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Types of Brain Injuries and Catastrophic Designation

By Matt Lalande in Brain Injuries on February 25, 2021

Types of Brain Injuries and Catastrophic Designation

What is a traumatic brain injury?

A traumatic brain injury is when sudden trauma by an external force causes temporary or permanent damage to the brain – such as a motorcyclist hitting their head off the pavement – causing the brain io move inside the skull.  The brain in turn, suffers from a disruption in normal function which can last hours…or in worst case scenario, a lifetime. Symptoms can be wide ranging and can be mild or very serious, and can range from mild alterations of consciousness to an unrelenting vegetative state and death. In severe cases of traumatic brain injury, the entirety of the brain is affected by a diffuse type of injury and swelling. Treatment types can no doubt vary based on  how severe the brain injury, and can range from daily cognitive therapy sessions to radical surgery such as bilateral decompression craniectomies.  The brain is the most critical organ in the human body. It controls the nervous system, which is responsible for every movement, thought, and action the body takes. Therefore, when an individual suffers a severe injury to the brain, the consequences can impact every part of the body and leave the individual completely and permanently disabled.

Traumatic brain injuries occur with alarming frequency in the Canada. Braininjurycanada.ca tells us that about 456 people every day, or one person injured every 3 minutes in Canada suffers from a traumatic brain injury. Despite this frequency, the majority of such injuries go undiagnosed and untreated simply because most medical professionals do not think to look for symptoms if it does not appear that the victim suffered a direct blow to the head, i.e., something that left bruises or scars.

If you are a loved one suffered a traumatic brain injury in a car accident, motorcycle accident, trucking accident, as a pedestrian or on a bicycle you will have access to accident benefits (through your own policy or the policy of the at-fault driver) which are no-fault auto accident insurance benefits available to anybody injured in or by a motor vehicle in Ontario. Accident benefits are available to assist injured victims fund their treatment and better their quality of life. The accident benefit system is divided into tiers, with each tiers having certain monetary amounts available to accident victims depending on the severity of their injuries. The upper tier is called the “catastrophic impairment” category – which is normally reserved for victims with very severe injuries. Victims that meet several criteria and who fall into this category, have enhanced benefits up to $1 million (in medical, rehabilitative and attendant care benefits) available for life.

Victims who suffered traumatic brain injuries in motor vehicle accidents may qualify to be deemed catastrophically impaired if they meet certain criteria, several of which is explored below.

General Types of Brain Injuries

There are two major types of head injuries:

(1) an open head injury which is the result of a penetrating wound and (2) the closed head injury. A penetrating injury is best exemplified by a gunshot wound, in which the scalp is penetrated, and brain damage created where the bullet actually moved through brain tissue.

Car Accident are often the cause of closed head injuries, which are injuries is one which usually results from blunt trauma to the head. Acceleration and deceleration forces cause the brain to rotate in the skull. As a result of this, maximum pressure is exerted on the frontal and temporal regions resulting in sheering and extensive white matter  damage. In a closed head injury, brain damage over a large area often results in a great variety of deficits including loss of consciousness, problems in attention and memory, and alterations in social behavior. Extensive research has confirmed that it can be very difficult for head injury victims to return to normal family or community life after a serious accident.

Head Injury Effects

To appreciate the effects of traumatic brain injury, one must understand the individual and the symptomatic disorders. Problems can include attention and arousal disorders communication and language difficulties, loss of memory, diminished ability to learn, visual and auditory perception, hampered information processing, reasoning, judgment and problem solving.

It is not unusual for a person who suffers a traumatic brain injury in a car accident to recover the ability to communicate and interact with other individuals, thus disguising these deficits to the casual observer. Only when detailed studies are completed and careful observation has been made in the home or rehabilitation center are these disabling consequences apparent.

How are Traumatic Brain Injuries Treated?

