Articles Posted in Brain Trauma

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After the child expired, a CAT scan and retina exam was conducted on the child and the doctors concluded that the bleeding in the brain had resulted in the presence of bruises in the child’s brain. The doctors wrote their opinions on the child’s medical chart: they found that the child died due to injuries consistent with shaken baby syndrome.

Since the child did not die of natural causes, a post-mortem examination was performed by a medical examiner. He noted that the child seemed dirty and disheveled. Dirt was found under the nails and the child had a bald spot in the back of her head. The cause of death was whiplash and broken spine due to shaking and blunt force trauma to the head which caused bleeding in the child’s brain. The medical examiner found bruising in the muscles around the cervical spine and in the thoracic spine. When the child’s spinal cord was examined, there was tearing and bruising present. The child’s death was ruled a homicide.

The mother was brought the police precinct where she was interviewed by a police detective. She admitted to having shaken the child and once or twice hit the baby in the bottom area. She blamed her live-in partner of having killed her baby. The mother gave statements to the assistant district attorney who interviewed her on camera. The district attorney gave the mother a doll so that she can demonstrate how she handled her child. She took the doll by the armpits with her thumbs on the baby’s chest and her fingers on her back. She then shook the doll four times and the doll’s head bobbed back and forth. She also demonstrated how she punched the baby in the head as he sat on her lap facing her when he woke up fussy at 3am.

Six months before the seven month old baby’s death, a social worker had been visiting the mother’s older sister, two years old, who was placed in the custody of her maternal grandmother because tthere was already a suspicion that the two-year old daughter was being neglected. Upon the seven month old baby’s death, child abuse charges were brought against the mother of both her seven-month old son and her two year old daughter. The prosecution claimed that although there was no direct evidence of the abuse of the two-year old daughter, there must be a finding of derivative abuse of her two year old daughter who was present in the same apartment at the same time when her seven-month old sibling was severely assaulted and abused by the mother.

At the trial, the mother did not testify. The mother’s lawyer argued that although there can be a finding of severe abuse of the seven month old son, there can be no finding of derivative abuse of the two year old daughter absent any allegation or proof of such derivative abuse.

The Court found that the two-year old daughter was derivatively abused when her seven month old sibling was subjected to the severe abuse that caused his death. The daughter lived under a constant and substantial risk of death even if she was not the child targeted for abuse The People have succeeded in proving aggravating circumstances and the presence of reckless and intentional acts that showed a depraved indifference to the life of her son.
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A man working as a janitor for a small private university was performing his usual tasks when he hit the back of his head on a metal pipe that overhung from the low ceiling of the basement of one of the buildings of the university. After hitting the back of his head against the metal pipe, he suddenly felt dizzy and his vision became fuzzy. He dropped to the floor and felt as though the entire left side of his body sagged. He was taken to a hospital immediately and was seen by a doctor’s assistant in the emergency room. He was immediately discharged when the doctor’s assistant noted that his symptoms had abated.

Dissatisfied with the diagnosis, man went to another hospital where he was diagnosed to have a brain injury: the area of his brain nearest the brain stem that leads to the spinal cord was bleeding. He stayed in the hospital for about thirty days. The Manhattan neurologist who treated him at the second hospital he went to gave a report that he believed that the brain injury sustained by the janitor was a direct result of the accident because the bleeding in the brain was in the same site as the area of his head that hit the metal pipe.

He later filed a complaint for damages under the Workmen’s Compensation Board. The doctor who treated him at the second hospital gave an opinion of his medical findings that the brain injury he sustained was a direct result of hitting his head against a metal pipe.

A year later, the janitor was examined by a neurologist retained by the Long Island university and he gave an opinion on his medical findings. He said that the brain injury sustained by the janitor was consistent with massive head trauma and not by hitting his head on a pipe. The neurologist for the university also opined that the janitor had been diagnosed with bleeding in his brain prior to the accident.

The Board found that the brain injury sustained by the janitor was caused by the accident. The university that employed the janitor asked for a review but the review board also found that there was medical evidence to support the conclusion that the brain injury sustained by the janitor was caused by his accident at the workplace. From his finding, the university appealed.
The only question before the Court is whether or not there is competent and credible medical evidence to support the finding that the brain injury sustained by the janitor was caused by the accidental hitting of his head against a metal pipe in the workplace.

