Brain Injury Lawyer Blog 24/7

Published on: August 10, 2012

It isn’t necessary to go into the entire pathology of primary brain damage here

by Stephen Bilkis

It isn’t necessary to go into the entire pathology of primary brain damage here. Suffice it to say that it is important to use primary brain damage to understand the initial level of consciousness of a patient and any neurological problems that might immediately be apparent, doctors in The Bronx and Brooklyn have determined.

Any changes that occur in the first few moments after injury should be understood whenever possible, so they can be treated as soon as possible. The damage caused directly the impact could very well be aggravated by secondary brain damage, resulting in effects ranging from concussion to coma and death, sources have learned. For example, a object that penetrates the skull will obviously cause direct damage, but it may also cause some loss of function or impairment. Any further loss of consciousness or brain function would be caused by secondary brain damage.

Experimental research has shown swelling occurs at the site of the injury within 15 minutes of traumatic brain injury. As hours pass, the injury can continue to worsen, due to misalignment of parts of the brain. Pressure inside the skull can increase, subjecting the brain to forces that will make matters even worse. Doctors have determined the first few minutes after head injury are vital. It takes trained medical professionals who know what to do with head injury to prevent what may seem like a straightforward medical problem from becoming something far worse, something that might cause lifelong impairment or even death.

Published on: August 7, 2012

The conscious level also helps to measure how serious the injury is

by Stephen Bilkis

The importance of the initial examination when it comes to closed head injury cannot be stressed enough, according to Manhattan doctors. The conscious level may be the best way for a clinician to assess brain function after a head injury. The level of consciousness is often tested early, as the medical professional tests the patient’s response to certain stimuli. Often, this assessment is taken before secondary brain injury sets in; if the injury seems to worsen, it may indicate there are problems with the brain that require a closer look. CT scanning helps with this process, but examination of the conscious level still remains a useful part of head injury observation, especially when the injury does not appear to be severe enough to require a scan at first impression.

The conscious level also helps to measure how serious the injury is, according to doctors. How conscious the patient is can help determine the extent of the injury, when coupled with how much time has passed since the impact. Other factors must be taken into account in these cases, however. Drugs, ethanol, lack of oxygen, and other factors can cause loss of consciousness, and these should also be ruled out.

Later evaluations can monitor and document the duration of loss of consciousness. This is yet another way to measure the severity of brain injury, studies have learned. These methods require away to measure impairments of consciousness, which fortunately medical professionals in Queens have had available for decades.

Published on: August 5, 2012

War, while terrible, can often bring many innovations

by Stephen Bilkis

War, while terrible, can often bring many innovations, such as new medical concepts, according to sources. A committee of British clinical neurosurgeons in World War II sought to develop a standardized terminology for states of impaired consciousnessand published a glossary of their work. This committee included several preeminent neurosurgeons and others were quick to adopt their terminology. The original publication did not have a graded scale of levels of consciousness, but the glossary was used to help build such a scale. Eventually, the Glasgow Coma Scale was created in 1974.

The GCS has been used for decades and has become a widely-accepted way of measuring consciousness, studies have learned. There are some who do not like some of the details of this scale, however, and the way it is used has changed since its first implementation. Differing levels of stimulus and response were experimented with in an effort o create a universal scale that most physicians could agree upon.

Criteria such as sensitivity to pain, reflexes, and eye motion were all taken into account. Eventually, it came to be understood that all patients with a GCS score of 7 or less were comatose, while many with a score of 8 could also be called comatose, with the maximum score being 15, at fully unimpaired consciousness. doctors in The Bronx and Brooklyn have learned the final value of the GCS is in early evaluation of the primary effects of a head impact, and it helps to track the progress of an injury in order to treat any complications that might arise.

Published on: August 3, 2012

The whole method of determining consciousness is changed when it comes to infants and young children,

by Stephen Bilkis

The whole method of determining consciousness is changed when it comes to infants and young children, doctors have discovered. Often, the severity of a head impact is overestimated, but it’s much more common for the reverse to be true. When an infant cries because of a head impact, it is thought to indicate full consciousness, when in fact serious brain damage may have occurred.

