Brain Injury Lawyer - New York

Drug found effective in treating cases of partial losss of smell

Anosmia is the inability to perceive smells and is a frequent complication following a head injury. The condition can be either temporary or permanent.

Although the sense of smell is controlled by the olfactory nerve, this nerve is seldom tested as part of the standard neurological examination and frequently victims of head trauma do not associate their loss with the trauma producing event. In our brain injury legal practice, we have encountered several individuals who lost their sense of smell following skull fractures, yet many months went by before their complaints were addressed by medical personnel. 

A drug once used to treat asthma and other respiratory conditions shows promise in restoring a sense of smell according to a study that appears in the June issue of the American Journal of the Medical Sciences.

The drug, theophylline has shown promising results in patients that have sustained a partial loss of smell but has not shown good results in those with a total loss.

Following Severe Brain Injury: Need to Monitor For Seizure Activity

Two new studies published  in the Annals of Neurology and Critical Care Medicine  demonstrate a need for more vigilant monitoring for seizure activity among intensive care patients who may be experiencing subtle seizures that are typically unrecognized. These subtle seizures may be affecting patients' prognoses and causing long-term brain damage, death and severe disability.

It has previously been shown that unrecognized seizures are common in the critically ill, particularly in those with acute brain injury, and that these seizures are associated with unfavorable outcomes.
 
The two studies found that electroencephalography (EEG)  was effective in detecting subtle seizures that are often impossible to detect by visual observation.

The findings demonstrated the value of continuous EEG (where electrodes are placed on the scalp – a noninvasive procedure used in nonsurgical ICUs)  and intracranial EEG (ICE), an invasive technology where a probe is placed in the cortex of the patient's brain. ICE is mainly used in Neurological ICUs for serious acute brain injuries, such as subarachnoid hemorrhage, severe head trauma and very large strokes (hemorrhagic or ischemic), which require other invasive brain monitoring devices.

The papers, are entitled  "Intracortical Electroencephalography in Acute Brain Injury," and  "Continuous Electroencephalography in the Medical Intensive Care Unit".

Could TV Pitchman, Billy May's Sudden Death Be Caused By A Traumatic Brain Injury?

TV Pitchman Biilly May, suddenly passed away on Sunday.  Word is spreading that on Saturday, while on board an airplane, he struck his head after the plane's tires blew out during a rough landing. 

Sounds similar to the fate of Natasha Richardson who also died suddenly after she struck her head.

The condition causing these sudden deaths is termed, "talk and die" syndrome.  What is implied by this terms is that someone hits their head and seems to initially be OK, but due to a rapid accumulation of blood, called epidural hemorrhage (bleeding between the skull and the brain), their are serious pressure changes within the brain, leading to death. 

The take away message is that any head injury must be taken seriously.  The individual experiencing the head trauma needs to checked out by qualified medical personnel to determine if the head injury requires treatment.

Decompressive Craniectomy: Studies Underway To Determine Effectiveness

Decompressive craniectomy , a procedure where a portion of the skull is removed to allow the brain to expand is widely used to treat intracranial hypertension (high pressure within the brain causing brain damage) following traumatic brain injury (TBI).

Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI.

It is important to determine if this procedure is really effective in reducing death and disability following a severe brain injury because there are many complications that can develop as a result of this procedure.

The complications surrounding this procedure are discussed in an article in the June issue of NeuroSurg Focus, vol.  26 No. 6  To evaluate the complications of decompressive craniectomy, a review of the literature was performed restricting information to literature pertaining to decompressive craniectomy for patients with TBI.

An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy.

The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI.

During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy.

The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.

Traumatic Brain Injury Can Cause Premature Death

An interesting news report from ABC News examines the link between traumatic brain injury and premature death .Can Brain Iinjury Lead To Death Years Later? 

It is important to realize that the impact of a traumatic brain injury may have long term consequences including premature death. Traumatic Brain Injury (TBI) for to many years has been overlooked as a source of long term disability and premature death.  The investigation and the studies cited in the news report have serious implications for the many service members returning from oversees with brain damage.  This signature wound may be a cause of premature death.  Who would argue that these service connected deaths are not entitled to proper compensation?

Progesterone Study For Traumatic Brain Injury Now in Third Phase

Preliminary research studies at Emory University, Atlanta, Georgia have shown that patients who receive progesterone injections shortly after sustaining a severe head or severe brain injury have reduced risk of death and long term disability.  The small pilot study had enrolled 100 Participants.

Now the National Institute of Health (NIH) has provided an additional 14.5 million dollars for a three year comprehensive study that will enroll 1,140 patients at 17 medical centers across 17 states to further study the protective effects of progesterone in minimizing death and the long term consequences of traumatic brain injury. 

Read the full Emory press release: progesterone for traumatic brain injury.

Three Years and Not One Service Member Tested for Subtle Brain Damage

Subtle brain damage is often missed by conventional MRI testing, leading many to falsely conclude that no structural brain damage has taken place.  This false premise has subjected many individuals who have sustained brain injury, including returning veterans to have their claims rejected. 

The absence of proof is not proof of the absence of an injury and the fact that often times brain injury is not detected using MRI Studies does not mean that an individual did not suffer a traumatic brain injury. 

