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Recognizing Mild Traumatic Brain Injuries in Auto and Slip and Fall Cases
Posted by HolzbergLegal | October 18, 2011
The Initial Client Interview will Reveal Your First and Best Clues
Always conduct your initial interview yourself. Mild traumatic brain injuries are subtle in presentation. Your client appears normal, and sounds and responds appropriately. This is the worst enemy of recognition. Begin with their first memories before the incident- most MTBI victims will have intact memories of the events leading up to the head injury (retrograde amnesia) because in most cases more serious head injuries affect these memories. If memory is more impaired after the incident (anterograde amnesia) you have your first clue. Now take a thorough history of symptoms right after the impact as follows: a) Loss of consciousness- any, including confusion, blacking out, no memory of conversations with others -though documented- “obtunded”; b) nausea c) vomiting; d) vision issues- blurry vision, double vision, floaters; e) white hot burning sensation in head; f) headaches; g) dizziness; h) disorientation; i) contusion, bleeding to head scalp, face, etc (facial impact can= MTBI).
Careful Review of all Medical Records From the Initial Physical Impact is Essential to Finding Your Best Evidence
Obtain all medical and law enforcement records and read them yourself. Your looking for evidence of symptoms- see list above, and don’t rely upon admission summaries or initial intake at ER. Read EMS records- though these often contain misinformation/dissonance. For example- AAOX3 is meaningless in MTBI cases – it’s a defense argument, possibly of significance in Severe or Moderate Brian injuries with “complications”; skull Fracture, brain bleed. Don’t get hung up on a 15/15 Glascow coma scale-those are what they say -looking for coma. They don’t negate MTBI. I have found doctors missing contusions on back of scalp which an nurse caught and reported in nurses notes -with evidence of blood and clean up- missed in ER. Nurses report vomiting later (x2-3 etc). look for different reports of LOC- sometimes a client will remember he/she lost consciousness other times(to other reporters will FORGET). the same is true for vision problems. Read initial doctor visits for next clues.
You Become Best Medical Advocate and Manage Referrals for Proper Medical and Psychological Care
As you begin talking to client and spouse, significant other, parent, children (especially if older client) you will begin to see a pattern of memory and concentration problems, focus difficulties, irritability, aggressiveness, personality and behavior changes, mood alterations, and problems at work at home and in social relationships. The spouse or closest loved one is the best reporter of this. I first ask my client these (very) direct questions , and then ask if I can separately interview spouse, etc. You will get some positive responses from client but they often either don’t recognize the changes or are covering then for fear of reprisal or confrontation(esp. at work). Once confirmed this is the time to begin the trio of ESSENTIAL MEDICAL CARE: 1) NEUROLOGIST -who gets MTBI- be careful in selection- a bad choice can kill your case; 2) NEUROPSYCHOLOGIST- A MUST FOR FINDING EVIDENCE OF COGNITIVE CHANGES and to do a thorough evaluation; 3) PSYCHOLOGIST- if signs of depression.
Timing is Everything
MOST Neuropsychologists will tell you that most cases of MTBI with sequela do not fully develop for 12-18 months after initial injury. It is probably best to not prematurely arrange for a neuropsychological battery until then. However you should consult with your neuropsychologist early in the case and develop a game plan. Likewise a good radiologist neuro radiologist can greatly assist your case and defeat the defense argument that a lack of positive radiological findings are indicative of no Brain Injury-NONSENSE- but having better testing than the standard T1 weighted MRI’s can find evidence of brain injuries where none was found before. PT scans, SPECT scans and T3 weighted MRI’s (MRA’s) are better and of course more expensive but can show hard to rebut evidence. These can be done earlier and give medical support to justify referral to the Neuropsychologist. Pay attention to these medical hand offs,they are invaluable to show the progressive nature of these pernicious injuries.
