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Brain Injuries Explained and Medicolegal Implications
By Sanjay Adhia, M.D.
Brain injuries can include Traumatic Brain Injury, or TBI, Concussion and associated injuries: Medical and Legal Implications.
A brain injury can be catastrophic and result in significant disability.
Understanding Common Brain Injuries
Medical-Legal Relevance is discussed.
Plaintiffs can be unable to work, attend school and maintain relationships. Defendants should consider the presence or absence of TBI if claimed by a plaintiff.
This should be considered if TBI is a feature of a case or damages.
Traumatic Brain Injury can be relevant to Competency to Stand Trial, NGRI (Criminal Responsibility) or Sentence Mitigation.
Brain injuries can result in neurocognitive disorders, mood disorders and psychosis. Often, the injury that resulted in TBI can also cause PTSD which could be relevant to criminal case.
Personal Injury and Traumatic Brain Injury (TBI)
Assessing damages in Personal Injury cases for settlement or trial where TBI is a consideration for Plaintiff or Defense.
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).
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. The three types of forces are blunt trauma, penetrating injuries and from blast overpressure injury.
Examples of blunt trauma include motor vehicle accident (MVA), falls and assault. Penetrating injuries include gun-shot 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?
Concussion is a Mild Traumatic Brain Injury or 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’s 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?
It 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 seven to ten days and resolve within three months. Sometimes, they can persist for a year or more.
Symptoms can include:
- Nausea and Vomiting
- Fatigue/ Sleepiness
- 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 Traumatic Brain Injury. 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 Traumatic Brain Injury (TBI) or non-traumatic causes such as a stroke, brain tumor, brain hemorrhage or other causes.
Dementia is a degenerative brain disease. Alzheimer’s Disease is a 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 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 at Tegretol.
There are medications that aid in recovery and cognition such as Amantadine, Ritalin and Aricept.
- 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
Personal Injury and Concussion or TBI damages
Psychiatric conditions associated with brain injuries and diseases (e.g. Alzheimer’s)