Brain Injury Attorney

Fairfax Injury Lawyer Brien Roche Addresses Brain Injury Cases

Brien Roche

Brien Roche is an experienced brain injury lawyer serving all of Northern Virginia, including Fairfax, McLean, Vienna, Burke, Annandale, Falls Church Reston, Centreville, Manassas, Alexandria, Herndon, Arlington, and Loudoun County. Call or contact us for a free consult.

Auto accidents, falls, industrial accidents, physical assaults, hypoxia, sports injuries are all causes of brain injury. Most brain injury cases involve what is called a “closed head injury”.  In other words, there is not an actual skull fracture.   A common diagnosis following a brain injury is post-concussion syndrome.  Brain injuries are mild, moderate or severe.  A head injury can have lifelong consequences. If you or a loved one has such an injury, you need aggressive and skilled representation. That attorney must recognize the symptoms of brain injury and identify the scope of the injury. Call or contact us for a free consult. For info on proving damages see the page on this site.

Symptoms of Injury to the Brain

It is difficult to fully comprehend the scope of the client’s injury. That is because there are a multitude of subtle symptoms and signs associated with brain injury:

  • Short term memory loss
  • Impaired judgment
  • Seizures
  • Personality changes
  • Ringing in the ear
  • Depression
  • Trouble staying focused
  • Blurred vision
  • Dizziness
  • Changes in Sleep Pattern
  • Headaches

What The Brain Consists Of

The brain consists of four lobes plus the cerebellum and the brain stem.  Injury to any one of those parts produces symptoms that indicate where the injury occurred. The brain is a bundle of neurons which are small cells that may be very short in size or may be very long.  Some neurons for instance extend from the lower back all the way down to the feet.  Some are fractions of a foot long and others may be many feet long.  Any injury to one or more of those neurons impacts the brain’s function.

The spinal cord and brain are covered by spinal fluid which is a cushion to protect them from injury.  The spinal fluid is also a conductor of electricity.  The brain is a soft Jell-O-like material within the skull.  A blow to the head that causes the head to move in one way results in the brain not moving as quickly as the skull. As a result the brain slaps up against the inside walls of the skull.  Some of those walls are ridged. Those ridges produce injury to the brain. Twisting and shearing produce further damage to the blood vessels. Call or contact us for a free consult.

Seeing the Brain Injury

Not all people who suffer a brain injury have a loss of consciousness. Without proof of that loss of consciousness, proof of the brain injury is tougher for some people to grasp. However seeing is believing.

There are a number of tests that allow you to “see” the brain injury:


  • These tests are used either to prove the traumatic brain injury or to rule out that the problem is a result of some congenital defect, tumor or other problem not related to the trauma.
  • Functional MRI.  These record dynamic changes in the blood flow to the brain.
  • Tesla MRI.  This filming yields very detailed data about the makeup of the brain.
  • DTI MRIs. These studies show water movement within the brain which then allows the doctor to see those areas that are not doing well. The scanner works by tracking the normal pattern of water.  Where that water flow is changed then the DTI scan shows the problem.  The areas where the water flow is blocked are a sign of injury.  The DTI scanner is not new technology but simply involves a software update which allows any standard MRI to perform the DTI scan.
  • NeuroQuant and NeuroGage are volume measuring devices that neurologists can use to determine loss of brain volume. The trick is determining whether this is due to injury or age. David Ross MD from Richmond, Va. is the main proponent of NeuroGage.


  • CT Scan is a first line scan used in the emergency room to get a good overview of the brain
  • Spect

  • SPECT imaging stands for Single Photon Emission Computed Tomography.  This form of imaging provides three dimension info.  The technique involves the injection of gamma emitting isotopes into the bloodstream of the patient.  A SPECT scan is like a PET scan (Positron Emission Tomography) in that they both use radioactive tracers and involve gamma rays.  SPECT scans emit gamma radiation that is measured. PET scans, on the other hand, emit positrons that kill electrons. PET scanners detect the emissions and  provide better images than a SPECT scan.  SPECT scans, however, are less expensive than PET scans.
  • Pet

  • PET scans.  These are films of the brain as it absorbs glucose.  An irregular uptake level provides proof of loss of function in that part of the brain. The PET scan is also a three dimension image.  This type of scan is done with the aid of a CT scan at the same time in the same machine.  PET scans are read alongside either CT scans or MRIs. They give info about both form and function. In other words, they produce a picture and also show what the structure is doing.Call or contact us for a free consult.
  • Meg

  • In addition there are MEG scans.  There are very few of these scanners in the U.S. They are 90 percent accurate in terms of showing traumatic brain injury.  It is hoped that with these types of scans doctors will be able to parse brain injury from Post-Traumatic Stress Disorder.  The MEG scan works by tracking the magnetic signals from neurons within the brain.  They give a picture of how these neurons are active in the brain and which ones are not talking to each other.  MEG scans provide detail when reviewed with a functional MRI.  The MRI shows blood flow through the brain while the MEG scan shows how these areas “talk” to each other.
  • In addition there is what is called “resting state imaging”. This requires that the patient be sedated before the scanning process in order to assure clear focus and detail.

