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Brain Injury

Coughlan and Vinel has a special expertise in Brain Injury cases and working with families of brain injury victims. We have handled some of the biggest brain injury cases in Southern California over the last decade. Ben Coughlan is a published author in the field of brain injuries and regularly is asked to speak to brain injury survivors, their families, lawyers and medical professionals on brain injuries topics across the country. Kacie Vinel is the current Vice President of the San Diego Brain Injury Foundation and regularly works with survivors and their families. 


What is a brain injury?


A traumatic brain injury (TBI) is a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head or a penetrating head injury. (Centers for Disease Control and Prevention. (2015) Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation.National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA.; see also Marr and Coronado, 2004.) To diagnose an alteration in brain function, only one of the following need be present: 1) any period of loss of consciousness, 2) any loss of memory for events immediately before or after the injury, 3) neurologic deficits that may include muscle weakness, loss of balance and coordination, disruption of vision, change in speech and language, or sensory loss, or 4) any alteration in mental state such as confusion, disorientation, slowed thinking, or difficulty with concentration. (Id., see also Menon, Schwab, Wright, and Maas, 2010.) 


A concussion is a form of brain injury. (Injury Prevention & Control: Traumatic Brain Injury & Concussion, Centers for Disease Control and Prevention (Sept. 28, 2016, 3:06 PM), Recovery from a brain injury could take days, weeks, or months or the impairment could be lifelong. (Id.)


Generally, symptoms can be broken down into one of three categories: 1) physical/sensory, 2) cognitive/communicative, and 3) emotional behavioral. (Jamie Reiter et al., Journey to Recovery: A Brain Injury Guide for Families (2d ed., San Diego Brain Injury Foundation, 2016). But remember, that because every brain injury is different, any combination of symptoms can, and may occur and persist.


Why is understanding brain injuries so important for a lawyer handling these types of cases?


According to, each year over two million Americans suffer a brain injury. These injuries occur every 23 seconds in the United States. (Jamie Reiter et al., Journey to Recovery: A Brain Injury Guide for Families (2d ed., San Diego Brain Injury Foundation, 2016). In San Diego alone, over 11,000 people each year suffer a brain injury. (Id).


However, understanding brain injuries is complex. The brain is the most complex organ in the human body - a prime reason why so much mystery still surrounds it. The brain is soft, and floats in cerebrospinal fluid and protected by the hard-shell skull. It is the command center of the entire body. 


Specifically, a healthy brain is composed of nerve cells (neurons) which are communication fibers that carry messages throughout the brain and the body. (Id.) Over 86 billion neurons are contained within the human brain. ( Billions of axons send electrical impulses (communications) from neuron to neuron. (Id.) These messages control all of our human functions. When these microscopic structures are insulted, any number of symptoms may follow depending on the area of the injury.


The brain is divided into the left and right hemisphere. Each hemisphere is divided in the frontal lobe, occipital lobe, parietal lobe, and temporal lobe. The limbic system, sits underneath the cerebrum. Likewise, the pituitary gland – which controls much of the body’s hormones - sits behind the nose below the base of the brain. The brain must be able to send and receive messages between the different parts – and the rest of the body - in order to properly function.


When any part of the brain is injured it can cause dysfunction and a variety of symptoms. Injuries or death of the neurons/axons, whether focal (in one area) or diffuse (in multiple areas) can be cause a major disruption in normal brain processing. 


Too often, injury attorneys without proper experience, background or resources attempt to litigate these cases to the detriment of the client. An injury attorneymust understand the basics of acquired brain injuries, have the resources necessary to take on a TBI case, and realize the patience required to work with brain injury survivors and their families.


How do brain injuries happen?


Trauma can cause injury to the brain in a number of ways including insult to the neurons/axons on a microscopic level, contusions or bleeding on the brain, and penetrating injuries.

(  If nothing penetrated the skull, it is termed a “closed head injury.” Additionally, the brain can be injured when oxygen is cut off to the brain (anoxia) or gets too little oxygen (hypoxia) (Zasler, N. Brain Injury Source, Volume 3, Issue 3, Ask the Doctor.)


While some injuries – penetrating injuries and brain bleeds can be very apparent – other injuries are microscopic. When the head is struck, strikes something or is shaken within the skull forces are exerted on the brain. ( The brain can move, twist and strike the inside of the skull, which  can cause the neurons to be moved, pinch, stretch and tear and upset the necessary balance required for the processing of information between the neurons. (Id.) While this type of injury may occur on a microscopic level, depending on the level of insult, the repercussions can be life altering.


A “coup-contracoup” injury occurs when the soft brain collides with the hard skull and then rebounds and strikes the skull directly opposite of the original impact. (Id.) This can cause contusions or axonal injuries on opposite sides of the brain.


At Coughlan and Vinel we handle brain injury cases differently…


Because of our wealth of experience working directly with survivors, Coughlan and Vinel has made it our mission to increase public understanding of these injuries while best supporting our clients to maximize their results in their cases. We believe to do this, we must treat every brain injured person who was through our door as a survivor and not just a client. 


We understand that helping our clients cope with their new realities of living with a brain injury can actually help our clients heal psychologically and physically. This requires patience with the survivor, understanding his or her needs, and willingness to encourage him/her even when he/she is difficult to work with. We understand this person has just gone through a life-altering event in a way most people will not every fully comprehend, and so it is important to be patient and empathetic.


We understand that although all brain injury survivors have suffered a disruption of the normal function of the brain, every brain injury is unique. (Centers for Disease Control and Prevention. (2015) Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA.) Understanding that our clients have suffered an alteration of their normal state is vital for approaching both interactions with our clients, and planning how to proceed with the case.

Brain Scans
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