The Court held that since the janitor’s claim for damages was brought under Workmen’s Compensation, the janitor has the burden of proving that the accident caused his disability. He may do so by presenting competent medical evidence. The evidence must not only consist of a medical opinion but it must also include objective medical data on which the medical opinion is based.

The Court also held that the Workmen’s Compensation Board has the obligation to resolve the issue of whether or not the evidence presented by the janitor is competent and whether or not the testimonies given by the janitor and his medical experts are credible.

Looking at the report and the decision of the Workmen’s Compensation Board and the Review Board, the Court noted that ample medical evidence was used to support its findings. Without any claim on the part of the employer of any grave abuse of discretion on the part of the Board, the Court refuses to substitute its own findings for that of the Board.
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The symptoms of bTBI (explosive blast traumatic brain injury) can actually be very subtle, doctors tell reps. Sometimes, there is no outward sign of injury until certain symptoms begin to arise, like headaches, vertigo, or short-term memory loss. Because of this, victims of bTBI should be evaluated by a Bronx physician or psychologist to determine how extensive their injuries might be, if any. Neurophysical evaluation should be a part of this examination. There are currently efforts to create neuropsychological tests that can be automated on laptop computer or are easy enough to be used to by first responders who may have less training.

Patient who may have PTSD (post-traumatic stress disorder) should see a combat stress team provider or a psychiatrist as soon as possible. It is very important to remember, sources have learned, that bTBI and PTSD can have very similar symptoms and may occur alone or together in a patient. It may be difficult to tell them apart.

When TBI may be present in a patient, that person should be excused from all combat-related duties. The patient should be put on light duty until the symptoms are gone or until he or she is moved to a place where advanced neuroimaging, like MRI, may be used, and a more detailed evaluation can be used. Brooklyn Doctors have determined that it is vital for a patient suffering TBI, or who may be suffering from it, to be treated with the utmost care, so the condition does not become worse.

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Blast TBI (traumatic brain injury) happens to many combatants, according to doctors. It can rightfully be considered a new class of TBI. While it might share a lot of features with standard TBI, it has some unique aspects that are all its own.

The milder forms of TBI can be very similar to PTSD (post-traumatic stress disorder), but it also has distinct aspects of its own. The military currently uses civilian standards of care for TBI when it comes to bTBI (explosive blast TBI), but they are constantly revising their standards to better provide for those injured on the field, according to sources. The theater of war requires different standards of medical practice.

It is apparent that there need to be more studies done on the precise effects of bTBI, both scientifically and clinically. The research will have to be focused upon how explosive blasts can lead to TBI. It is also important to learn how prevalent this disease is, and the exact causes. Once the research reaches a certain level, it will become much easier to diagnose and treat bTBI. A clinical definition of bTBI should quickly create the means to treat bTBI, doctors in Queens and Staten Island believe.

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The Facts:

On 9 September 2000, infant plaintiff was in an infant walker. Thereafter, infant plaintiff fell down a stairway leading to the second floor apartment in Bronx County.

As a result, a personal injury action has been instituted. Infant plaintiff allegedly sustained the following personal injuries: traumatic brain injury; developmental delays including speech; impaired motor and sensory processing skills; blunt face and head trauma; abrasions, tenderness and swelling to nasal area.

The Manhattan defendants, the manufacturer of the infant walker and others, filed a motion for a summary judgment and a judicial declaration that there is no causal connection between the neurological and developmental delays as alleged and precluding plaintiffs from introducing any evidence at trial in support of their claim that said injuries resulted from defendant’s alleged negligence. Defendants assert that there are no triable issues of fact herein because the infant plaintiff has neurological deficits and developmental delays due to the fact that he has autism and not because he fell down a set of three (3) stairs.

The Ruling:

Summary judgment is a drastic remedy and should not be granted where there is any doubt as to the existence of a triable issue. To obtain summary judgment, it is necessary that the movant establish his cause of action or defense sufficiently to warrant the court as a matter of law in directing judgment in his favor and he must do so by the tender of evidentiary proof in admissible form. Once the movant has made such showing, the burden now shifts to the party opposing the motion to produce evidentiary proof in admissible form sufficient to establish the existence of material issues of fact which require a trial of the action.