Eye Sync

  • A Boston start-up by the name of SyncThink has a product known as Eye-Sync which the FDA has approved.  It uses virtual reality goggles to see concussions.  The device tracks the eye and produces a number to determine whether or not the person has had a concussion. The company’s founder is Dr. Jamshid Ghajar.  He is in charge of the Stanford Concussion and Brain Performance Center at Stanford University.  He is also the President of the Brain Trauma Foundation. Dr. Ghajar says that the eye is a part of the brain that can be seen and therefore tested.  SyncThink was launched back in 2009.  It produced Eye-Sync with funding from the Department of Defense.   The device has been used to test thousands of U.S. military members and also many school age and college athletes.

    How It Works

    Headgear is placed over the eyes.  The viewer then sees a point of light.  That point of light rotates in a clockwise fashion.  The device tracks how well the eye follows the light.  It then produces a chart.  That chart tells the tester whether the person’s eyes were off track while following the light. What that means is that the eye and the brain are not working on the same time schedule.

    SyncThink believes that it will be able to embed this in other virtual reality headgear including devices such as Facebook’s Oculus Rift. Doctor Ghajar is based at Stanford University.  The Stanford University football team and 36 other sports teams at the school have done baseline studies.  Those studies will be compared against studies conducted after an injury to see whether there is any change. That change may be a sign of injury. This type of brain injury testing provides objective proof in TBI cases.

  • Neuropsych Testing

    • Neuropsychological testing.  These tests can confirm lack of brain function.  Neuropsych testing is reasonably precise without the “picture”.

    The standard CT scans and MRIs have limited ability to pick up many of these injuries. The injuries are very minute. These studies only pick up larger defects.  Likewise, an EEG does not pick up this type of injury. It only records gross brain activity.

    The best proof of injury may well be neuropsychological testing.Call or contact us for a free consult.

    Mild to Moderate Brain Injury

    Mild to moderate brain injury is a misnomer.  Doctors, however, use this term to describe brain injury. The injury may be quite severe but it will be classed as mild to moderate.

    Personal injury attorneys are accustomed to seeing mild to moderate brain injuries with a host of symptoms such as those listed above.

    Any person that has suffered a mild to moderate brain injury needs to have a spokesman and advocate. The injury prevents the person from doing many ordinary tasks. Therefore they become their own worst enemy. They cannot explain what they have undergone. In addition they cannot carry out tasks given to them. Without a spokesperson or advocate they are adrift.


    It is quite common that people with brain injuries learn how to make up for what they have lost. But they can only do this in familiar settings. For example, at work they know the environment and through post-it notes and “cheat sheets” they may be able to perform their routine office tasks. The same may be true at home. But take that person outside of their comfort zone and they are confused and panic may reign. This can present a problem as far as proof. The injured person may have learned to adjust so well that fellow workers may not even be aware of the problems. Call or contact us for a free consult.

    Head Injury Of NFL Players

    In a case filed in California in September 2014, Chelsea Oliver sued the National Football League.

    Mrs. Oliver was the wife of Paul Oliver, former San Diego Charger and New Orleans Saint. He had suffered from Chronic Traumatic Encephalopathy (CTE) and other forms of brain injury at the time of his death. Mr. Oliver and his family had not known that at the time.

    The brain injury came to light after Paul Oliver shot himself in the head in front of his wife and family in 2013.

    The 88-page Complaint says that at the time of his death Paul Oliver had severe brain injuries including CTE as a result of the repeated head trauma he suffered while playing football for the Chargers and the New Orleans Saints from 2007 through the 2011-2012 season.

    The Complaint says that since its inception, the National Football League has gone outside of any labor agreement to control every aspect of football with respect to safety and health and to conceal those health hazards from its players

    Head Injury-Reckless Culture

    The old culture within NFL players was to shake off a head injury and get back on the field. Many would go back on the field within minutes of a head injury. That culture has caused many of these men to live for years after their career ends with severe impairments. The injuries were untreated as was the case here.

    The fault of the NFL is based on the idea that they knew of the severe nature of these impacts and resulting head injury and took no steps to prevent them or to treat the players. Call or contact us for a free consult.

    Variable Symptoms From Brain Injury Based On Gender

    The January 2011 issue of the Journal of Athletic Training reports, based upon studies of a hundred different American high schools, that males and females show varied symptoms after head injuries.  The symptoms noted by males more often fall into the area dealing with feeling like they are in a fog, trouble focusing or memory issues. Females on the other hand report more behavior and somatic symptoms such as sleeping more than usual, drowsiness, fatigue, nervousness, headaches, nausea, being sensitive to light and noise and balance problems. Any injury lawyer handling sports cases needs to be aware of this.

