Understanding Brain Injuries: Explaining the Complex Impact on the Body

0:00:10 - Hey, I'm Shane from Shane Smith Law. I'm here today with Thomas, one of our attorneys on the brain and concussion injury group here at Shane Smith Law, and we were just sort of talking about brain injuries and what happens, but also looking for a way to explain what happens to the rest of the body, and what I mean by that is, you know, everybody's familiar with the initial injury. That's the impact when either your head hits some other object or when your skull, basically when your brain hits the skull because of some kind of spinning force or some kind of just I guess force overall causes it to go back and forth, right?

0:00:43 - Yeah.

0:00:44 - I think I was going to say and so that's the initial injury. But then how do we explain what happens to the rest of the body, what happens there? Because obviously, something in your hands you know it didn't take an injury, or something with your hormones, it didn't take the injury. The injury was to the brain. So what did the experts tell us? How do they explain it?

0:01:01 - Yeah, I think they use stories to explain it. That's one of the things that I think that we can do really well. Also is how can we explain this and make it so anybody can understand what's happened to them or what's happened to one of our clients?

0:01:11 - Because that's part of our job, right, we've got to take the injuries our clients have and explain it to an adjuster or explain it to a jury and also explain it to their family. Right, and situations where we're not being the doctor but we're taking the medical stuff and explaining it to the family because maybe the doctor is busy or maybe the clients didn't think about it when they were there. And then after the fact they're like, well, what does this mean?

0:01:34 - Yeah, and it's complicated, and so I think some of the stories that we can use or one of the examples we can use is you know, your brain's not a computer, it's not just zeros and ones and input and output. But one of the examples that people like to use is to compare your brain to either a city or a castle.

0:01:52 - So definitely, a city is obviously amazingly complex and when I think of a city, I think of this area, and then made up of millions of different people inside of the city all doing different things, and one person can do this and mess this up, and it's incredibly complex, yeah.

0:02:06 - Yeah, an example you could use and one I use, and explain it to my clients. A lot is imagine there's a tornado that drops down in the heart of Charlotte. You're going to have the initial damage from what that tornado does and then you're going to be finding trash cans three blocks away. You know your dog's up in the tree, your cat's over. There's going to be things that it takes you some time to figure out what happened.

0:02:27 - And I mean even, like you know, the tornado damages this area, but then also you have infrastructure failures and things that happen in other parts of the city based on what happens here, or even just transportation, right, because if one highway's torn all up, everybody's got a detour, which creates other problems.

0:02:42 - Exactly If that windstorm or that tornado came down and severed the power lines. Right, okay, if you have blackouts in some areas, power surges in some of the other areas, this would represent the disruption of the electrical impulses that happen in your brain. So you have tornado come down, blow things around, rip power lines.

0:03:00 - Not just in this area, but it impacts blackouts maybe miles away, right?

0:03:04 - Yeah, so maybe you're getting sensations in parts of your body. Here you're having certain different emotional imbalances. There's lots of different things that could go wrong from the electrical.

0:03:10 - And it sounds, you know you're talking about it electrical and emotional, and everything else, sometimes unexpected stuff too right, yeah, yeah, power goes out. I don't think about the fact that I'm gonna date myself here, but my VCR used to have to be reprogrammed, or my DVD. You know, you got to go fix all the clocks in your house, right? I mean, you don't expect that. Once the AC comes up, you're like, okay, it's all better, but it's not really.

0:03:34 - Right, yeah, and another example would be you know, in that city, let's say, a water pipe gets damaged all of a sudden you've got flooding all throughout the city or in other areas you know there's not any water going there. These could be, you know, cerebral edema. You know bruising or swelling or inflammation. You know these things kind of come in and you know create impacts in the city, that you know that excess of fluids in your brain might create intracranial pressure that leads to pain. You know, later on down the line, not necessarily within the first couple days of the collision, but could be within, but could also be a little bit later down the line.

0:04:08 - Really so it could. You could think it's all getting better, but then that inflammation damaged something else and as soon as it starts we think getting better than we figure out there's a problem here which creates other issues.

0:04:21 - Right. Things just continue to multiply and build on each other. Another example would be you know, gas lines are rupturing. You've got fires spreading from block to block. That could be, you know, lined up in terms of the inflammatory response in your brain and where the immune system comes in to repair. What's what's going wrong here? It might inadvertently harm healthy cells. You know, fire does not discriminate, neither does the inflammatory response at times.

0:04:45 - So it sounds like the experts are telling us that they use a bunch of different analogies inside the city from the one tornado windstorm. Right they power out electricity out, water out, all these things, which is, I mean, if you sort of think about it, like the brain is incredibly complex and initial injury can create a whole bunch of different types of injuries throughout. Right that cascade effect.

0:05:05 - The ripple effect all throughout. You know even the. You think about the city's communication network. You know tornado comes and you have the loud sirens. You can hear different announcements about things that are going on. That could be mirroring what happens in your brain. With a diffuse axonal injury, that's where you're having the connections between the neurons in your brain, which are the communication lines. Those are getting severed and that disrupts the flow of information throughout the city or throughout the body. Wow, that could lead to cognitive behavioral impairments, anything that's imaginable.

