A “closed head injury” is the name doctors give to brain injuries that are caused by impacts that do not break open the skull. Most brain injuries are closed head injuries. They can result from collisions and falls, as well as contact sports and crimes of violence. When another person's negligence is responsible for a closed head injury, the victim is entitled to pursue a claim for compensation.
Concussions are a common example of closed head injuries. About half of all concussions for which individuals receive treatment occur while playing a sport. Participants in athletic events are likely to receive treatment since coaches and other players are usually aware of the danger of concussions and encourage the injured player to see a doctor. People who experience a concussion after a fall are less likely to seek treatment.
The danger of an unexamined concussion is illustrated by the tragic death of Natasha Richardson, an actress who was married to Liam Neeson. She fell during a skiing lesson and sustained a concussion. A few minutes later, she seemed to have no difficulty thinking, speaking, or walking. Refusing medical treatment, Richardson returned to her hotel room. She began to have a headache a few hours later and died the next day. An epidural hematoma, or bleeding that causes a buildup of pressure between the brain and the skull, was determined to be the cause of her death.
The lesson to be learned from Natasha Richardson's death is that not all closed head injuries produce immediate symptoms. Bleeding or swelling within the skull can occur gradually over a period of days or weeks. If you experience a blow to the head, it is essential to seek medical attention immediately, even if you feel fine. The days of asking “how many fingers am I holding up?” and accepting a correct response as definitive proof that the injury victim is fine are long gone.
When symptoms of a closed head injury do appear, they may include:
- Disorientation or confusion
- Slurred speech
- Blurred vision
- Feeling sluggish or groggy
- Sensitivity to light or noise
Only 10 percent of closed head injuries cause a loss of consciousness. If an injury victim does lose consciousness, however, it is even more essential to obtain a prompt medical examination. Even a momentary “blackout” could signal a serious hidden injury.
Health care professionals will conduct a physical examination to make sure that no spinal damage accompanied the head injury. They will typically use a number of evaluation tools to determine whether a brain injury has occurred, including:
- Symptom checklists
- Neuropsychological tests (written or computer-based tests that assess an injury victim's brain function)
- Postural stability tests (an evaluation of the injury victim's ability to balance that often employs sophisticated diagnostic equipment)
- Neuroimaging (computed tomography or MRI scans may be warranted when a physician concludes there is a risk of severe injury)
Unfortunately, a CAT scan or MRI may appear normal despite the existence of a serious condition. The effects of a closed head injury can be difficult to detect and no test that can rule out the possibility of trauma.
Since swelling or pressure within the skull may take days to develop and may not be detected by scanning, it is important for a victim to return to the doctor if headaches persist or if new symptoms develop.
Traumatic Brain Injuries
Some brain injuries, particularly when an accident victim experiences a loss of consciousness for more than thirty minutes or enters a coma, may be serious and lasting. As a general rule, the longer a person remains unconscious, the more severe a brain injury is likely to be. Recovery from a traumatic brain injury — the kind that people often refer to as “brain damage” — may be prolonged. A traumatic brain injury may lead to:
- Difficulty thinking
- Memory loss
- Attention deficit
- Personality changes
- Mood swings
- Limited use of arms or legs
- Abnormal speech
The victims of these injuries are often unaware of these symptoms. Family members and friends who notice any change taking place in someone who experienced a head injury should make sure that person receives prompt medical attention.
If an injury is mild, rest may be the only treatment that a doctor prescribes. Activity impairs recovery so the rest must be complete. That means staying in bed and doing nothing that stimulates the body or brain.
More serious injuries may require drugs to reduce swelling and manage pain. Surgery may be necessary to drain blood from the skull in order to relieve pressure. Removal of tissue may be required to make room for swelling. Bleeding vessels may also need to be surgically repaired. Surgeons will sometimes implant a monitoring device to measure changes in pressure within the brain cavity.
Over the long term, severe cranial injuries may require extensive treatment. The conditions may be long-lasting or permanent, but treatment often leads to improvement. Physical therapy can help patients recover motor control, particularly if sessions begin soon after the injury occurs. Speech therapy may be necessary to help the patient regain the ability to articulate clearly. Cognitive rehabilitation is geared to helping patients recover memory, improve attention, and increase the speed at which they think and make decisions. Medications may help patients cope with depression-like symptoms, anxiety, and other mild and severe emotional disturbances.
These injuries can cause permanent or long-lasting changes in a person's lifestyle. In the most serious cases, the injured person may require daily assistance to prepare meals, to eat, to bathe, to dress, and to engage in other basic activities. In other cases, the injury victim may need specialized medical care as well as physical and occupational therapy.
If a closed head injury was caused by another party's negligence, the injury victim should seek compensation for the expense of receiving that care. In addition to health care costs, compensation should cover lost wages, loss of future capacity to earn, loss of life enjoyment, pain and suffering, and expenses that must be incurred in order to adapt to a new lifestyle.
Negligence means carelessness. When a truck driver changes lanes without noticing that the lane is occupied by a motorcyclist, the resulting collision (and the motorcyclist's head injury) is caused by the truck driver's negligence. When someone sustains a head injury after falling down a flight of stairs because of a defective handrail, the negligent failure to inspect and repair the property defect may entitle the injury victim to compensation. In some cases, a coach may be negligent for sending a player back into a game after the player sustains a concussion.
Whether an injury was caused by negligence is not always clear. An experienced personal injury lawyer is in the best position to make that assessment. Even if the injured person was partly or mostly at fault for the accident that caused the injury, California law may permit the accident victim to recover partial compensation for his or her injuries.