Here, the court finds that defendants have established as a matter of law that there is no causal connection between the neurological and behavioral injuries alleged in plaintiff’s bill of particulars and the infant plaintiff’s accident.

First, the rules provide that: upon request, each party shall identify each person whom the party expects to call as an expert witness at trial and shall disclose in reasonable detail the subject matter on which each expert is expected to testify, the substance of the facts an opinions on which each expert is expected to testify, the qualifications of each expert witness and a summary of the grounds for each expert’s opinion.

In the instant case, even though defendants made such requests of the plaintiffs, plaintiffs did not disclose the identity of their expert until approximately seven (7) months after they filed their note of issue and certificate of readiness. Said expert affidavit was admittedly submitted in response to the motion for summary judgment submitted by the defendants.

Courts have frequently rejected an expert’s affidavit submitted in opposition to a motion for summary judgment when the expert was never identified in pre-trial disclosure.

In a similar case, the Supreme Court providently exercised its discretion in rejecting the affidavit of the purported expert proffered by the plaintiffs, since they failed to identify the expert in pretrial disclosure, and served the affidavit, which was elicited solely to oppose the defendants’ motion for summary judgment, after filing a note of issue and certificate of readiness attesting to the completion of discovery.

In the case at bar, plaintiffs’ expert affidavit was elicited solely to oppose defendants’ summary judgment motion and said expert was retained after plaintiffs filed their note of issue and certificate of readiness attesting to the completion of discovery. Plaintiffs have not provided good cause for their failure to timely disclose said expert witness and in fact, make no argument whatsoever as to why the said expert was not disclosed prior to the motion for summary judgment. Thus, the affidavit of plaintiffs’ expert is rejected. And even if the court were to consider the affidavit, it fails to create an issue of fact that would preclude summary judgment with respect to whether or not there is a causal connection between the infant plaintiff’s accident and his neurological and developmental delays. The affidavit states that there are clear signs of trauma to the brain and signs and symptoms consistent with brain injury but does not articulate what those signs are; that absent an EEG, the infant plaintiff could not be definitely diagnosed as not having suffered a traumatic brain injury but then goes on to state that the infant plaintiff does have pervasive developmental disorder which is seen in children like E.V. who has traumatic brain injury. Clearly, the affidavit does not in any way explain how plaintiff’s expert came to the conclusion that the infant plaintiff has traumatic brain injury as a result of the subject accident, particularly when he himself states that an EEG is needed to determine if he suffered a traumatic brain injury.

As a rule, an expert’s affidavit containing only conclusory allegations and assuming facts not supported by the evidence is not entitled to consideration.

Moreover, plaintiff’s expert does not explain why an EEG should have been performed when all of the ambulance and hospital records related to the infant plaintiff’s fall state that the child sustained a bloody nose, swollen face and nose and minor head trauma or head injury but no loss of consciousness and no concussion. Even when the infant followed up with his pediatrician, two to three days after the accident, he made no significant findings. What’s more, plaintiff’s expert does not explain what type of examination he performed on the infant plaintiff before he concluded that the child suffered a traumatic brain injury and that, within a reasonable degree of medical certainty, the infant plaintiff was a child with a good intelligence despite these traumatic injuries he suffered that proximately resulted from the accident on 9 September 2000 with his walker.

Therefore, defendants’ motion is granted with respect to the fact that plaintiffs have failed to establish a causal connection between the infant plaintiff’s neurological and developmental delays and the subject accident but denied with respect to the other injuries allegedly sustained.
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A study reports that almost one-third of all cases of TBI (Traumatic Brain Injury) eventually lead the sufferer to a depression experience. A Vanderbilt University Medical Center team spent a considerable amount of time analyzing existing research on such brain injury-inducing incidents as: blunt force trauma to the head from traffic accidents, falls, sports and assaults.

Attorneys have long seen the correlation between the two events, but it is always welcome when an expert in the field corroborates the evidence. “Any patient who has a traumatic brain injury is at a real risk for developing depression, short and long term,” the study’s co-author said in a medical center news release.

