some symptoms of mild TBI include:

• Headache
• Fatigue
• Sleep disturbance
• Irritability
• Sensitivity to noise or light
• Balance problems
• Decreased concentration and attention span
• Decreased speed of thinking
• Memory problems
• Nausea
• Depression and anxiety
• Emotional mood swings

This information is not intended to be a substitute for medical advice or examination. A person with a suspected brain injury should contact a physician immediately, go to the emergency room, or call 911 in the case of an emergency. Symptoms of mild TBI can be temporary. The majority of people with mild TBI recover, though the timetable for recovery can vary significantly from person to person.

Moderate Brain Injury (GCS of 8-12)

A moderate TBI occurs when there is a loss of consciousness that lasts from a few minutes to a few hours, when confusion lasts from days to weeks, or when physical, cognitive, and/or behavioral impairments last for months or are permanent. Persons with moderate TBI generally can make a good recovery with treatment and successfully learn to compensate for their deficits.

Source: Defense and Veterans Head Injury Program & Brain Injury Association. Brain Injury and You. 1996.

Severe Brain Injury (GCS Below 8)

Severe brain injury occurs when a prolonged unconscious state or coma lasts days, weeks, or months. Severe brain injury is further categorized into subgroups with separate features:

• Coma
• Vegetative State
• Persistent Vegetative State
• Minimally Responsive State
• Akinetic Mutism
• Locked-in Syndrome

Tips to Aid Recovery

• Get lots of rest. Don’t rush back to daily activities such as work or school.
• Avoid doing anything that could cause another blow or jolt to the head.
• Ask your doctor when it’s safe to drive a car, ride a bike, or use heavy equipment, because your ability to react may be slower after a brain injury.
• Take only the medications your doctor has approved, and don’t drink alcohol until your doctor says it’s OK.
• Write things down if you have a hard time remembering.
• You may need help to re-learn skills that were lost. Contact the Brain Injury Association in your state to learn more about the programs, supports and services available to people with brain injury and their families.

Help is Available

If you or a family member are struggling with the effects of a brain injury, here are some useful first steps:

• Contact your State Brain Injury Association. The Brain Injury Association of America (BIAA) is the country’s oldest and largest nationwide brain injury advocacy organization. The Brain Injury Association state offices will have information about Programs, support groups, and resources that could be helpful to you. They understand brain injury, and understand the resources available. Use that resource!
• Contact an experienced brain injury attorney. Most experienced brain injury lawyers work on a contingent fee basis. That means there is no cost to you to have your case investigated.
• Understand that recovery after a brain injury is a journey. You do not have to go it alone. An experienced brain injury lawyer can assist you with acquiring services and finding programs to help with your recovery.

How We Can Help You

People with brain and spinal cord injuries face lifelong medical care and assistive services. In addition to the emotional stress this will place on you and your family, the cost of these services will be enormous. Even when financial assistance is available through insurance or Medicaid, coordinating care appointments, and ensuring the necessary and proper services can become a full- time, frustrating and emotionally draining task.

As experienced brain and spinal cord injury lawyers, can help. In addition to investigating your case, we can put you in touch with professionals who can assist with understanding your condition, and help obtain the services you need to get better. We can also to help find programs that can help you. For example, one group that we work with, Maryland Therapeutic Riding, uses horses to help disabled people build core strength while creating a positive emotional bonding experience.

Are Brain and Spinal Cord Injuries Common?

The Centers for Disease Control estimates that more than 1.7million traumatic brain injuries occur each year in the United States. It is a major cause of death, especially among young adults, and lifelong disability is common in those who survive. It is estimated that in the USA, around 5.3 million people are living with a brain injury-related disability. Brain injury commonly leads to impaired attention, inability to form visuospatial associations and poor executive function. Up 70% of brain injury survivors develop depression. Many survivors also exhibit increased impulsivity, poor decision-making, and impulsive–aggressive behavior. Such impairments in self-regulatory behaviors can affect interpersonal relationships and contribute to the poor community, social and vocational integration, and may lead to long-term placement in an institutional setting. In the United States, monitoring of brain injury causes is conducted by the Centers for Disease Control and Prevention.

The annual incidence of spinal cord injury (SCI) in the United States is approximately 17,000 new cases each year. The number of people in the U.S. living with a spinal cord injury is estimated to be almost 300,000. The average age at injury has increased from 29 years during the 1970s to 42 years currently. Males account for approximately 80% of new SCI cases.

Vehicle crashes are currently the leading cause of injury, followed by falls, acts of violence (primarily gunshot wounds), and sports/recreation activities. Medical and surgical errors are also known causes of spinal cord injuries.

Incomplete tetraplegia (four affected limbs) is currently the most frequent neurological category. Incomplete paraplegia (two affected limbs), complete paraplegia, and complete tetraplegia follow respectively.

What causes brain injuries?

Brain injuries are caused by concussions and other traumatic head forces that cause damage to the brain (e.g., car crash, gunshot wound to the head, assaults, falls). Brain injuries can also be caused by subconcussive head impacts or hits to the head that don’t cause full-blown concussions. Furthermore, brain injuries can be caused by other health issues like strokes, bleeding in the brain, lack of oxygen to the brain, brain infections, fluid buildup in the brain, toxic exposure and poisoning, and brain tumors.

Can brain injuries cause mental illness?

Yes, brain injury can cause mental illness, depending on the area(s) of the brain injured. Some injuries (e.g., a gunshot) are confined to a focal area whereas in other injuries (e.g., excessive shaking), the damage to the brain diffuses throughout the brain. Research has found that those with TBI are more likely to develop schizophrenia, depression, and bipolar disorder.

