Posted by Bernard Walsh on 06/21/2016

Bernard Walsh On Closed Head Injury Cases - TBI

Closed Head Injury Or Traumatic Brain Injury Cases Are some of the toughest cases for an personal injury lawyer to prove. Attorney Bernard F. Walsh outlines the essentials every attorney considering representing a client for a TBI or closed head injury law suit.

Hi. I'm Bernie Walsh of the law firm of Shapiro, Goldman, Babboni, and Walsh. As an attorney here, I have to present closed head injuries on a regular basis. Today's topic that I've been asked to talk about is closed head injuries.

Distinguish the closed head injury from an open skull injury. They're two different types of injuries and must be approached differently. These are some of the toughest cases to prove. They require a lot of time, and they require a lot of knowledge on everyone's part -- not only your experts, but yourself as an attorney.

Let's start with how we term "closed head injury." I never use that term. I always call it "traumatic brain injury," or TBI, traumatic brain injury. I use that term with all my witnesses, the lay witnesses. There was the family, coworkers, and the experts that I called.

Experts. Who do you have to have to start building a case on traumatic brain injury? You need a radiologist, either a nuclear or a neuro radiologist, or a combination of both. That expert or experts in radiology must be prepared to work with your clinician, which is the medical doctor or the physician or expert who is treating your client's traumatic brain injury. The interaction between those two experts, the radiologist and the clinician, is critical.

Let's get into what is a clinician or a clinical expert. It can be a neurologist, it can be a neuropsychiatrist, it can be a neuropsychologist, it can be a psychologist, or it can be a psychiatrist who is rendering the care for the traumatic brain injury to your client.

How do you gain the knowledge to present one of these cases? You do what attorneys have done for a very long period of time. You keep asking questions so that you gain the knowledge to present your case on behalf of your client.

What do you have to understand? You have to understand diagnostic testing of the brain in traumatic brain injury type cases. Let's start with some of them.

SPECT, SPECT scanning. This stands for "Single Photon Emission Computed Tomography." This is a type of testing that can give you insight into microinjuries to the brain that are common in TBI, traumatic brain injury.

PET scan, which is "Positron Emission Tomography," same type of approach that we're using on a SPECT scan. It happens to be a little different in how the scan is performed and how the changes in the brain are modified to look for the microdamages.

Magnetic Resonance Imaging, which everybody refers to as MRI. If you think getting an MRI of the brain is going to put you in a position to present your claim on behalf of your traumatically brain injured client, you're making a mistake. You must understand MRI technology as it is in today's world.

What type of MRI do you use? There is a minimum of a 3-Tesla MRI, and if you have the ability to get your client to a 7-Tesla MRI magnet, these will show the microinjuries and microhemorrhaging much better. There is SWI, a type of MRI: Susceptibility Weighted Imaging. Again, always looking for a study that shows the damage to the brain, even if it's small microdamage to the axons or microhemorrhaging. These are the MRI techniques you have to talk about with your radiologist. fMRI: Functional Magnetic Resonance Imaging. Again, looking for the same type of microdamage. DWI: Diffusion Weighted Imaging. Great studies, again, all looking for this microdamage to the brain to establish your traumatic brain injury case. DTI: Diffusion Tensor Imaging. Again, always looking for the small microdamage to the brain. You must discuss all these with your radiologist and determine where the studies can be done and how best to do them.

To do that, you have to understand other brain injury terminology. There's a French term, "coup contrecoup." What does this mean? It means damage to both sides of the brain, whether it be front and back, side and side, from the head being pushed at a speed from a trauma, like an accident, so that the brain injures itself on both sides. Coup contrecoup. You must talk to your clinician and your radiologist about findings consistent or inconsistent with coup contrecoup.

Brain shear: another terminology in terms of traumatic brain injury you must understand. The brain is made up of gray matter and white matter. They rest on top of each other. In a traumatic event like an auto accident, these two parts of the brain, which have different densities, can move across one another. If they do that, then they damage the micro blood vessels of the brain, they damage the axon endings. In other words, the small neurons of the brain can be damaged or severed when the brain moves white matter over gray matter apart from themselves. You've got to look for these connections to see if they've been disrupted by brain shear, and of course, you have to discuss this with not only your clinician expert but your diagnostic radiology expert.

How do you summarize what you have to do on these cases? It's very simple to summarize, not so simple to do. The key is time investment. You must spend time with all your experts, you must have them communicate with one another. You must become very proficient at understanding the diagnostic testing and how it affects your presentation of your claim, and you have to involve the family and coworkers and friends of your client so that they can put a day to day reality on traumatic brain injury. If you can do this, you're ready to go on these cases.

Thank you.

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