“It doesn’t matter where on the timeline that you check the patient population — six months, 12 months, two years, five years — the prevalence is always around 30 percent across the board.” Compare this to the rate of depression in the general population which is about 9 to 10 percent, and the issue is apparent.

Each year, U.S. hospital emergency departments treat 1.2 million cases of traumatic brain injury. At 30%, these findings suggest that at least 360,000 of those patients will suffer depression sometime after their head injury. Whether it is immediately after or in weeks, months, or years – the study doesn’t pinpoint when each victim will experience it, it just highlights that is should be a serious consideration for loved ones of TBI sufferers to consider.
The authors of the study said their findings are important because it is still being debated whether antidepressants are a safe and effective treatment for the brain-injured. Brain Injury doctors based in New York agree that there is currently a lack of research in the area.

The co-director of the Vanderbilt Evidence-based Practice Center said, in a news release that, “It’s unacceptable, with so many people sustaining TBIs — both in combat and civilian life — that we know so little about treating depression in this population.”

With more research into the area, advancements will be made in the area. At the very least, figuring out whether brain-injury patients in NYC or Westchester should have their depression treated differently than patients without TBI is of utmost importance.
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A boy had the misfortune of experiencing accidents. All the four accidents resulted in trauma to the head. In 2000, the boy was hit by a baseball above the left eye while he was sliding onto first base. He was not treated for this injury.

In 2001, the boy also figured in an accident in his home. He was in the bathroom when the ceiling fell and hit him on the neck and head. His mother found him semi-conscious. He was taken to the emergency room and bruising in his neck and back were noted.

On May 15, 2002, he was struck in the head with a basketball. He was taken to an emergency room and he was diagnosed with contusions of the face, scalp and neck.

In September 2004, he was sitting in the passenger seat of their car; he had his seatbelt on when their car rolled over three times. He was hospitalized and a CT scan was performed on his head and x-rays on his spine and left knee. The results were negative.

In October 2004, he again figured in another vehicle accident. He was taken to the hospital because he complained of headache and dizziness, tremors in the legs and lack of appetite. He was diagnosed to be suffering from a viral infection and post-concussion syndrome.

The boy’s mother then filed this case in damages against the owner of their apartment. The complaint seeks the payment of damages for the brain injury he sustained resulting from the ceiling falling on the boy. The mother claims that her son suffered from impaired brain function due to the trauma to the head.

During pre-trial the mother informed the apartment owner that she was presenting a neuropsychologist with a doctoral degree. And that the neuropsychologist was not a medical doctor but that he was going to testify as to the effects of the head trauma experienced by the boy consequent to the collapse of the ceiling on his head. He was going to testify that the boy’s learning abilities and educational achievement were diminished as a result of the accident. The mother submitted a report written and signed by the neuropsychologist on the traumatic brain injury which resulted from the collapsed ceiling.

The apartment owner then moved to stop the neuropsychologist from testifying. The apartment owner argued that the testimony of the neuropsychologist and the conclusions he made were not based on any objective medical evidence in the record; also, the apartment owner insisted that the conclusions reached by the neuropsychologist that the boy’s learning abilities were impaired is flawed because the neuropsychologist did not even include a review of the boy’s school records before the 2001 accident and after it. The apartment owner also pointed out that the neuropsychologist’s report did not consider all the other accidents the boy head which may have contributed to the impairment of his learning capacity. And the neuropsychologist failed to note that CT scans of the boy were negative for brain injury but just the same the boy was brought back to the hospital complaining of headache and dizziness and a new CT scan was performed but also had a negative result.

The trial court allowed the neuropsychologist to testify on traumatic brain injury and on the effects of traumatic brain injury. The neuropsychologist in Queens and Staten Island was also allowed to give his opinion on how traumatic brain injury can be diagnosed and treated; and to explain the mental, emotional and behavioral symptoms of traumatic brain injury. The trial court, however, prohibited the neuropsychologist from testifying that the boy suffered from traumatic brain injury that resulted from the ceiling collapsing on him. The trial court held that there just was no medical evidence that the traumatic brain injury suffered by the boy was caused by the collapsed ceiling.

