Diffuse Brain Injury -- a Misnomer?

When a head is twisted violently, such as in a car crash, microscopic brain structures, called axons, can tear.  The damage to the brain is a called a "diffuse axonal injury," or DAI.  When the axons tear, chemicals that were contained in those structures can leak into the brain tissue.  The torn axons and chemicals in the brain tissue disrupt the brain’s regular processes.  

The injury has been named "diffuse" because it was believed the damage occurred throughout the brain, and not in any one particular location.  We now know that that isn't quite right.  For example, in severe cases, the axonal injury appears on an MRI.  When it does, it usually appears as one small foggy area.  (Seen in the center of the graphic as an opaque area.)   In fact, as it turns out, the damage caused by a "diffuse axonal injury" is usually centered in a specific part of the brain called the corpus callosum -- the bundle of fibers that connect the two-halves of the brain. 

Victims suffering from DAI often have cognitive problems such as:

  • lack of concentration
  • poor long-term memory
  • difficulty dealing with more than one thing at a time,
  • lack of attentiveness
  • trouble keeping track of appointments, and
  • disorganization.

A victim can suffer a diffuse axonal injury even if there wasn't any impact to the head. Because there is no tell-tale external bruising or bleeding, and because the DAI doesn't always appear on an MRI, health care providers sometimes fail to diagnose the injury initially.  To represent an accident victim effectively, the personal injury attorney must be alert to symptoms which may suggest that the client should seek further medical evaluation.

Risk of Seizures Following Traumatic Brain Injuries (TBI)

Most TBI victims suffer from seizures and so need anti-seizure drugs. The drugs don't eliminate the seizures, they attempt only to control them. Even if the TBI victim takes the drugs exactly as prescribed, the victim may still experience "breakthrough seizures." The seizures can lead to embarassment, social stigma and most troubling, a blackout while driving. The victim who experiences breakthrough seizures may lose his driving privileges until he is seizure free for three months or maybe permanently. A TBI victim is entitled to compensation for all seizure-related damages. So, for example, if the victim loses his driving privileges, one form of damages might be the costs of hiring a driver. And don’t forget damages in the form of pain and suffering associated with the loss of driving privileges (ie. embarassment, loss of independence, etc.).
 

Are Waivers Enforceable Against Family Members?

Waivers signed by parents, releasing liability for future negligent acts committed against minor children in recreational and related settings, are generally enforced by judges in California as discussed here. Interestingly, a clear majority of courts in other states have held that a parent may not release a minor's prospective claim for negligence.

And when the victim is an adult family member who dies participating in an activity for which he signed a waiver, those who can bring a lawsuit on his behalf will also likely be bound by the waiver.
 

Diffuse Tensor Imaging -- More on Brain Injuries

Neuropsychologist researcher and professor Erin Bigler, PhD. recently spoke about the advances in images of post-concussion brains.  As discussed here, concussions or mild traumatic brain injuries may not show up on standard MRI or CT images.  Dr. Bigler described a new technique for analyzing MRI scans called "diffusion tensor imaging" or DTI.  This technique illustrates the direction of water flow through the fiber tracts of the brain. A comparison of images between an injured group and a control group revealed differences in the fiber tracts of injured patients.  It is believed that the head injuries caused swelling or edema in the fiber tracts, disrupting their normal ability to transmit messages in the brain.  This imaging allows researchers to determine the extent of injury between the fiber tracts.  Such research will have many applications, including diagnosing and assessing the scope of damage to a mild traumatic brain injury victim.