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Around Our Town...Legally Speaking

06/01/2005 - Motor vehicle accidents are the leading cause of Traumatic Brain Injury or TBI.

TBI may be caused by striking your head or by simple whiplash. TBI generally causes headaches. Physicians consider headaches "post-traumatic" if they begin within two weeks of the traumatic event.

Effortful visual or mental concentration may often trigger migraine headaches in closed head injury victims. For such persons it literally hurts to think. The harder they concentrate on a task the more intense the headache until it evolves into a full blown migraine. Contrary to popular belief migraine is a neurological disorder and is not psychological.

The effects of a closed head injury result from the structural characteristics of the skull and the brain and the direction and size of the forces acting on the head. The brain is soft with a consistency somewhere between egg white and jello. The outer layer of the brain is connected to the inside of the skull at various points suspending the brain within the skull. The brain sits atop the brain stem. Injuries arise from three characteristics: the rigidity of the skull, the incompressibility of brain tissue and shearing forces.

The first two characteristics may result in bruising or bleeding on the surface of the brain. There are usually two bruising sites in a brain injury. The first "coup" injury occurs at the site of the blow to the brain. The "counter-coup" injury arises where the brain bounces off the skull opposite the "coup" injury. Bleeding may also occur when the outer membrane is torn from the inside of the skull.

Shearing forces, the third characteristic, involve rapid, forceful movements of the head, such as in motor vehicle accidents. Whiplash, rapid acceleration and deceleration of the head, causes movement which is small near the brain stem but which successively increases further from this point. Different levels in the brain move relative to one another, stretching and tearing nerves.

Attorneys often meet with a client shortly after an accident, and before any diagnosis of a closed head injury has been made. The attorney should pay particular attention to head injury symptoms. Symptoms following head trauma include headaches, loss of concentration, difficulty communicating, fatigue, irritability, intolerance to light and noise, personality changes, dizziness and vomiting, although often some of these symptoms may not be present.

Attorneys should be careful not to play "doctor" and if symptoms exist should advise a medical diagnosis

Often, those who have sustained a major head injury find their life in tremendous chaos immediately following the accident. Not only are they suffering injuries, but they have problems with day to day life. They often lose friends and support systems, fall into financial crisis, and their personal life may drastically deteriorate.

The problem with TBI is convincing a jury or judge of the devastating consequences of the injury. Unlike obvious trauma, closed-head injuries can be difficult to present to a jury or insurance company since the injury may not be as apparent as say, a broken neck. You may appear to be functional, respond well to questions and thus appear uninjured to the untrained eye, especially during a relatively brief appearance in court.

However, when placed in a less structured environment, or under stress at work, you may display substantial deficits. Such subtle but debilitating problems may not be understood by lay individuals in the jury who may have a pre-existing mind set about what brain injury is or should look like. The commonly held misbelief that migraines are psychological must also be confronted.

Medical experts, such as neurologists, neurosurgeons or psychoneurologists are paramount. Anecdotal testimony from family members, friends and acquaintances who knew you before and/or after the accident can testify about your acuity and demeanor prior to and after the


It is most important to seek competent medical and legal advice after any accident.

Tom Sedar, P.C. is an attorney-at-law practicing in Casper.

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