Marasco & Nesselbush Brain Injury Center

A traumatic brain injury is an injury to the brain that disrupts its normal function. Traumatic brain injuries can be classified as mild, moderate, or severe, depending on the extent of the trauma and location. Different treatments can help repair physical trauma, reduce side effects, and limit the risk of complications.

Traumatic brain injury lawyer

A Guide To Understanding A Traumatic Brain Injury

This resource guide was developed by Marasco & Nesselbush and the Brain Injury Association of Rhode Island (BIARI) to help survivors of traumatic brain injury (TBI), and their families understand and navigate the challenges they will face.

Important information is provided about the medical and neurological conditions facing TBI survivors. Guidance on overcoming insurance barriers and addressing legal ramifications is also included.

At its core, a traumatic brain injury (TBI) involves damage to the brain that impairs its normal function. Typically, a traumatic brain injury is the result of a sudden bump, blow, or jolt to the head.

Some brain injuries are minor and may resolve on their own. However, severe TBIs require immediate medical care or surgery to reduce the risk of complications, additional trauma, or even death.

Ongoing treatment and therapy can help brain injury victims manage symptoms and improve their quality of life.

Every year, thousands of people across the United States suffer traumatic brain injuries. It’s estimated that in 2020, 176 people died every day because of traumatic brain injury. Thousands more survive, but with the cost of learning how to live with the consequences of impaired or limited brain function.

What Are The Types Of Traumatic Brain Injuries?​

The term “traumatic brain injury” is a broad term and may refer to a few different types of trauma to the brain.

Penetrating Brain Injury

A penetrating brain injury refers to an injury sustained when the skull is pierced, shattered, or broken in some way. Common causes of penetrating brain injuries include gunshot wounds and explosions. A car crash can also cause a penetrating brain injury if objects penetrate the skull during the collision.

Closed Brain Injury

closed brain injury refers to any brain injury that occurs without penetration of the skull. There are several types of closed brain injuries, including concussions, diffuse axonal injury, contusions, hematomas, and hemorrhages.


A concussion is one type of closed brain injury. It’s caused by the rapid movements of the brain inside the skull. The force of these movements alters the function of brain cells. Researchers are still working to understand exactly how and why this occurs, but they believe that unusually rapid movements of the brain cause biochemical changes in brain cells that temporarily interfere with their ability to function.

Concussions are generally classified as mild traumatic brain injuries because their effects tend to be relatively minor and short-lived (compared to other types of TBIs). With proper treatment, most people recover fully. However, sustaining multiple concussions can lead to more substantial and permanent brain damage and even death.

Diffuse Axonal Injury

Diffuse axonal injury, or DAI, is more severe than a concussion. When force causes the brain to rapidly rotate or twist in the skull, it can tear nerve fibers known as axons. Axons are used by neurons to transmit messages. When they’re damaged, neurons may be unable to communicate normally, resulting in a loss of brain function.

While this type of injury to the brain occurs at a microscopic level, it can cause significant consequences. In general, DAI is more severe than a concussion and often causes patients to be in a coma.


A contusion is bruising that occurs when the brain makes contact with the hard inner bone of the skull. Normally, cerebrospinal fluid cushions the brain and prevents it from hitting the skull when the head moves. However, with a very rapid and forceful head movement, this fluid is not enough to stop the brain from impacting the skull. The brain can become bruised.

Bruising means that small blood vessels are broken, and the tissue begins to bleed. Minor contusions can heal on their own. More severe contusions may require treatment to prevent them from worsening and becoming hematomas.

A contusion of the brain commonly occurs directly beneath the point of impact with the head. The force can then cause the brain to move in the opposite direction and hit the opposite side of the skull, causing another contusion on the other side. This is known as a “coup-contrecoup” injury. Coup-contrecoup injuries are commonly seen in car accident victims.

Brain Hematoma

A hematoma is essentially a bruise of the brain. This occurs when blood begins to pool outside of blood vessels, forming clots. Hematomas can develop right away, or they can manifest days or weeks after suffering a blow to the head, as blood slowly leaks out of blood vessels following an injury.

There are different types of brain hematomas depending on the location of the injury in the brain. An intracerebral hematoma refers to pooling of blood in the brain, a subdural hematoma refers to pooling of blood on the surface of the brain, and an epidural hematoma refers to pooling of blood between the brain and skull.

A hematoma, depending on its size and location, can require emergency treatment. The build-up of blood inside the rigid cavity of the skull can lead to an increase in pressure in the skull. This pressure can reduce blood flow to the brain and interferes with brain function. In more severe cases, it can push the brainstem (located at the base of the brain) down through the hole where the spinal cord exits, which can be fatal.

Brain Hemorrhage

Brain hemorrhages occur when an artery in the brain bursts and causes uncontrolled localized bleeding in or on the brain. Unlike a hematoma, which involves a slower bleed that has mostly or fully clotted, a brain hemorrhage involves fresh blood. Bleeding on the surface of the brain is referred to as a subarachnoid hemorrhage, and bleeding inside the brain tissue is referred to as an intracerebral hemorrhage.

Hemorrhages are actually a type of stroke. The presence of fresh blood is inflammatory to brain cells and can even kill them. Pressure can also build very quickly, resulting in serious consequences.

Traumatic brain injury lawyer

A Guide To Understanding A Traumatic Brain Injury

In addition to being committed to providing extraordinary legal care to our clients, our mission at Marasco & Nesselbush includes serving our community.