0:05:39 - And as we're talking about this, it sounds like it's mostly physical stuff, but same analogies work for the emotional and mental stuff as well.

0:05:46 - Yeah, absolutely. In terms of the emotional aspect. You know these can. All you know different parts of the brain correspond with different actions, with different emotional regulatory response to your ability to control emotions. If you're irritable, you know, if you're having mood swings, personality changes even.

0:06:02 - Can you so? Can you look at where the initial injury is and know like, hey, these are all the symptoms they're gonna pop out for you, or is it like you just can't? You know there's an injury and we know that's gonna be there, but we don't know everything it's gonna impact.

0:06:15 - Yeah, I think there are definitely some patterns that can recur in terms of motor vehicle accidents and where you'll see certain areas of the brain be impacted more than others. A lot depends on the mechanism of the injury, though, you know. Are you having just a sudden acceleration, deceleration, Are you having a spin where the brain's starting to almost kind of twist inside your head while your body moves? Those different things can impact and kind of line up and be something that the experts can look at the diagnostics to say, okay, we know this is how the accident happened and we see this area damaged on the brain and we know that gets damaged in these specific types of motion.

0:06:54 - Got you so they can sort of narrow it down, but obviously it's not a perfect science, yeah not a perfect, because every every brain is different in some sense. You know, we're all different people, yeah now, when you say an acceleration, deceleration, that is primarily what like a rear end collision, you get hit from behind. So the brain accelerates, then it decelerates, or the head does.

0:07:13 - Yeah, and it could be one or the other too. It could just be like a rapid acceleration and then a stop. You know you don't have to have acceleration and then deceleration, but I guess they do kind of go together. Yeah, so you could have, you know, just a sudden, but it's just a one impact, as opposed to a forward and backward kind of thing.

0:07:27 - Right, right, and is the spin normally? You know, when you talk about that shearing or the spinning of the brain, is that usually like if you're I was hit from the side like a t-bone, or is it if I was looking one direction or the other? Is that when that normally comes up the most?

0:07:40 - I think you would probably see it the most is if it was a t-bone that happened either at the front of the car or the back of the car and then that sends it off into a spin, almost like when you're stuck in the teacups with your kid at Disney World and you don't want to be there. Yeah almost like that kind of spin. At least I don't want to be there.

0:07:54 - Gotcha, I can understand that. So that sort of puts on how it happens, yeah, or how those injuries occur the most. And you said the experts. Then so when the experts happen they can look at how the accident occurred and sort of I don't wanna say guistimate, but I mean narrow down where they think the injuries are gonna take place. Then they look at the imaging that shows yes, these are the areas that are affected. Then that sort of leads to what treatment they would expect.

0:08:22 - Yeah, I think what's gonna happen at first is you get kind of an initial, a specialist, somebody who's trained in looking at brains. You want them to be looking at it. You know you don't want your primary care doctor necessarily, or an orthopedic doctor, you want somebody who's been trained on looking at brains. And then they are gonna get your symptoms and move from there to saying we should probably do some more advanced diagnostics on this to figure out what's going on. And then you know there are experts who can do a full fluid map of the inside of your brain essentially Diffusion tensor imaging is what's called where they're charting the water flow through your brain. Yeah so our brains, you know, like the oceans, like 95% of water or whatever it is, our brains are largely water. So this advanced diagnostic DTI diffusion tensor imaging came out FDA available three to five years ago and since then they've been able to especially calibrate MRI machines to look at the flow of water through your brain through about 29 to 30 different angles, to chart how it flows through your brain and actually reproduce color imaging of that flow of water through your brain in terms of you know how much is there, how little is there, and basically map it. It almost looks like if you have a bunch of grapes and you've taken all the grapes off and you see like all the branches go out in different directions and hey, there's none here, like this area of the brain is completely absent of water flow. So clearly that's bad, that would be bad, and experts would be able to look at that presumably and say, well, this area of the brain that's missing or there's not as much water flow here. This was, you know, let's say, on the side of their head, and this is the same side of their head that they had the collision that took place. And so it's likely, you know, based on all the symptoms and everything that we've seen, that you know this was caused by this.

0:10:12 - Well, I mean that sounds cool and I know in one of our future podcasts or episodes we're gonna talk about the DTI and go through to sort of see some of those images and how that takes place. I mean, to be honest, it sounds crazy to me. You know, it sounds like something right out of a science fiction magazine. You know, when we start talking about 3D stuff, I mean that's what you see in all the movies the scanner comes in and it's all there and you can figure out what's going on. But that's becoming real.

0:10:41 - Yeah, that's where we are now. It's amazing.

0:10:43 - Wow, I know when we were talking before the show where we were talking a little bit about also sometimes the experts, instead of using a city, they talk about a castle analogy. Tell me about that? What's that mean?