    Sports trainers and doctors should be aware of these reports.  Many of the symptoms reported by females may be missed or more likely linked to problems other than a brain injury. Brain injuries by their very nature involve rather diffuse symptoms that doctors may not always relate to the sports injury.

    Closed Head Injury-CT Scan

    The most common way to diagnose a closed head injury is through a CT scan. CT scans will show skull fractures. They will also show any pocket of blood inside the skull. These pockets of blood are called hematomas. The pocket may be epidural, meaning that it is between the skull and the dura. The dura is the layer of tissue over the brain. Blood that is beneath the dura is called subdural. They can put pressure on the brain.

    An exam of a person that has suffered a closed head injury must include an exam of the ears. Sometimes there can be blood behind the eardrum. That is a clear sign of head trauma and bleeding inside the skull.

    Blood inside the skull that is not supposed to be there can be dealt with. A hole is cut in the skull. The purpose is to relieve the pressure. Once the pressure is relieved then the brain’s swelling from the impact will subside. Call or contact us for a free consult.

    Hypoxic Brain Injury

    Hypoxic brain injury is from the brain being deprived of oxygen for a long time. This type of brain injury is from choking, trauma, drug overdose, smoke inhalation, carbon monoxide poisoning or near drowning. Brain cells need oxygen to survive. If they do not receive enough oxygen, then those brain cells may start to die within minutes.

    Signs and symptoms of hypoxic brain injury:

    • Short term memory loss
    • Seizure
    • Amnesia
    • Poor judgment.
    • Loss of coordination
    • Inattentiveness

    Brain Injury Treatment

    Brain Injury treatment has been fairly simple: rest.  Lots of rest is thought to give the brain a chance to heal.

    Although rest is a part of any treatment mode, rest alone may well promote depression and an overall increase of symptoms.

    New Mode of Treatment

    First, a clear diagnosis must be made as to what part of the brain or vestibular system is injured. Then treatment is tailored to that injury.

    The vestibular system is a network involving organs in the inner ear with paths to various areas of the brain, the eyes and muscles throughout the body.  In regards to brain injury treatment, doctors have focused on vestibulo-spinal system treatment.  That is the system that helps control posture and maintain balance.

    However some concussions affect the vestibular-ocular system which allows stable vision while moving our heads. Injury to this system causes dizziness, nausea and other symptoms.  Also the injury may be to the vision system.  The vision system is what allows us to track moving objects without effort.  Injury to this part of the brain can cause blurred vision, headache, trouble reading or walking in a crowded area.

    Many brain injuries involve all of these systems.  As such treatment may need to address both balance and vision.

    Traumatic Brain Injury Treatment: Fairfax Family Practice

    Fairfax Family Practice in Fairfax, Virginia has a concussion center that provides brain injury treatment which follows the philosophy that sometimes the brain has to be taxed a bit to heal and adapt.

    The testing of someone who has suffered a head injury must assess their balance in many positions i.e., standing on two legs, standing on one leg, on the ground and then on a foam board and then with eyes open and eyes closed.  Eye movement and being able to track a moving object are also measured to see whether symptoms worsen with any of these tasks.

    Focus On The Injury

    Concussions are brain injuries that damage cells. They cause chemical changes. They disrupt the brain’s normal function in a number of ways.  Although rest, staying in a dark room, turning off screens, limiting movement and cutting out things that require focus are the mainstay of treatment that theory is changing. Although rest is still critical in the first days after an injury, if there is not a prompt recovery then there is a need for more active treatment. That treatment must pinpoint the problem and prescribe targeted therapy.

    There are some studies that show good results from exercise or vestibular treatments.  Just as every stroke patient is not treated the same way, brain injury treatment does not follow a cookie cutter approach.  If the patient has a language problem, trouble with their eyes, trouble with their gait, then those things need to be measured and those problems need to be treated.Call or contact us for a free consult.

    Focus on the Person

    The Center for Disease Control estimates that 2.5 million people in the U.S. suffer a traumatic brain injury every year.  That of course doesn’t include the many people who don’t even report these types of injury.

    The idea of exercise therapy in terms of treatment is now more accepted.   Monitored exercise promotes recovery.   Concussions affect the flow of blood to the brain and thereby disrupt what is called the autonomic nervous system. This controls such functions as heart rate and blood pressure.  Controlled exercises may help correct these.

    Headaches are a frequent symptom of traumatic brain injury.  The headache may be due to injury to the vision system. Such headaches may respond to vision therapy.  Neck injury may be the cause of headaches.  Medication or therapy may help with those neck injury symptoms.