Toward that end, Marasco & Nesslebush established the Marasco & Nesselbush Charitable Foundation. Each year, the Foundation supports numerous charitable efforts and organizations that enhance our community and improve people’s lives throughout our state, New England, and elsewhere in the world.

What Are The Common Causes Of Traumatic Brain Injuries?​

Traumatic brain injuries are generally caused by unexpected, violent trauma to the head, neck, or body. According to the CDC, the most common causes of TBIs include:

  • Car Accidents
  • Truck Accidents
  • Motor Vehicle Accidents
  • Slip and Fall Accidents
  • Bicycle Accidents
  • Motorcycle Accidents
  • Falls
  • Sports
  • Assaults

Sports injuries are also an increasingly common cause of brain injuries, especially in children and young adults.

What Are The Risk Factors For Traumatic Brain Injury?​

Although anyone can potentially be at risk for a TBI, certain groups are at a higher risk than others. Some of the major risk factors for TBI include:


Certain age groups are at an increased risk, including babies and very young children, teens and young adults, and seniors.


Overall, males are more likely than females to experience TBI. The gender difference is greatest in teens and young adults.


People in certain occupations are more likely to experience a work-related TBI, including those in the construction, transportation, agriculture, forestry, and fishing industries.

Recreational activities
Some activities, including contact sports, skiing, snowboarding, skateboarding, and horseback riding, increase risk.

What Are The Signs Of A Traumatic Brain Injury?

The signs and symptoms of a traumatic brain injury vary based on the specific type of injury you’ve suffered and how serious it is.

Some of the most common signs of a TBI include:

Doctors and health care providers can use these symptoms to help diagnose a traumatic brain injury and set up a treatment plan.

a doctor examining an x-ray of a brain

How Is A Traumatic Brain Injury Diagnosed?​

After a person experiences a head injury, doctors must determine whether that person has a TBI. TBI diagnosis can be done using a combination of the person’s medical history, including a description of the injury, and the physical exam. The neurological exam, which doctors use to evaluate the function of the nervous system, provides crucial information that allows the doctor to determine whether the patient has a TBI.

In some cases, a doctor will order imaging studies to diagnose a traumatic brain injury. In the early phases after the injury, this usually involves a CT scan. The purpose of the CT scan is primarily to determine whether interventions, such as surgery, may be needed to prevent further brain injury.

However, imaging studies are not always needed to diagnose TBI, and many TBIs don’t even show up on scans. It’s possible for a medical professional to diagnose a TBI based on the medical history and physical exam alone.

What Are The Treatment Options For Traumatic Brain Injuries?​

Traumatic brain injuries fall into one of three categories: mild, moderate, and severe. Classification depends on the length of time a victim loses consciousness and the victim’s Glasgow Coma Scale (GSC), which analyzes eye-opening response, verbal response, and motor response.

Treatment will depend on the specific type of injury that’s sustained, its location, and its level of severity.

Common treatments for traumatic brain injuries can include:

a person resting

Rest, physical and cognitive, to allow the body to recover on its own

doctors in the OR

Surgery to repair damaged arteries, reduce pressure inside the skull, remove blood clots, or repair skull fractures

a medication bottle from a pharmacy

Medications, including anticoagulants, anticonvulsants, antidepressants, stimulants, diuretics, and muscle relaxants

massaging someone's back

Rehabilitation and therapy, including cognitive therapy, physical therapy, occupational therapy, and speech therapy

If you have been involved in an accident or sustained a blow to the head, seek immediate medical treatment. A physician can perform an examination, identify indicators of a brain injury, and diagnose a serious condition before it has time to worsen.

Can A Person Recover From A Traumatic Brain Injury?​

Most patients with mild TBI (also known as a concussion) make a full recovery. For those with more severe injuries, the course can be more variable, but recovery is possible. Studies have shown that around three-quarters of all patients with moderate TBI recover well enough to function independently, and around half of patients with severe TBI recover to at least this level.

Studies have found that between 10 percent and 20 percent of TBI patients recover fully after their injuries. People with TBI and their families should remain hopeful about the potential for recovery.

Rehabilitation can take a year or even longer after the injury. It’s important for a TBI patient to stay motivated and to be diligent about completing all of their therapy exercises, as this will help them achieve the best possible outcome.

What Resources Are Available For Tbi Survivors And Their Families?​

Life after a TBI can present challenges, and it helps to know that you’re not alone. Many TBI survivors and their families can benefit from the support of others who have been through a similar journey. Support groups are available for both patients and their caregivers and family members.

The Brain Injury Association of Rhode Island (BIARI) is an excellent resource for TBI survivors in our state. We’ve compiled a list of other TBI resources that may also be helpful, including educational sources, practical guidance for navigating daily life, and ways to connect with support groups in your area.

Cost Of A Traumatic Brain Injury​

Research suggests that the lifetime cost of a traumatic brain injury can range from $85,000 to $3 million.

This reflects medical expenses, rehabilitation, unemployment and lost wages, disability, and other economic losses associated with recovering from and living with a TBI.

However, it’s important not to underestimate the psychological and emotional trauma of suffering a traumatic brain injury. These types of issues can be costly, too. Living with a traumatic brain injury can cause depression, anxiety, and other types of emotional distress, resulting in additional medical costs and reduced quality of life.

Many traumatic brain injury victims can recover compensation in an insurance claim or personal injury lawsuit, which can help to offset the significant financial costs associated with their head injury.

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