The apartment owner moved for a directed verdict. When the trial court granted this motion of the apartment owner, the mother appealed. The only question before the Court is whether or not the trial court erred in limiting the testimony of the neuropsychologist.

The Court held that the trial court prohibited the testimony of the neuropsychologist because the expert opinion was not based on any evidence. The Court saw that there is no medical foundation for the proposed testimony. It was not precluded because the neuropsychologist was not a doctor. It was the lack of a medical foundation for his proposed testimony and not because he was not qualified to testify. The expert’s conclusions were not based on medical evidence that the brain injury that caused the impairment of the child was the brain injury sustained when the ceiling collapsed on the child.

The Court reversed the directed verdict and remanded the case to allow the mother the opportunity to present medical evidence as basis for the testimony of their expert.
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The ongoing Global War on Terror has resulted in an increase of traumatic brain injury, or TBI, studies have noted. A number of them suffer from an explosive blast (bTBI). Physicians have decided this type of injury is distinct from other forms of brain trauma, such as penetrating TBI (pTBI) and closed head TBI (cTBI).

Explosive blast causes more than 60% of combat casualties in the two current major American campaigns, Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom, according to Lawyers. The main source of danger are the much talked-about IEDs – improvised explosive devices. The head is often injured in battle, accounting for 20% of all combat-related injuries in modern wars. When it comes to the wars in Iraq and Afghanistan, the data is still coming in. So far, the data from hospitals in Nassau and Suffolk seems to closely match that of previous wars.

Operation Iraqi Freedom and Operation Enduring Freedom are distinct from 20th century wars in the higher survival rate of those who are injured in combat, even those who suffer from TBI, according to doctors. An important factor to be considered is the use of body armor. Doctors used to believe that the severity of bTBI was due to pTBI from fragments of the explosive device or cTBI from the head striking an object after the victim was thrown.

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Physicians currently do not have many distinctions between explosive blast traumatic brain injury (bTBI), closed head traumatic brain injury (cTBI) and penetrative traumatic brain injury (pTBI), according to doctors. The military also uses the same criteria to assess such injuries as civilians.

A 1993 definition from the Mild Traumatic Brain Injury Committee of the American Congress of Rehabilitation Medicine of TBI apples to bTBI when an explosive blast causes loss of consciousness, amnesia, or loss of focus. The severity is determined by how long the altered mental state lasts. Less than 5 minutes is mild, though it can lead into difficulties like headaches, confusion, and amnesia, as well as a difficulty to concentrate, altered mood, problems sleeping, and general anxiety. These symptoms usually go within a few hours or days.

Studies in Manhattan and Long island have discovered that even these mild cases could result in post-concussive syndrome which could happen days later. Government agencies are currently developing guidelines to manage this condition, which seems to respond to simple reassurance and specific treatments like non-narcotic analgesics, anti-migraine medication to treat headaches, and anti-depressants. Just as with civilian cTBI, the problem might last only a few weeks, but it might well last a year or more in some cases.

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Organization when it comes to head injury may actually save a great many lives worldwide, according to studies. Improving the intensive care and pharmacological treatments in areas that already have the best treatment is not enough. Different avenues need to be pursued when it comes to head injuries so people can be treated away from the hospitals and the best facilities as quickly and correctly as possible.

Reporters in Nassau and Suffolk have known this for years and certain physicians have worked to act upon it. A group of British neurosurgeons have created guidelines for head injury management which has already been adopted throughout the UK, as well as some other places in the world. Some of these guidelines focus on children and they are constantly being updated. These guidelines have increased the number of hematomas detected in the areas that utilize them.

These guidelines are best applied in cities, towns, and rural areas that do not have access to local 24-hour CT scanning facilities for all head injuries. The guidelines can detect certain traumatic brain injuries and those who are determined to be at risk than then be sent to the appropriate facility where 24-hour scanning is available. Without this preliminary examination, some may develop brain injuries later on that could result in serious consequences and complications, doctors have learned. Following guidelines to discover the signs for brain injury may well save many lives, and even lead to ways to prevent lingering injury or symptoms in the long run.

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