Newer MRI techniques such as the more powerful Tesla 3 MRI machines are now capable of detecting brain injuries that were missed in the past. Other useful techniques for detecting subtle brain injury include functional MRI studies (fMRI)
 
Three years ago, the Department of Veterans Affairs established a laboratory at the University of Texas at Austin with high expectations that it would conduct state-of-the art research into combat-related brain injuries using powerful MRI technology.  However after 3 years no studies have ever taken place!

Last month, the VA announced it was moving the facility to Waco, Texas, after spending more than $3 million without testing a single veteran with traumatic brain injury.  The Waco facility is reported to have the world’s most powerful research MRI machine.

The decision follows a two-year battle between VA and the former director of the Brain Injury and Recovery Laboratory, who has accused his superiors of fraud, mismanagement and wasting taxpayer money.

The uproar has sparked a congressional inquiry, an investigation by the federal Office of Special Counsel and several internal investigations.

Hopefully, research will finally get underway to objectively document subtle brain injuries in returning vets.

You can read more on the controversy and investigation of the Austin facility by clicking a story in the Washington Post , “VA Moves Texas Brain Laboratory After Years Pass Without Testing”

Comparing Brain Damage in Brains of Wounded Vets to Brain Damage in Football Players

The Sports Legacy Institute and the Boston University Center for the Study of Traumatic Encephalopathy have announced that they will be now examining the brain tissue of service members who have passed away after suffering from blast injuries.  They will be comparing the pathological findings in the brain tissue of victims of blast injury to the findings in tissue examined in football players who have sustained multiple concussions. The full story is reported in the New York Times article, "A Chance for Clues to Brain Injury in Combat Blasts".

The researchers hope to determine whether single, non-impact blasts in battle can cause the same type of brain damage found in the brains of football players who have been subject to years of repetitive head injury.

They researchers also are interested in determining whether their are physical changes to the brain in service members who have been diagnosed with post traumatic stress disorder (PTSD) since many of the symptoms associated with this condition, such as depression, erratic behavior , diminished ability to concentrate are all similar to the post concussion symptoms faced by professional athletes and other concussion victims.

Brain Injury Resource Lecture at The George Washington University

I am thrilled to be in Washington DC today to again lecture at the Master's Degree Program in the Center for Education and Human Services Acquired Brain Injury Masters program at The George Washington University.

This semester’s lecture is focused on examining the various sources of information that is available on the internet in the area of traumatic brain injury. We will be exploring government web sites such as the Center For Disease Control and the National Institute of Health, great brain injury resource sites such as BrainLine, web sites that emphasize management of sports concussions, web sites that provide useful information on special education, various neuropsychological accrediting groups, brain injury association pages, brain injury professional societies and of course the brain injury news and information blog and brain law and the brain injury legal guide web site.

The Master's Degree Program in Special Education: Emphasis in Acquired Brain Injury is focused in addressing the national shortage of special education and related service personnel qualified to meet the needs of students with traumatic brain injuries (TBI) and their families. Graduates are uniquely prepared to be educators and systemic improvement specialists in schools, hospitals, rehabilitation programs, advocacy programs, and related organizations. Scholarship support for qualified students is available. You can obtain more information on the GW Acquired Brain Injury Program by clicking here.

Cognitive Fatigue Following Brain Injury Documented in New Study

A recent study by Kessler Foundation Research Center published in Brain Injury, the official journal of the International Brain Injury Association, uncovered the possible cause of cognitive fatigue in patients suffering from traumatic brain injury (TBI). Cognitive fatigue has been shown to be one of the most challenging symptoms following TBI, greatly affecting everyday life activities such as work and school.

The study also addressed the difficult task of measuring cognitive fatigue through the use of functional MRI (fMRI), an advanced imaging technology.   It is hoped that this information will also be useful in addressing the symptoms of traumatic brain injury in returning service members.

It has been reported that 73 percent of TBI patients report significant levels of fatigue even five years after they have sustained brain trauma.
 
A roadblock in the progress for treating patients for cognitive fatigue is the availability of  assessment tools. Researchers have been struggling for nearly a century to find ways to measure and diagnose cognitive fatigue. Common methods include self-reporting and objective assessments. This study offers a new and innovative paradigm to investigate brain activation during a cognitive task.
 
The study entitled “The Neural Correlates of Cognitive Fatigue in Traumatic Brain Injury Using Functional MRI” (Kohl et al, Brain Injury 2009;23(5):420-32),  details how fMRI was utilized to assess cognitive fatigue in people with TBI while they were performing behavioral tasks.  Researchers compared the readings of eleven healthy controls with those of eleven participants with moderate to severe TBI. The fMRI images illustrated increased brain activity in the patients with TBI, which indicates greater cerebral effort indicative of cognitive fatigue. 

“Cognitive fatigue has been shown to be one of the most debilitating symptoms after a traumatic brain injury. It can hinder every aspect of a person’s life,” stated John DeLuca, Ph.D., one of the study author’s. “The study could potentially improve the quality of life for civilians and veterans with TBI as well as stroke survivors and individuals with multiple sclerosis, Parkinson’s disease, and AIDs.”