    Treating Football Players

    An article of June 8, 2012 in The Washington Post  recounts some comments of Daniel Amen, a California doctor, who noted that he has had success with football players and others who have suffered many concussions. He has improved their decision making, mood and memory and also helped them deal with depression.

    Amen himself has worked with 117 former NFL players and says that 8 out of 10 of his patients have great improvement.  Nick Bell, a former running back with the Raiders, is one of Amen’s patients.  Bell reports that he had many concussions and that after one he actually wound up going into the other team’s huddle for the next play.  He says that back then if you complained to the coach, you were benched and may not see any further action.

    Amen’s Treatment

    The routine that Dr. Amen has put Bell on involves supplements, hyperbaric oxygen treatment, fish oil and exercise.  The goal is to try to grow brain cells and boost the neuron connections. All of this may improve brain function.  Dr. Amen reports that in Bell’s case there has been a 30% improvement in terms of memory, attention span and processing speed.

    Another common effect of these injuries is sleep apnea. This can cause a person to stop breathing while sleeping, high blood pressure and a tendency to gain weight.

    All of these problems can be dealt with through proper treatment as seen by the treatment by Dr. Amen.

    Military Studies Of Traumatic Brain Injury

    Combat soldiers from Iraq and Afghanistan with injuries from bomb blasts show acute signs of stretched and damaged nerve fibers at both the front and back of the brain. The New England Journal of Medicine has published a detailed study.

    Part of the problem with brain injury cases is the symptoms are like the symptoms found in post-traumatic stress disorder.

    Damaged Axons

    The research included MRI scans of 63 service members and found that in 18 of the 63 patients there was damage to axons, the fibers that connect the nerve cells. These often run several inches in length. The damaged axons were either in the front or back of the brain. They were found to be present shortly after the injury and then also six months later when the scans were repeated. Damaged axons prevent proper “chatter” between regions of the brain. Areas of the brain most often affected were areas near bony structures that could damage the brain during a blast. Call or contact us for a free consult.

    Sports Concussions

    The good news is that many states and groups have taken the lead to set standards for dealing with sports concussions for young athletes.

    National Athletic Trainers’ Association has issued guidelines for concussion management.

    CDC Guidelines

    The Center for Disease Control has several sources on how to prevent and control brain injury in sports and to increase the knowledge of the danger.  Guidelines published by the CDC state that head injured players should be removed from play and evaluated by a health care professional who is trained in dealing with this type of injury. Parents should be informed about the effect of concussions. The player should be kept out of play until a health care professional reports the player is symptom free and ready to return to play.

    In addition, the National Federation of State High School Associations, which is the national association to which most State High School Associations belong, has adopted the guidelines of the Center for Disease Control.

    Many states have likewise laws dealing with this issue.  The state of Virginia in Virginia Code §22.1-271.5 has guidelines for high school athletes dealing with concussions.

    Neurotoxic Brain Injury

    This form of brain injury is caused by toxins such as lead, paint or other chemicals.  The brain and nervous system control all body functions.  Any insult or injury to the brain or the nervous system affects the entire body. There is no easy way to make the diagnosis of neurotoxic brain injury.  Many doctors are simply not aware of the symptoms of this type of injury. Call or contact us for a free consult.

    Signs Of Injury

    To determine whether or not a person has suffered a such a brain injury there are several things to consider:

    • The Material Safety Data Sheet (MSDS), required by law of every manufacturer, is a good starting point when seeking info about a chemical’s adverse effects.  The MSDS lists those effects.
    • A common result of this type of brain injury is multiple chemical sensitivity.  That is, the client becomes sensitive to a number of other products as a result of  this event. People who suffer from multiple chemical sensitivity become very ill from the exposure to everyday chemicals such as perfumes,  paints or cleaning products.
    • The body stores these toxins in fat and other tissues. They are longer lasting than if they existed  in the blood or urine.  Searching for some sign of the injury is like searching for a bullet that has fully passed through the human body.  The bullet is never found but that does not mean that the subject was not shot.

    Safety May Be A Compromise

    • The fact that the product complies with the standards for exposure does not mean that the product did cause injury.  So called “safe” levels of exposure are sometimes a compromise between what the industry wants as to that product and what the consumer protection people will accept.  In addition, such safe levels are set to protect a healthy male worker.  Those who do not fit into that group are not covered.
    • The fact the product may be inert does not mean that it is  harmless.  The portion of the product that is not inert may be what is toxic and active.
    • Simply smelling the product may cause injury.  Breathing in or having skin contact allows the substance to enter into the blood stream without any filter.  For instance, doctors now use skin patches to administer morphine and even birth control.

    See other pages within this site on brain injury by using the search function and review the pages on Wikipedia

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    Brain Injury Attorney

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