Are TBIs permanent?

TBIs can result in permanent brain damage as a full recovery is not guaranteed and largely depends on the severity of the brain injury, the nature of the injury, and the treatment received among other factors. Mild TBIs are defined as loss of consciousness and/or confusion and disorientation for less than 30 minutes while severe TBIs are defined as loss of consciousness for more than 30 minutes and memory loss after the injury or penetrating skull injury for longer than 24 hours. Some TBIs may not be permanent but they may be long lasting.

How are TBIs diagnosed?

• Mild TBIs may not be diagnosed until a person begins to struggle with tasks or social interactions previously done without problems.
• Doctors may assess the initial severity of the brain injury by using the Glasgow Coma Scale: higher the score, the less severe the injury.
• CAT scan, MRI, SPECT, and/or PET scan may be performed to bring out evidence and location of brain injury.
• Neuropsychologist may perform a cognitive evaluation with formal neuropsychological testing.
• Evaluations by physical, occupational, and speech therapists may be done to determine specific deficits of an individual.

What are the long term effects of a TBI?

The long term effects of TBI are physical, behavioral, mood, and cognitive impairments, including headaches, aggression, irritability, anxiety, depression, rapid mood changes, impulse control problems, suicidal thoughts, paranoia, confusion, impaired judgment, memory loss, dementia, and eventually an early death.

Difference Between a TBI and a Concussion

• All concussions are TBIs but not all TBIs are concussions.
• TBIs can be moderate or severe. A concussion is a mild or moderate TBI.
• TBIS are divided into two categories: open and closed. Open head injuries are when the skull is broken or removed, allowing an outside force to act directly on the brain. Closed head injuries happen through an intact skull where the external force never comes into direct contact with brain matter.
• Concussion is the most well known type of closed brain injury. Concussions do not result in immediate danger of death but can have nasty long lasting effects. Concussions are usually difficult to diagnose.
• Severe TBIs can be life endangering and can lead to a coma. Severe TBIs can also result in long-term disabilities and permanent brain damages.

What is a CTE brain injury?

A chronic traumatic encephalopathy (CTE) brain injury is a progressive degenerative disease that afflicts the brain of people who have suffered repeated concussions or other traumatic brain injuries, e.g., athletes and military service members that have impacted the cranium over a period of years or decades. The brain gradually deteriorates and loses mass over time. A protein called Tau forms clumps that slowly spread throughout the brain, killing brain cells. Symptoms may not appear until years after the onset of head impacts. Symptoms may include aggression, depression, paranoia, and impulse control problems. As the disease progresses, some experience problems with thinking and memory, such as confusion, impaired judgment, memory loss, and dementia.

What is Acquired Brain Injury?

Acquired Brain Injury is “damage to the brain, which occurs after birth and is not related to a congenital or degenerative disease. These impairments may be temporary or permanent and cause partial or functional disability or psychosocial maladjustment” (World Health Organization, 1996).

How to Deal with the Brain Injury of a Spouse

1. Participate in family counseling with a counselor who specializes in traumatic brain injuries. The counseling will help each family member to identify behaviors that contribute or exacerbate the problem behaviors of your injured spouse, learn new strategies for your spouse and your family to use when your spouse experiences volatile emotions and anger, and practice those strategies repeatedly until they become second nature to your family.
2. Create a safety plan for when your spouse’s behaviors or emotions become dangerous. The plan should include a safe place for each family member to go when your spouse’s anger gets out of control.

Chances of Recovery from Brain Damage

• Every person and every brain injury is unique. Generally speaking, the more severe the brain damage, the less likely the person will fully recover. Some of the factors that affect recovery are: severity of injury, part of brain damaged, patient’s personality and attitude toward recovery, participation in official and unofficial rehab programs, and support from patient’s family and friends.
• Brain has a limited ability to heal itself by repairing or growing new brain cells after injury. Most of the recovery is the brain rewiring itself and finding other pathways to bypass the broken channels.

Who receives money after a successful brain or spinal cord injury lawsuit?

In brain and spinal cord injury cases, much of the money will be for the person who has suffered the injury. While family members often suffer right along with their injured loved one, the law does not usually allow them to be financially compensated. If the injured person is a child, or not mentally capable of handling their own affairs, the law requires the money be placed in a protected trust and only used for the injured person’s direct benefit.

This can be difficult for many parents and family members to accept. We often hear things like “why would anyone think I would steal from my baby?” Or, “I have other children and family members who have been impacted by the added time and money it has cost to care for our injured loved one. Why can’t we use the money to help our whole family?”

These are legitimate and totally understandable questions. Dealing with these issues is never easy. That is why we continue to work with our clients even after the case is successfully resolved. We work with trust managers, trust lawyers, and asset managers who are experts in this area of law, and who understand that our clients need to be cared for as a family unit. While each case is different, our goals are always the same: (1) ensure that the injured victim will be able to afford the care and services he/she will need in the future; (2) ensure the injured victim will be safe and secure even after his/her family can no longer care for him/her; (3) ensure that the family is satisfied with the plan that has been put into place.

Do I have a case?

The answer to this question is rarely easy. The first step is contacting us to discuss the facts and circumstances of your injury. We never charge a fee for this discussion. In fact, we don’t charge our clients any fees unless we are able to secure a recovery for them.

How much will it cost to file a brain or spinal cord injury case?

Nothing. There is no cost to you unless we win. If the case is successfully resolved, the costs of the lawsuit are repaid from the recovery.