Why Diffuse Axonal Injuries Are Catastrophic Brain Injuries

By Jack Hickey | August 22, 2023

A Traumatic Brain Injury (TBI) even if it is “mild” can have a devastating effect on your life. Brains are vulnerable to injury. The brain is soft. It has the consistency of tofu. It is encased in a hard skull which has a lot of sharp edges on the inside. When there is some sudden movement – like when someone is in a car and the car stops suddenly or crashes – the brain can move back and forth within the skull. That in turn causes the brain to hit the inside surfaces of the skull.

An axon is “a nerve fiber or long slender projection of a nerve cell, or neuron, which conducts electrical impulses” according to Wikipedia. Diffuse axonal injury happens when the brain’s nerve fibers experience significant damage, like tearing. Diffuse axonal injuries can happen when the brain experiences strong shaking and rotation from physical forces, usually car accidents. These injuries can affect various regions of the brain. Victims can suffer from long-term neurological issues and impairment. In severe cases, victims can suffer from comas or death.

If victims are lucky to survive a diffuse axonal injury, they may rely on physical therapy, speech therapy, and other rehabilitation services for the rest of their lives. These are considered in most cases a way to cope with brain injury. In other words, therapies will not cure or make the injury better or healed.

Other causes can include:

The tearing of the nerve fibers interrupts the brain’s regular processes.

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What happens to your brain in a car accident

The brain is surrounded by cerebrospinal fluid within the skull. Because of that, the brain moves back and forth within the skull if there is a sudden acceleration or deceleration of the body and the head. This movement, called coup/contra-coup can injure the brain even if you do not fracture your skull or even hit your head.

When a brain is injured in this way, it causes a condition called a concussion. Concussions can cause a bleed in the brain, and the secretion and buildup of cerebrospinal fluid. (For this reason, after an injury physicians say that the brain can weep.) This buildup of fluids takes place in the skull. But the skull does not expand. So the brain can be pushed against the walls of the skull and be compressed in the skull.

With enough compression, at least two things can occur. First, the brain can be moved over away from the side of the hemorrhage or collection of blood and fluid. That is called a mid-line shift. If the shift is far enough over, usually 5mm or more, the surgeons want to perform a craniectomy – cutting out of the skull – to relieve the pressure on the brain. Second, if the brain is compressed the architecture of the brain can change. That change is referred to as mass effect.

Even without skull fracture, without any hematomas, without a midline shift of the brain, without any mass effect, there can be injury to the axons in the brain.

Complications of diffuse axonal injuries

Depending on other areas of the brain that were damaged, victims can experience other symptoms. These symptoms include:

      • Severe headaches
      • Dizziness
      • Nausea
      • Fatigue
      • Vomiting
      • Blurred vision
      • Difficulties with communication
      • Behavioral changes

How Hickey Law Firm works with Miami brain injury victims

At our firm we have the initial screening process for TBI. Then we give our clients and their loved ones a TBI Checklist. This TBI Checklist is a comprehensive list of the signs and symptoms over a period of time of the effects of TBI. We know what specialists and what tests are critical to detection and diagnosis of a TBI. We have worked in the past with neurologists, neuro-radiologists, neuropsychologists, and other TBI specialists.

The initial screening for TBI consists of questions for the person or their loved one. At the start of our interview of any prospective client, if we suspect that this person suffered a TBI, we ask questions like:

      • Did you hit your head on a surface or object? If so, what part of your head came into contact with what surface or object? (The back of the head is the most vulnerable to a TBI).
      • Did the hit leave a bump, bruise, or laceration (tear of the skin)?
      • Did your head whip back and forth or was there a sudden deceleration while in a vehicle for example?
      • Did you lose consciousness* or were you dazed and confused? If so, for how long?
      • Is there a period of time that you do not recall what happened? From what event to what event was that? (Then ask someone else who was there how long that would have been).
      • Were you nauseous or did you vomit at any time in the 48 hours after the injury?
      • Have you suffered any seizures since the injury?
      • Were you ever diagnosed with a concussion following this injury? Where and by whom?
      • When was the first time you sought medical attention?
      • Did you tell them that you did lose consciousness and if so for how long?
      • Did you get a CT scan of the brain and if so did it show a bleed on the brain?

*Note: Our brain does not have an on/off switch. “Did you lose consciousness?” is a bad question because

      1. The person who was injured is not a reliable historian of this. How can someone know if they lost consciousness and certainly how can they know how long they were “out”? And
      2. Consciousness is a sliding scale or gradation, not an on/off situation.

Then we ask about symptoms now and in the last six months. The symptoms or problems can be in the areas of memory, long term and short term, executive function (the ability to plan and execute the plan), emotionality (tearing up frequently and in situations which would not have made you emotional before, not feeling like yourself, feeling out of it, or the feeling of malaise like you are not quite there), irritability, and depression.

TBI can alter your brain’s processing speeds. For this reason, it may be difficult for you to plan, to know where you are, to recall why you went to a certain room of your house, and to perform simple, everyday tasks.

When you or a loved one has suffered a TBI, you need a specialist

At Hickey Law Firm we know what to ask and what to do. And we listen. We have represented people with mild, moderate, and severe TBIs for over 25 years.

The lead trial attorney John H. (Jack) Hickey is Board Certified by The Florida Bar in Civil Trial and Admiralty and Maritime Law and by the National Board of Trial Advocacy (NBTA) in Trials. Best Lawyers in America recognizes Hickey and Hickey Law Firm in three areas: Personal Injury Litigation – Plaintiffs; Admiralty and Maritime Law, and Medical Malpractice – Plaintiffs.

Hickey Law Firm has secured over $100 million on behalf of their clients in Florida and across the country. One example of a TBI case is the $12,000,000 settlement in the Adkins v. Florida Keys Dive Center case, a case where a dive boat backed over two of its divers, causing severe head and brain injuries to a young boy and his father. The insurance on the vessel was only $1 million.

Hickey lectures other personal injury lawyers and publishes articles on TBI. This is a specialty for a lawyer. You have to know the medicine and the signs and symptoms of a TBI. We do.

Hickey Law Firm has built a reputation for being a voice for the seriously injured. The slogan “Fighting For You” is not just a slogan for Hickey Law Firm. It’s who we are and what we do. We meet with clients and families in their homes, a hospital, or other convenient locations if they cannot come to our office.

When you want to be properly compensated after suffering a brain injury, speak with a seasoned Miami, Florida brain injury lawyer today. Call Hickey Law Firm or complete our contact form to schedule a free consultation.

Posted in Personal Injury