0:10:54 - Yeah, I've heard it talked about as a cerebrum castle.

0:10:58 - Cerebrum castle okay.

0:10:59 - If you think your brain is a castle and let's imagine you know there's a giant boulder that comes rolling along and that boulder, you know it comes and it crashes into the side of the castle, okay, and that would be your primary injury, your first impact, and now presumably there's gonna be things that happen structurally to that castle as a result of a massive boulder hitting it.

0:11:20 - And I got you kind of like I'm thinking about the little object years ago where you would pull the ball out and it would hit here and it would go over it. You know all this force is out somewhere over here. So if we hit the wall of the castle it's not just here, it's gonna impact structurally the rest of the castle as well.

0:11:35 - Exactly, you would have that boulder coming and crashing in and that impacts the structural integrity of the castle. This is something you could compare to that you know diffuse axonal injury, again, where the brain's communication lines are being disrupted by this massive impact and affecting everything transmitting the messages around the brain from different regions of the brain.

0:11:56 - I know we're gonna have to get you on and talk just about the brain and what really all that. You know, I don't know. Sometimes the brain people think about it just like in cartoons. You know, it's just this pink thing up there and who knows what goes on. So we're gonna get a little more into specifics there. But so much of the brain is all communication, right, I mean that's. So one little injury to that messes up the whole body.

0:12:18 - That's like you almost think of those cartoons where you had, you know, the eyeballs that somebody was looking through while they were moving the gears on the inside of the brain, making the rest of it work. You know, if the brain shuts down, you know, as you see when people who are seriously injured or in a coma, if the brain's not working, the rest of the body's not gonna work either.

0:12:34 - And it doesn't have to be something I didn't and a lot of our clients. You know they go to the emergency room and they're not. You know they're not getting the CT scans, they're not in a coma. Basically you know they're not suffering the huge open bleeding skull or swollen skull. How bad does that have to be to suffer some of this permanent injury.

0:12:52 - Yeah, when you think about a CT scan and that's there to detect if there's internal bleeding or a brain bleed, something that's gonna cause you to die or become comatose or have a massive, catastrophic impact.

0:13:06 - So the ER is not looking for personality changes or these communication errors. They're looking to make sure you don't die on the table, basically before you can get home and get better care.

0:13:13 - Exactly. And then that's where, at the end of those ER records, you hear them say with their discharge papers seek follow-up care with a specialist. Take a look at somebody else who knows this area.

0:13:25 - Can just a concussion lead to some of this stuff?

0:13:28 - Yeah, absolutely. A concussion can absolutely lead to some pretty significant impacts over the course of somebody's life.

0:13:34 - So it sounds like we shouldn't just call it just a concussion, basically like it's common, because I think about boxers and stuff like that and our football players. I mean well, there's been huge studies in football in the last several years about concussions and the impact of concussions and that might be something to dig into later on.

0:13:51 - Yeah, I mean a concussion. I tell our clients you may have had a concussion, but a concussion is a traumatic brain injury. It's a traumatic. It may be a mild traumatic brain injury, but it's a traumatic brain injury nonetheless. We can't let that label, you know, get us away from the fact that there's been trauma to the brain I was gonna say mild makes me think it's not bad, but Right mild can have some of the worst impacts that you might have. It might have a more moderate or kind of severe brain injury that causes a lot in terms of the direct injury but in terms of what happens later on down the road, it might be something that might seem lesser to you and I that causes some of the worst impacts.

0:14:22 - Just depending on exactly where it injured and what part. Because I know with John the other day we talked about, we pulled up a picture of the brain and we were looking at it and you know, some of those areas that control certain important functions are pretty small. Yeah, so if you just took an injury right to that area, that could have devastating consequences, even though it was sort of mild. I mean, it wasn't that bad of a hit, but it just happened to hit the wrong spot, right, right, exactly. Or I can think about the times when you know I suffered a minor injury. But even think about the amount of pain you suffer if you hit your funny bone.

0:14:56 - Right, yeah, you know right on.

0:14:58 - That nerve cluster is what it is. But if you hit that nerve cluster in the brain, yeah, prick in your famed gear for a blood draw. Yeah, that's for weeks after Well, John, all right, Thomas. I think those are great analogies and great ways. I like the castle one. I mean it makes more sense. I know when you first told me I was like, really, but you know the fact that, yeah, it's gonna impact all the structure of your brain. You know structurally that the rest of that castle makes sense to me, and then the city, and obviously the brain is hugely complex and we find new things out every single day. I think, yeah, absolutely, all right, you're welcome, great. Well, that is our episode for today. Remember, I'm Shane from Shane Smith Law, and we're here with Thomas from the concussion and brain injury group, here at Shane Smith Law talking about concussion injuries. And if you're in pain, call Shane 9-8-0, 9-9-9, 9-9-9,. If you're suffered a concussion or something like that, feel free to find more information on our channel. that, hopefully can help you out.

[END OF EPISODE]