How the Brain is Injured

The human brain although enclosed in a thick and hard protective covering known as the skull is subject to injury in many ways as a result of head trauma.

As brain injury lawyers, the New York based brain injury law firm of De Caro & Kaplen, LLP is frequently called upon to explain the concepts of brain trauma and the mechanism of brain injury in courtrooms and during professional presentations. In trials of accident cases such as a car accident, bus accident, truck or train accident and falls resulting in brain injury and head injury, our brain injury attorneys must explain the mechanism of brain injury to a jury.

The skull provides poor protection to the brain from trauma

Despite being contained in a hard protective barrier (the skull), the brain is very susceptible to injury because of its soft jello like composition and because of the interior contours of the skull.

Inside of skull contains rough surfaces

While the outside of the skull is strong and hard, the inside of the skull contains many sharp ridges and edges which can cause damage to the soft brain tissue when the brain is traumatized. Much of the damage to the brain is related to the structure of the interior surface of the skull.

The brain floats in the skull in a layer of fluid called cerebral spinal fluid.  When the brain is subject to forces causing it to move forward or backward or rotate in the closed skull cavity, the brain is forcefully propelled against the sharp edges and protrusions in the interior of the skull causing bruising, bleeding and destruction of nerve cells.

 

Coup and Contra Coup injury to the brain

The brain can also be injured when a hard object strikes the skull (such as being hit by a baseball bat) causing movement of the brain within the skull cavity. The brain can also be injured when the head strikes a fixed object (such as when the back of the head hits the floor during a fall), again causing movement of the brain within the interior of the skull and striking the rough and hard surfaces of the skull.

Forces are transmitted to the brain after contact causing damage and injury to the brain’s nerve fibers. The initial contact between the brain and skull is called a coup injury. The brain then rebounds after striking the skull and strikes the skull on the opposing side causing a secondary injury known as a contra coup injury.

When it is a moving object striking the still skull, the initial coup injury will be more substantial then the secondary contra coup injury.  BUT, when it is the moving skull that strikes a fixed object, the contra coup injury will be more significant then the initial coup injury.

 

Rotational injury to the brain

In addition to direct trauma, the nerves fibers of the brain can be stretched, sheared or severed when the brain moves.  The entire brain does not move at the same rate of speed or velocity.  As a result, different forces are applied to different areas of the brain. Each of these different movements will produce it’s own type of brain injury.

The brain can be injured by the twisting or stretching of the nerve cells and nerve fibers, a process known as a shearing injury to the brain.  In car accidents the violent and sudden  movement or turning of the head can cause damage to the nerve fibers and is called rotational injury

TYPES OF TRAUMATIC BRAIN INJURY

Focal Contusions: sliding impact of brain on skull.  The frontal and temporal lobes are most susceptible and this type of brain injury is the most likely to yield cognitive problems and difficulties with emotional control.

Skull Fracture: This implies significant impact and can lead to significant injuries including loss of smell and taste.

Lacerations: caused by skull fractures.  The brain may actually be cut

Focal Injury: caused by  a lack of oxygen also known as hypoxic ischemia or anoxin.  This is frequently seen in drowning and strokes. It can also occur as a result of brain swelling and the brain’s inability to regulate its blood pressure.

Brain bleeding or brain hemorrhage: The tiny blood vessels in the brain can be injured as a result of trauma.  When the brain bleeds, iron is deposited which often leads to seizure activity and traumatically induced epilepsy.

Diffuse Axonal Injury: Not localized to any particular area of the brain. Caused by rapid acceleration, deceleration of the brain which causes the nerve cells to stretch and compress over and over.  This type of injury tends to occur in the white matter of the brain where axons are located

You can’t judge a book by its cover

The brain may be injured but the skull may be fine.

Think of shaking an egg.  Even if you shake the egg very hard, you will damage the yoke without ever breaking the skull.  The same principal applies to the movement of the head within the skull.  This is a concept is well known in the shaking baby syndrome.

Each injury to the brain is different

Because each area of the brain controls different functions, depending upon the area that is damaged, different injury and different consequences may result. Detailed neuropsychological testing is necessary to pinpoint the areas of the brain that are damaged.

Injury to the brain lobes:

Each side or hemisphere of the brain can be divided into four areas or lobes.  These lobes known as the frontal lobe, temporal lobe, parietal lobe and occipital lobe control different and important brain functions.

Injury to the frontal lobe:

The area in the front of the brain in the region of the forehead is known as the frontal lobe.  This area controls motor functions (movement) and regulates our ability to think and problem solve.  The frontal lobe also controls our ability to regulate and control our behavior (self control).  Injury to this area of the brain often results in cognitive and behavioral problems.

Injury to the temporal lobe:

The area on the side of the head known as the temporal lobe controls our memory and the processing of auditory information.  This area of the brain also plays an important role in the assembling and processing of information.  Injury to the temporal lobe often results in short term memory difficulties, losses of the sense of smell and taste and vestibular difficulties.  It also leads to impairments in executive functioning (the ability to perform multiple tasks at the same time)

Injury to the parietal lobe:

This area of the brain controls our sense of touch and plays an important role in our ability to read.

Injury to occipital lobe:

The occipital lobe  is the primary area of the brain involved in the processing of visual information.

Injury to corpus callusom:

This area of the brain functions to allow information to pass from one side of the brain to the other.  Because of its location, this area of the brain is frequently injured as a result of trauma.  When the corpus callusom is injured, the brain can’t properly communicate with itself.

Injury to hypocampus:

The hypocampus is the memory center of brain.  It is very sensitive to oxygen deprivation.  When it is injured a person will experience short term memory loss.

YOU DO NOT NEED TO LOSE CONSCIOUSNESS IN ORDER TO HAVE SUSTAINED A CONCUSSION OR ANY TYPE OF BRAIN INJURY

Many individuals are under the mistaken belief that before any damage to the brain takes place, a person must be rendered unconscious.  This is simply untrue. If you or a loved one has sustained a brain injury, you need competent legal representation. You need the training and skill of lawyers that understand brain injury and the devastating and lifelong consequences that can result from brain damage.

The brain injury attorneys at the New York Brain Injury Law Firm of De Caro & Kaplen, LLP understand traumatic brain injury and are prepared to represent you or your loved one for brain damage caused by car accidents, bus accidents, trucking accidents, unsafe construction sites, negligent landlords and unsafe premises as well as brain damage caused as a result of medical negligence and medical malpractice.

Our brain injury attorneys co-author the New York Law Journal outside counsel column on the legal aspects of traumatic brain injury; have co-authored the chapter on neurolaw for the Psychiatric Clinics of North America edition on traumatic brain injury and have lectured at the ground rounds of Mt. Sinai Medical Center on brain injury and medical malpractice in emergency medicine.

Call us toll free at 1 866 BRAINLAW or email us a michael@brainlaw.com for a fee no obligation consultation.