U.S. | Houston, Texas HQ
Brain Injuries Explained Medicolegal Implications
By Sanjay Adhia, M.D.
Brain injuries can be life-changing.
Before tackling liability or damages, read this.
Understanding Common Brain Injuries
This article begins with a description of brain injuries and how they are diagnosed, followed by a discussion of medical-legal implications.
Brain Injuries
Brain injuries can result in neurocognitive disorders, mood disorders and psychosis. The injury that resulted in TBI can also cause PTSD, which could be relevant to a criminal case.
What Is Traumatic Brain Injury?
Traumatic brain injury (TBI) is a type of acquired brain injury. It is brain dysfunction caused by an outside force. TBI can be classified by the biomechanical forces involved. The three types of forces are blunt trauma, penetrating injuries and blast overpressure injury.
TBI can cause a neurocognitive disorder, which can impact one’s cognition in various domains such as memory, concentration and executive functioning.
TBI can also result in mood disorders such as depression, anxiety disorders and psychosis.
TBI can produce neurological issues like seizures, headaches, speech disorders and inability to walk. It can be accompanied by spinal cord injury (SCI).
Examples of blunt trauma include motor vehicle accidents (MVAs), falls and assault. Penetrating injuries include gunshot wounds (GSW) and injuries with sharp objects such as knives and arrows. Blast injuries include improvised explosive devices (IEDs) and dynamite. Sometimes one can encounter multiple types of injury. For example, in a bomb blast, there could be the initial blast injury, penetrating injury from shrapnel and blunt injury from a blast wave causing a fall.
What Is a Concussion?
A concussion is a mild traumatic brain injury (mTBI). It results from a direct impact to the head or a violent shaking of the head and body. It may be accompanied by a loss of consciousness (LOC) and post-traumatic amnesia (PTA).
There is no specific treatment for concussion. Rest and activity restriction are recommended to allow the brain to recover. Medications can help alleviate symptoms of post-concussive syndrome (PCS).
What Is Post-Concussive Syndrome?
Post-concussive syndrome (PCS) is a disorder in which various symptoms last for weeks and sometimes months after the injury that caused the concussion. Typically, the symptoms occur within the first 7 to 10 days and resolve within 3 months. Sometimes, they can persist for a year or more.
Symptoms can include:
- Headaches
- Dizziness
- Nausea and vomiting
- Fatigue/sleepiness
- Irritability
- Anxiety
- Insomnia
- Diminished concentration and memory
- Ringing in the ears (tinnitus)
- Blurry vision
- Noise sensitivity
- Light sensitivity (photophobia)
- Decreases in taste and smell
What Is “Acquired Brain Injury?”
Acquired brain injury (ABI) can be the result of TBI. It is defined by the World Health Organization as brain damage “which occurs after birth and is not related to a congenital or a degenerative disease.” ABI can be the result of TBI or non-traumatic causes such as a stroke, brain tumor, brain hemorrhage or other causes.
Dementia
Dementia is a degenerative brain disease. Alzheimer’s disease is a type of dementia. People sometimes refer to dementia as “senility.”
Testamentary Capacity and Competency to Enter into a Contract (e.g., a Revocable or Irrevocable Trust) can be impacted by dementias. A person with dementia can experience good days and bad days, meaning lucidity waxes and wanes. A person with dementia may, on a “good” day be competent in a way they are not on a “bad” day.
Can you treat TBI with medication? Is it a good idea to take medication for TBI?
Those with TBI can be more sensitive to the effects of psychoactive medications. When treating those with TBI, I will go “low and slow,” meaning I would start the medication at a lower dose and increase it slowly. Those with TBI are more sensitive to the effects of alcohol and illicit drugs.
Medications to avoid or limit and medications that can help
Certain psychiatric medications should be avoided or limited in TBI. Strong antipsychotic medications such as Haldol can impair brain recovery after a TBI. Certain anxiety medications such as Valium or Xanax are not advised as they can adversely impact memory and increase the fall risk. Some seizure medications can have neurocognitive side effects in TBI such as Tegretol.
There are medications that aid in recovery and cognition such as Amantadine, Ritalin and Aricept.
Litigation
How does a brain injury impact civil damages? A person might be unable to work, attend school, or maintain relationships if they have suffered certain types of brain injuries or permanent brain damage. These are factors in evaluating damages.
The expert witness who is experienced in assessing brain damage in the context of damages, considers complex medical information. The effects of brain damage, depending on recovery, can be severe.
This isn’t only a Plaintiff’s attorney’s consideration. Defense counsel also needs an accurate picture of damage, or lack of it, to represent their clients.
It is difficult to malinger a brain injury given the extensive diagnostic tools used to diagnose such as CTScans and other radiography and/or neurocognitive testing. People still try.
Criminal Cases
- Severity (Concussion? TBI, Brain damage?)
- Symptoms
- Context
- Recovery, or lack of recovery
- Relationship between the injury and behavior
- Executive function: decision-making
- Which part of the brain is impacted
Traumatic brain injury can be relevant to Competency to Stand Trial, NGRI (Criminal Responsibility,) sentence mitigation.
Endnotes:
- Dr. Adhia is one of about a dozen Board-Certified physicians in the US in both Forensic Psychiatry and Brain Injury Medicine.
-
Dementia and testamentary capacity. Read more https://forensicpsychiatrynow.com/understanding-dementia-and-medical-legal-implications
-
Personal injury and concussion or TBI damages
-
Psychiatric conditions associated with brain injuries and diseases (e.g. Alzheimer’s)
-
Neurocognitive disabilities
