Background

Not all “head injuries” result in injury to the brain.  Importantly also, the terms “acquired brain injury” and “traumatic brain injury” are not interchangeable.  One, (traumatic brain injury), is a subset of the other (acquired brain injury).  A traumatic brain injury is an insult to the brain, caused by an external physical force.  An acquired brain injury may result from, and therefore includes, traumatic brain injuries, but an aquired brain injury may equally result from, and therefore includes, injury to the brain as a result of aneurisms, infections of the brain or stroke.  Degenerative or congenital defects of the brain are not usually considered to be “acquired brain injuries”.  Of course, sufferers of degenerative/congenital brain defects demonstrate the same or similar symptoms as individuals who have suffered an aquired brain injury (ABI).

Most brain injuries are the result of bruising, bleeding, twisting or tearing of brain tissue.  Damage may occur at the time of injury, or develop later as a result of swelling or bleeding within the head or other medical complications of the injury.  Indeed, survivors of an ABI may have more than one type of injury.

The brain consists of a jelly like mass made up of millions of microscopic cells that are suspended in cerebrospinal fluid.  The brain is composed of individual cells called neurons.  An ABI can cause these cells to malfunction or even die.

There are three main areas of the brain:-

• Cortex (cerebrum);
• Cerebellum; and
• Brain Stem (diancephalon).

The cortex is the largest area of the brain and is the centre where most thinking functions process.  The cortex itself has four “lobes” that control specific functions and skills.   The cortex call also be divided into two hemispheres, the right and the left.  The left hemisphere is usually the dominant one and controls functions such as speaking, reading and writing and calculating.

The right hemisphere controls visual-spacial functions such as visual memory, drawing and music/rhythm.

The four lobes of the brain include:-

• Frontal Lobe.  This is often damaged because of its size and location near the front of the cranium.  The frontal lobe is involved in many cognitive functions including processing of emotions and development of personality.
• Temporal Lobe.  Damage to the temporal Lobe has been associated with behavioral disorders.

• Occipital Lobe.  This is located at the back portion of the brain and is associated with interpreting visual stimuli and information.

• Parietal Lobe.  Injury to parietal lobe will effect processing of tactile sensory information such as pressure, touch and pain.  The parietal lobe is essential to the processing of the bodies senses.

The cerebellum is responsible for coordination, balance and posture.

However, perhaps the most critical part of the brain is the brain stem.  It connects the brain to the spinal cord and controls survival functions such as breathing, beating of the heart, consciousness and alertness.

The brain is protected by the cranium (skull).  When the brain moves inside the skull (which can occur as a result of external force eg – car accident) it can be torn and bruised by being thrust against the inside of the cranium, causing injury.  The swelling and compression that follow such injury can cause long term effects.

Neurological imaging (CT scan, CAT scans or MRI imaging) can take pictures of the inside of the brain and are able to image blood in the brain, cell death (atrophy), swelling (edema) and other damage to brain tissue.

Types of Brain Injury

1. Skull Fracture – A skull fracture is a break in the bone that surrounds the brain.  The fracture may heal on its own or, if there is tissue damage below the fracture, require remedial surgery.  A skull fracture can be depressed (meaning part of the skull is pushed into the brain) or non-depressed (which can still be very serious).
2. Anoxic Brain Injury – An anoxic brain injury is caused by a lack of oxygen to the brain.  It usual results from lack of blood flow due to injury or bleeding and will cause the swelling of brain tissue.
3. Contusion/Concussion – Such injury is often misdiagnosed as a “mild” injury to the brain.  While there usually is little or no loss of consciousness, the long terms results/effects certainly may not be “mild”.
4. Defuse Axonal Injury (DAI) – A DAI results when a rotational or shearing force is exerted on the nerve fibers.  DAI may cause a loss of consciousness or indeed a coma may result, for a short time or may extend indefinitely.  The rotational force of this injury causes a shearing of the nerve connections and pathways.  These pathways may tear and be lost permanently.  If this occurs, the brain must then try to find alternative pathways to resume the functions of the severed paths.  DAI can be especially devastating and indeed frustrating in that some DAI injuries are microscopic and usually cannot be detected in radiological imaging.  Nonetheless, other diagnostic techniques (eg – PET scan) can sometimes detect them.
5. Hematoma– A “epidural hematoma” is an accumulation of blood between the skull and the top lining of the brain (dura).  This clotting may cause pressure changes in the brain, which require emergency surgical procedure in most cases. The size of the clot will determine whether surgery is necessary.  Such bleeding may increase pressure on the brain, causing it to be forced down the spinal column, compressing the brain stem, which usually results in death.An “intra cerebral hemorrhage” is a blood clot deep in the middle in the brain which is hard to remove.  Pressure from this clot may cause tissue damage and may require surgical intervention to relive the pressure.A “subdural hematoma” refers to the formation of a blood clot between the brain tissue and the dura.  The clot may cause pressure and require surgical intervention.
6. Coup – Contra Coup – A “Coup” injury is caused when the brain is propelled against one side of the skull.  Because brain tissue is suspended in fluid, it often rebounds and collides with the opposite side of the skull.  When it strikes both sides of the skull, the injury is sometimes called a contra coup injury.
7. Spinal Cord Injuries – Unfortunately, a brain injury is often associated with a spinal cord injury.  It is important that an expert in TBI also be involved in management of these complex injury situations.

Claims involving head injury, in particular significant TBI are complicated and involve complex medical and legal concepts.

The substantive and procedural laws which govern the conduct of personal injuries claims in Queensland are complex and, in most cases, involve short time frames in which to provide appropriate notification to those responsible for the injury.  However, it is usually the case that individuals who suffer brain injury (or other serious injury) will require significant care and support, including medical, rehabilitation and indeed accommodation requirements.

It is important to seek specialist legal advice as soon as practical following sustained serious traumatic brain injury.  Mr Cameron Hall, Accredited Personal Injuries Specialist and Principal in charge of the Accident Compensation of Hall Payne Lawyers, personally conducts all claims involving TBI or, other serious injury, given the complexities and quite often urgent medical and rehabilitation needs attaching to claims of this nature.  Cameron can be contacted on 1800 659 114.