The Glasgow Coma Scale (GCS) uses verbal and motor responses to assess consciousness, which is not possible for preverbal infants. Even after they learn to speak, a frightened but fully conscious child might not be able to fully aid in assessing his or her own state of mind. Doctors in The Bronx are well-aware of attempts to devise a scale that operates for children who are five years of age or less, so their needs can be better served.

Pediatricians and neurological nurses have studied these preverbal responses and are of great help in devising a scale that can assist in the treatment of small children. One such scale includes social, adaptive, vocal and motor responses, and even suck/cough responses, either spontaneous or induced by stimulus. Each of these was given a score from 0 to 4. Another scale was based off the Glasgow scale for eye opening and motor responses, but it had different criteria for the verbal portion, including such things as smiling, eye orientation, consolability, and interaction.

Published on: July 30, 2012

Non-impact generally means the head did not suffer a direct impact

by Stephen Bilkis

Many experiments have been done to determine if brain injury could occur without actual head impact, according to studies. An impact injury that deforms the skull may have some sort of mitigating factor because the skull distributes some of the force that would have otherwise been transferred directly to the brain, similar to the way a motorcycle helmet protects the head of the motorcyclist.

Non-impact generally means the head did not suffer a direct impact. The distinction is important to both forensic physicians and brain doctors. There have been a number of child abuse cases where the defense alleged brain damage was caused to infants by being shaken, rather than being struck by, or against, an object. Some studies have shown that shaking the torso of an infant was unlikely to harm the brain of the child, apart from a blow to the head. This is consistent with research from car crashes, which shows that force that comes from the torso to the head is unlikely to cause harm, even with the much greater force involved in a car crash.

Mathematical models in Nassau and Suffolk have been used to simulate the human body, in order to show how likely it was for injury to occur with differing impacts in a car crash. They tend to conclude that acceleration of the head is unlikely to reach a level that could cause brain injury, studies have learned. In a previous study of 400 fatally injured road users, there were no cases of brain injury without head impact.

Published on: July 28, 2012

Traumatic brain injury, not caused by flying objects, can be divided by physicians into primary and secondary types

by Stephen Bilkis

Traumatic brain injury, not caused by flying objects, can be divided by physicians into primary and secondary types, according to doctors in The Bronx. The force that causes the injury directly damages blood vessels, brain cells, and other parts of the brain, which in turn cause secondary damages like inflammation, and changes in neurochemistry and metabolism. The study of these secondary injuries has lead to a number of pharmacological therapies that can help limit this type of damage.

The primary damage is anything that is a direct result of the force that caused the injury, which deforms the tissue at the moment of injury, New York Brain Injury Lawyers have learned. This is blood vessel damage, damage to brain cells, and other brain injuries that have a different effect depending upon the parts of the brain that are harmed in the initial impact.

Secondary traumatic brain damage is a complication of the primary damage and often includes cerebral swelling, changes in pressure inside the skull, and infection. Secondary brain damage is sometimes reversible with treatment. Study of these injuries have enabled pharmacologists to develop therapies that can do a lot to mitigate the harm done by a head impact. These studies in Brooklyn have also shown Lawyers, among others, that brain injury is not a single type of injury, but one that has many different manifestations that can occur and combine in any number of ways.

Published on: July 25, 2012

Physically, the only real difference between the head being still or in motion when struck, is frame of reference

by Stephen Bilkis

Physically, the only real difference between the head being still or in motion when struck, is frame of reference. The real difference, doctors have learned, is that does not lie in if the head is in motion or not, but in such factors as the velocity of impact and the characteristics of the object that strike the head.

So, a high-speed crash will have a greater impact velocity than a low-speed crash – in most cases. In reality, researchers have learned, such details as the type of crash can be very significant. A high speed rollover can be relatively harmless, compared to collision with another vehicle or a fixed object, even if the speed is much lower. Even in crashes that seem very similar, it isn’t uncommon for one person to receive a major head injury, where another did not receive an impact to the head at all.

