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Early Identification of Traumatic Brain Injuries (TBIs) and Maximizing The Value of

Your TBI Case

Bethany L. SchneiderSchneider Injury Law

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What Is A Traumatic Brain Injury (TBI)?

•Umbrella term for trauma to the brain

•Can range from mild (e.g. concussion) to severe (e.g. skull fracture)

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What Causes a TBI?

•Any force applied to the brain• Car wreck – whiplash or head

impact

• Fall – striking head

• Struck by object

• Gunshot

• Shock wave

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Concussion (Mild TBI)

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Criteria For Mild TBIThe American Congress of Rehabilitation Medicine defines a mild traumatic brain injury as a patient “who has had a traumatically induced physiological disruption of brain function, as manifested by at least one of the following:• any period of loss of consciousness;• any loss of memory for events immediately before or after the accident;• any alteration in mental state at the time of the accident (e.g., feeling dazed,

disoriented, or confused); and• focal neurological deficit(s) that may or may not be transientBut where the severity of the injury does not exceed the following:• loss of consciousness approximately 30 minutes or less;• after 30 minutes, an initial Glasgow Coma Scale (GCS) of 13-15; and• post-traumatic amnesia (PTA) not greater than 24 hours.”

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Screen Every MVA For Potential TBI

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Findings On the Day of Wreck Do NOT Rule Out TBI• Loss of consciousness not required – alteration of consciousness

meets criteria (90%+ do not lose consciousness)

• Glasgow Coma Scale = 15 (normal) is consistent with mild TBI

• CT scan cannot detect mild TBI

• No head pain at the ER does not rule out mild TBI

• Normal neurological exam at the ER does not rule out mild TBI

Most ERs Miss Concussions

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Post-Concussion Syndrome (PCS)

•Constellation of symptoms

•Continuing symptoms past 6 weeks

•After 1 year = more likely than not permanent

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Axon Shear (Post-concussion Syndrome)

Normal Axon Shearing of the Axon Post-trauma Condition

Nucleus in cell body

Dendrites

Cell body

Axon

Neuroglial cells

A. Trauma causes the axon to twist and tear.

B. The result is permanent death of the brain cell.

Myelin sheath

Nissl bodies

Axon terminal

© 2014. NUCLEUS MEDICAL MEDIA. ALL RIGHTS RESERVED.

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Symptoms of PCS

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Treaters for TBIs

•Neurologists

•Neurosurgeons

•Neuropsychologists

•Neuroradiologists

•Concussion centers

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Brain Imaging to Identify TBIs

•MRIs

•DTIs

•MRIs with NeuroQuant

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Anatomy and Functional Areas of the BrainFrontal lobe

Cerebral cortex

Lateral View Sagittal View

Superior View Inferior View

Parietal lobe

Occipital lobe

Temporal lobe

Brain stem Cerebellum

Functional Areas ofthe Cerebral CortexVisual Area: Sight Image recognition Image perception

Association Area Short-term memory Equilibrium Emotion

Motor Function Area Initiation of voluntary muscles

Broca’s Area Muscles of speech

Auditory Area Hearing

Emotional Area Pain Hunger “Fight or flight” response

Sensory Association Area

Olfactory Area Smelling

Sensory Area Sensation from muscles and skin Somatosensory Association Area Evaluation of weight, texture, temperature, etc. for object recognition

Wernicke’s Area Written and spoken language comprehension

Motor Function Area Eye movement and orientation

Higher Mental Functions Concentration Planning Judgment Emotional expression Creativity Inhibition

Functional Areas ofthe CerebellumMotor Functions Coordination of movement Balance and equilibrium Posture

Cerebellum

Brain stem

Pituitary gland

CerebellumBrain stem Occipital lobe

Temporal lobe

Parietal lobe

Frontal lobe

Respiratory centers

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© 2014. NUCLEUS MEDICAL MEDIA. ALL RIGHTS RESERVED.

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Other Testing for mTBIs

•Vestibular testing

•Neuropsychological testing

•Depression screening

•New blood tests

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Treatments for mTBIs

• Migraine medications

• Epilepsy medications

• Occipital nerve block

• Vestibular rehab

• Cognitive rehab

• Anti-depressants

• Sleep aids

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Demand Letters for mTBIs• Emphasize diagnoses of concussion and post-concussion

syndrome

• Highlight TBI symptoms

• Present medical evidence of permanency

• Repeat “traumatic brain injury”

• Include other TBI verdicts

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Demand Letters for mTBIs

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Demand Letters for mTBIs

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Long-Term Effects of mTBI

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Max’s Family’s & Friends’ Observations• Immediate personality changes

• Mood swings

• Doesn’t enjoy life

• Cannot help with Haitian festivals

• Always tired

• Very forgetful

• Repeats things – gets frustrated

• Loss of sense of security

• Loss of sense of self

• Very absent

• Withdrawn

• Can’t listen to music

• Can’t exercise

• Little things set him off

• Anxiety

• Wants to stay inside

• Low energy

• There are moments he blanks

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Questions?Bethany L. SchneiderSchneider Injury Law

Bethany@SchneiderInjuryAttorney.com

(404) 800-3060

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