Some technical points about head injuries
Types and severity of head injury
What is head or brain injury?
Traumatic brain injury, or TBI in medical-speak, is an injury to the brain caused by any kind of external force to the head or complication arising from that force. Common causes of TBI are traffic accidents; head impacts from falls or other incidents at work or in public places; criminal assault.
It is distinct from other causes of brain injury, such as stroke; genetically-linked illness such as inherited epilepsy; or damage caused by oxygen depletion, eg. in the course of medical procedures.
The 'three layer chain' of brain injury
Every traumatic brain injury starts with some kind of outside force, but includes complications that can flow from that initial cause, such as pressure or swelling in the brain, or oxygen starvation. There are typically three layers to every brain injury:-
- The “first” injury- covers the initial trauma and its immediate effects in the next few seconds afterwards. There are three types of “first” injury- (a) closed head injuries (the most common, where the brain is subject to rapid acceleration or deceleration, damaging it against the skull- traffic accidents or head impacts, for example); (b) open or penetrating head injuries (where the skull is broken and the brain exposed and damaged- penetrating wounds caused by impact with sharp objects, for example); (c) crush injuries (the least common, but often result in damage to the brain stem and nervous system and can be very severe).
- The “second” injury- covers the developing injuries and consequences within the brain which follow in the minutes or hours after the initial trauma, when the oxygen supply to the brain may be reduced. If the victim’s airway has been obstructed, or if there is serious bleeding from other injuries, the blood flow and oxygen supply to the brain can be reduced, which can worsen the effects of the first injury. How long this period is and how much damage occurs can be dramatically influenced by how quickly medical help is given and how specialised that help is;
- The “third” injury- can occur at any time after the first and second injuries, in days or even weeks that follow, and often is the result of slower, longer-term damage resulting from the overall injury, such as blood clots, leaking fluid within the brain, swelling of the brain causing pressure damage or reduced oxygen supply.
Different severities of brain injury- minor, moderate, severe
Whether or not the victim was unconscious, there is always a period after any TBI where the person seems confused and disorientated, even if they are aware of things around them. They may not be able to speak sensibly, or remember normal things or facts, or they may say or do bizarre things. This period is called “post-traumatic amnesia” (PTA). Along with any actual loss of consciousness, it is a vital indicator of the likely severity of the initial injury.
This is a very rough guide to assessing that severity:-
- Minor brain injury- unconscious for less than 15 mins or not at all; less than 1 hour of PTA
- Moderate brain injury- unconscious 15 mins- 6 hours; 1-24 hours PTA
- Severe brain injury- 6-48 hours unconscious; 24 hours- 7 days PTA
- Very severe brain injury- more than 48 hours unconscious; more than 7 days PTA
Minor head injury and concussion is one of the most common of brain injuries. It can leave the victim feeling sick, dizzy, tired, unable to tolerate light/noise and can lead to anxiety or clinical depression. It is most important that the victim and those around him keep a careful watch during the next 48 hours for any signs of more serious underlying injury, such as vision disturbance, inability to stay awake, slurred speech, weakness in limbs or on one side of the body or face. If any of these are noticed, then dial 999 for an ambulance immediately and explain there has been a head injury.
The effects of traumatic brain injury
Some effects of brain damage may be immediate and obvious. Any impact of the brain upon the skull beyond a certain level will produce unconsciousness, which may be only a matter of seconds or much longer. At its most extreme, damage to the deep central areas of the brain can result in coma.
Damage to certain parts of the brain may result in difficulty in certain parts of the body functioning, or weakness in limbs. Damage to the brain stem will often result in speech and language impairment. Damage to the occiput (at the back of the head) can cause vision damage or blindness.
Even apparently minor head injury can cause “hidden” brain damage, resulting in changes to the victim’s personality, ability to think, to rationalise, to express themselves, and to their memory. Such damage is often only measurable after specialist testing and may not be obvious to the victim or those around him.
With even moderate head injuries, there can be an increased risk of developing epilepsy. This is particularly true of open or penetrating head injuries. Epilepsy can cause devastating changes in the victim’s life, even if there has been a very good recovery from the other consequences of head injury and is reflected in the likely size of compensation in such cases.
Care and rehabilitation after brain injury
Remarkable results can be achieved nowadays with helping brain injury victims regain their abilities, even in more serious cases. Specialist therapists all aim to help the victim regain his abilities, self-sufficiency and self- respect. Medical knowledge about the brain and its processes is growing all the time and injuries which even 25 years ago would have severely limited the victim for life may now be overcome with the help of alternative coping strategies and re-learning techniques.
Slee Blackwell has the knowledge and experience to liaise with suitable experts and help to ensure that the best rehabilitation is obtained for the injured client.
Brain injury and Medical Negligence
Most commonly, brain injury resulting from medical negligence is caused at, or around the time of birth, in some cases only minutes before a baby is born. This usually happens when the baby is deprived of oxygen and can suffer irreversible damage to the brain. Cerebral palsy can also be the result of poor medical care immediately after the birth if, for example, an infection is not picked up or a congenital abnormality is not recognised, such as a heart defect.
These cases can sometimes take time to reach a settlement, but our team of lawyers will ensure that if an early admission of fault is made then an interim payment will be obtained to provide the additional assistance you may need.
These cases are often complex and it is important that you instruct a lawyer who is familiar with this area of law and has a proven track record of success. Birth injury is a specialism in itself and our team has extensive knowledge in this area of medical negligence law.
Legal help in brain injury cases
In the immediate aftermath of a significant head injury, neither the victim nor his/her family will have time to think about the legal consequences. It is only human nature to worry about survival and recovery before all else. But when the dust has settled a bit, the real worries may strike home:-
- How can we cope when mum or dad comes home from hospital?
- How will the family manage financially if they cannot work?
- Will we lose our home?
- Who is going to look after the children?
- How long will it be before they fully recover?
- Will they ever be the same and what if they aren’t?
- Who can I turn to for financial help, for help with care, with alterations and equipment, about work, about the medical issues so that I can understand?
- Is there even a claim for compensation at all?
This turmoil can be overwhelming, so it is vital that you get the right help and advice from the word go. As specialist head injury solicitors, we cannot turn back the clock, but we can put you in touch with people who can help you with the everyday practicalities and worries.
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