Immediately post-accident, the victims is normally treated in a hospital setting. The head injury usually involves treatment by a neurologist; where organic damage is present it will require treatment by a neurosurgeon. At the outset, the victim in addition to normal medical treatment will normally receive an evaluation, both physical and psychological, by a physiatrist (a physician specializing in physical medicine). Post-discharge treatment is usually resumed in a rehabilitation center where the physiatrist supervises treatment. Usually a number of therapies will be involved in the rehabilitation including a physical therapist, an occupational therapist, a visual therapist, a specialist in cognitive remediation. These stays are often lengthy and painful for the victim.

Catastrophic Designation under Ontario’s Statutory Accident Benefit Schedule

In Ontario, being declared catastrophically impaired soon after a car accident or any type of vehicle accident involving insurance is a key component to properly funding treatment. In Ontario there are three tiers of accident benefits available. If a victim sustains minor injuries in a car accident, motorcycle or trucking accident, he or she is entitled to receive up to $3500 in medical and rehabilitation benefits. Non-catastrophic victims suffer serious injuries are entitled to receive up to $65,000 in medical, rehabilitation and attendant care benefits over five years. If a person suffers a very serious injury, or a catastrophic injury, that person would be entitled to $1 million in medical, rehabilitation and attendant care benefits for life.

Being deemed catastrophically impaired is an extremely difficult test to meet in Ontario – and the determination for testing differs between minors and adults. However, there is one similar criteria in the accident benefits schedule that will apply to both minors and adults when determining whether the traumatic brain injury should be deemed catastrophic. No matter if the victim is a minor or an adult, there must be positive findings on a computerized axial tomography scan, a magnetic resonance imaging or any other medically recognized brain diagnostic technology indicating intracranial pathology that is a result of the accident, including, but not limited to, intracranial contusions or haemorrhages, diffuse axonal injury, cerebral edema, midline shift or pneumocephaly.

What does “Positive Finding” mean?

Whether a CT scan, MRI or other medically recognized brain diagnostic technology – a positive finding means that the particular medical image confirms the presence of a certain condition. In other words, the clinical image does not rule out suspected problems, but rather confirms traumatic brain issues to near certainty.

What is an Intracranial Contusion or Hemorrhage?

In simple terms, an intracranial contusion or cerebral contusion is a bruise to the brain. While a bruise may be a minor injury when it’s located on the external body, it is extremely severe when it occurs on the brain. A bruise on the brain often occurs after a car accident, when the sudden jolt of force causes the brain to strike the sides of the skull. Intracranial contusions are different from concussions in that an intracranial contusion can hemorrhage and cause structural damage to the brain.

Hemorrhagic progression of a contusion occurs when blood leaks through the area of injury and into the brain tissues, which is very dangerous because blood is extremely toxic when exposed to the brain. To treat this issue, the individual may be required to undergo a craniotomy, where part of the skull is surgically opened to remove the contusion. An intracranial contusion may cause disabling symptoms such as seizures, unconsciousness, impaired cognitive function, personality changes, nausea and vomiting, impaired coordination, and vision loss. If not treated immediately, a hemorrhaged contusion can also lead to death.

What is a Diffuse Axonal Injury?

A diffuse axonal injury is a very severe type of traumatic brain injury that occurs when the fibers in the brain (axons) are torn, twisted, stretched or sheared. Axons are nerve fibers that connect the nervous system to the brain. When they are cut off from the brain, the brain can no longer receive signals or communication from the nervous system. Diffuse axonal injuries occur when the brain rapidly shifts back and forth inside the skull, usually as the result of a blunt force or blow, and the fibers are torn away. This is most commonly caused by motor vehicle accidents, motorcycle accidents, and slip and fall accidents. Sadly, it is also a common child injury found in cases where small children suffer severe abuse or shaken baby syndrome.

The most common and notable symptom of a diffuse axonal injury is loss of consciousness, and therefore most victims are left in a coma. Unfortunately, this type of brain injury has a poor prognosis and one of the major causes of death from brain injury. If the individual does survive, they are usually left with permanent symptoms that include fatigue, disorientation, confusion or reality distortion, disruption in sleep patterns, impaired cognitive function, and/or a persistent vegitative state.

What is a Cerebral Edema?

