The risk of brain injury following trauma to the head is well known and many firms will have policies in place to try to identify such cases early.
At Brain Injury Group member firm, Carpenters, whenever there is reference to loss of consciousness or concussion, they speak to their client about the mechanics of brain injury and symptoms, after which a member of the Serious Injury Team will review the case.
Mark Benson is experienced in dealing with such cases. As a specialist with Carpenters in cases involving life-changing injuries, he is only too aware that brain injury can result from secondary injury. Mark spoke to us about secondary brain injuries and told us Jane’s story:
Secondary Brain injury
One such example of brain injury sustained as a secondary injury is a case that we have recently settled at Carpenters. It acts as a reminder that there can be less obvious causes of secondary brain injury and that we cannot always rely upon the treating clinicians to identify it.
In the summer of 2019, Jane (not her real name) instructed Carpenters to bring a claim for damages arising out of a high-speed head-on road traffic collision. The immediate medical focus was on Jane’s severe lower limb injuries, including bilateral open distal femoral fractures with significant blood loss. There was no evidence of a traumatic head injury and no amnesia. Although her Glasgow Coma Scale (used to assess the level of consciousness after an injury, commonly referred to as GCS) continued to be recorded as 15/15, about 2½ hours after the collision, her blood pressure dropped. Her GCS then started to drop and reached as low as 4/15. She was treated with blood transfusions in the air ambulance and then at hospital.
No indication of a brain injury
Whilst receiving treatment in A&E she had a CT scan of her head and neck which identified no abnormalities. She remained in hospital for about 5 weeks due to the severity of her lower limb injuries. Jane reported symptoms including fatigue, slurred speech when tired, visual disturbance, word and number blindness, poor memory and concentration and low mood – all of which improved, but did not resolve, during her stay in hospital.
Due to these symptoms, she was reviewed by a Consultant in Rehabilitation who stated that there was “nothing to suggest primary brain injury” and that the decline in GCS was following ketamine and a drop in blood pressure. They concluded “secondary brain injury [was] unlikely” and that she was suffering from “post concussion symptoms following rapid deceleration”. They “reassured [her] that she should make [a] full recovery”.
Following her discharge, an Occupational Therapist was instructed to provide Case Management. She noted that Jane had been diagnosed at hospital as suffering from a concussion and reported issues such as memory and concentration difficulties, slurred speech when tired and number and word blindness. She felt that Jane’s challenging domestic circumstances were relevant to her presentation and made no recommendations other than counselling with a psychotherapist.
An undiagnosed brain injury not initially caught by Doctors
In early 2020, lawyers from Carpenters visited Jane, along with a barrister who specialised in brain injury. After discussing her difficulties with her, we formed the view that there may be an undiagnosed brain injury and arranged a 3T MRI scan.
The neurologist who reviewed the scan identified extensive ischaemic damage which was consistent with watershed stroke. A watershed stoke occurs when the blood flow to parts of the brain is severe reduced leading to brain tissue death. In Jane’s case, the neurologist felt this was due to compromised circulation with hypotension and reduced oxygenation of the blood, following massive blood loss from the open lower limb fractures sustained in the road traffic collision.
As part of the claim, neuropsychological testing was performed which found evidence of impaired processing speed, auditory working memory (the memory used to remember and work with information that you hear) and verbal fluency (the ease with which a person can produce words) due to the brain injury.
Compensation for lifelong case management assistance
Experts who assessed Jane felt she would need lifelong case management assistance and whilst Jane had the mental capacity to manage her finances, it was felt that she could be at risk of financial exploitation. Jane’s ability to return to work was impaired by her leg injuries and her cognitive impairments.
This case highlights the importance of instructing a specialist solicitor who will listen and is able to recognise the signs of a possible brain injury and act upon it. As lawyers, we cannot just assume that there has not been meaningful brain injury just because there was no traumatic head injury or because the initial radiology was clear. Whilst it is rare for treating clinicians to miss meaningful brain injury it does happen, and this reiterates the importance of ensuring that cases are dealt with by specialist lawyers.
This article was produced by Mark Benson of Carpenters Group
Mark specialises in acting for clients who have suffered life-changing injuries as well as fatal accident claims. He represents children and adults including where Court approval is required as the client is a protected party due to lack of mental capacity.
About Carpenters Group
Carpenters Group have offices in Liverpool, Birkenhead, Glasgow and Haywards Heath.
Their specialist brain injury lawyers combine years of experience and expertise with a friendly and empathetic approach to ensure clients and their families are fully supported as soon as possible following their injuries.
How can Brain Injury Group help?
If you have been injured in an accident and would like a free, no-obligation chat with a specialist brain injury solicitor about the circumstances surrounding your accident, please email enquiries@braininjurygroup.co.uk, telephone 0330 311 2541 or visit our website to access live chat.
We are also able to offer free welfare benefit checkups to all affected by brain injury, to ensure you are receiving the right benefits for your individual circumstances.