A major factor in head injury is the striking object itself. Given that the object does not pierce the skull as a bullet would, the important characteristics of the struck or striking object is how stiff it is and its general surface area. Doctors in Staten Island and Suffolk County.

Published on: July 23, 2012

The clinical assessment of head injury severity is commonly based on what is known as the Glasgow Coma Scale (GCS)

by Stephen Bilkis

The clinical assessment of head injury severity is commonly based on what is known as the Glasgow Coma Scale (GCS) according to doctors. A score of 3-8 means severe injury, 9-12 is a moderate brain injury, while 13-15 is mild head injury, based upon examination six hours after injury. The score is obtained by observing the patient’s impairment in speech, motor function, and eye movement. It does not, however, show what might have caused the impairment. Patients with the same GCS score may well have completely different causes for it, which means completely different treatment is necessary. Fatalities may even occur in patients who are not treated properly, even those with GCS scores above 9.

The damage to the brain is often vascular, studies have learned. The contusion index rates these injuries, giving them numerical values according to surface extend and depth. Another means to assess vascular injury is the hemorrhagic lesion score. This measures, in Westchester and Brooklyn, the total vascular damage in a traumatized brain by mapping macroscopic and microscopic evidence of bleeding on a diagram of sections of the brain, which are further divided into sectors.

Cell damage is a bit harder to quantify. The distribution and extent of such damage is not uniform or symmetrical, so systematic microscopic study of the brain is required to properly assess it. It has often been divided into three grades of severity, depending upon a number of criteria determined by examining both macroscopic and microscopic lesions.

Published on: July 21, 2012

Before 1950, trauma was classified by the external cause

by Stephen Bilkis

Authorities in Long Island have studied a publication by the World Health Organization (WHO) called the International Classification of Diseases (ICD). In this publication, trauma and head injury are included in the chapter ‘Injury and Poisoning’. Before 1950, trauma was classified by the external cause, which makes it impossible to collect data regarding only injuries to the head. The fifth version, ICD-5, added a classification based on the nature and diagnosis of the injury.

Still, all brain injuries were classified as ‘Intracranial injury without skull fracture’, which included hematomas of the scalp – not necessarily a brain injury. This focused on such problems as skull fractures, rather than impacts that might damage the brain without causing significant damage to the skull itself.

The ninth edition, ICD-9-CM, provided a three-digit code system for major diagnostics, such as 800 meaning skull fractures. An additional digit, such a 800.1 – Closed head injury with cerebral laceration and contusion; 800.2 – Closed head injury with subarachnoid, subdural, and extradural hemorrhage, serve to further classify injuries and diseases. The CM stands for Clinical Modification, which could add yet another digit, to provide further definition.

Published on: July 19, 2012

The way surgeons deal with shrapnel or bone fragments in the brain has changed

by Stephen Bilkis

The way surgeons deal with shrapnel or bone fragments in the brain has changed since the days of Korea or Vietnam, doctors tell sources. It was once the standard to remove every last fragment of bone or any other foreign body, so the brain would have a lower risk of infection and there would be less chance of developing post-traumatic epilepsy. Studies in Westchester County of Vietnam War patients has shown that removal of all fragments is not actually necessary, though objects that cause gross contamination should still be removed.

Closure of the scalp and replacement of the dura are absolutely vital to prevent, or at least reduce the chance of, CSF leakage and meningitis. A soldier who seems to have good neurological status, with only small fragments in the brain may be able to be treated locally to prevent leakage. One with a more extensive injury will have to undergo a large decompressive creniectomy and removal of the fragments.

Another source of head injury from an explosive blast can result from being bodily thrown by the explosion. The soldier’s head could strike some other object, causing tertiary blast injury. This can cause injuries in a number of places in the patient’s skull. There is also the risk of infection in cases such as these, often from bacteria that are drug-resistant. A number of dangerous injuries can result from such trauma, New York City doctors know. It can be very important to repair such injuries as facial fractures quickly.