A cerebral edema occurs when pressure builds up in the tissues around the brain, causing swelling to the area. When the swelling grows larger, it can begin to restrict oxygen flow to the brain and destroy brain cells. Additionally, it can destroy the blood-brain barrier, which normally prevents toxic fluids from entering the space around the brain. Generally, this occurs as the result of a brain injury, either at the onset of the impact or when the body’s natural reaction to sudden trauma begins to trigger swelling (just as it does with injuries to other areas of the body).

This type of injury may also occur as a secondary symptom of another condition, such as a stroke, a brain hemorrhage, a tumour, or even an illness such as meningitis. Cerebral edema injuries can have fatal consequences, and those who survive are often left with irreversible, permanent damage. If an individual survives, they are left with a variety of symptoms, including impaired cognitive function, difficulty speaking, memory issues, neck pain, migraines, mobility issues, loss of consciousness, and vomiting.

What is a Midline Shift?

When the brain suffers a severe blow, blood vessels can burst or rupture, leaking blood into the brain and causing a buildup. This leads to pressure and swelling that build up around the site of injury, causing the entire brain to shift its position off-centre, known as a midline shift. Usually, a midline shift may happen as the result of other types of traumatic brain injury mentioned above, such as a cerebral edema or intracranial contusion.

A midline shift requires immediate emergency medical attention, and can lead to death if not treated urgently. Often, surgical intervention is required to relieve the pressure and remove the buildup of blood in the brain. The prognosis and survival rate depend on the size of the shift – if it is less than 10mm, the outcome is more favourable.

Since a midline shift leads to a re-positioning of the brain off the centre, individuals often experience symptoms associated with balance, vision, and coordination since the brain is no longer centred. Therefore, long-term symptoms in those who recover include imbalanced or limited vision, disorientation, lack of coordination, decreased spatial awareness, and dizziness.

What is Pneumocephaly?

A traumatic pneumocephalus occurs when air fills the intracranial cavity after a traumatic event. Generally, the air gets in when the skull is fractured or cracked, but it could also occur when there are tissue tears. When this happens, the air can cause a buildup of pressure to the brain, leading to severe neurological damage. In some cases, the air buildup may be delayed, but if it is not diagnosed early or treated as early as possible it could be fatal. The longer the air builds up, the more pressure it can place on the brain and ultimately damage brain cells.

Individuals with traumatic pneumocephalus have also reported feeling a “gurgling” sensation in their head, which can cause discomfort. Other symptoms may include dizziness, headaches, seizures, loss of consciousness, irritability, nausea and vomiting, among other impaired cognitive functions.

If You or a Loved One Has Suffered a Catastrophic Brain Injury, Make Sure You Get the Compensation You Deserve

Matt Lalande is a brain injury lawyer who has assisted countless victims with traumatic life-threatning brain injuries across Ontario since 2003.  Our Hamilton Brain Injury Lawyers have seen firsthand how devastating and disabling these injuries can be. When an individual suffers from a brain injury, they often become a fragment of the individual they once were, which can deeply impact their family, social, emotional, and physical life. Adding financial burden on top of these devastating consequences can be unbearable.

Seeking catastrophic designation for your brain injury may be difficult and is not a process you should have to take alone. A Hamilton personal injury lawyer can take care of the process for you, allowing you to work on your recovery while we handle the legal factors. You do not need to suffer more than you already have, and fair compensation is the first step in leading the best life you possibly can.

Book a free, no-obligation consultation with us as soon as possible. We’ll listen to your case details, empathize with your situation, advise you on the best course of action, and most importantly, we will never charge you fees up front. You can schedule a call back on our online contact form, or call us province-wide at 1-844-LALANDE  or local in the Hamilton/GTA at 905-333-8888.

1 King Street East, Suite 1705

Hamilton, On L8P 1A4

*The above information was approved by Matt Lalande or another lawyer at Lalande Personal Injury Lawyers. The information comes from legal experience, trial experience, extensive medical research and discussion with medical professionals, medical journal review and updates and/or consultations with fellow friends and colleagues in the legal and medical field.



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