Written by Stephen C. Saris, MD

Traumatic brain injury (TBI) cases often present some of the most complex and contested issues in medical malpractice and personal injury litigation. Determining causation—what injury occurred, how it occurred, and whether it directly resulted from the alleged incident—requires careful, evidence-based analysis grounded in neurosurgical expertise.

As a Spinal & Cranial Neurosurgery Expert Witness, I frequently evaluate cases involving closed head injuries, subdural hematomas, and intracerebral hemorrhages. These conditions can arise from a wide range of mechanisms, including falls, motor vehicle accidents, or delayed diagnosis and treatment. In many cases, the medical facts are not immediately clear, and the distinction between acute injury, pre-existing conditions, and unrelated findings becomes critically important.

A key component of causation analysis involves correlating clinical presentation with imaging studies and the documented timeline of events. My training in neuroradiology allows for detailed interpretation of CT and MRI scans, helping to determine whether imaging findings are consistent with the alleged mechanism of injury. For example, distinguishing between acute traumatic hemorrhage and chronic or spontaneous bleeding can significantly impact the direction of a case.

Equally important is the evaluation of standard of care. In malpractice claims, the question often centers on whether earlier intervention would have altered the patient’s outcome. This requires a thorough review of medical records, clinical decision-making, and accepted neurosurgical practices at the time of care. In some instances, delays in diagnosis or treatment may contribute to worsening neurological outcomes, while in others, the progression of injury may have been unavoidable despite appropriate care.

Attorneys must also consider the role of confounding factors. Pre-existing conditions such as cerebral atrophy, anticoagulant use, or prior neurological disease can influence both susceptibility to injury and recovery trajectory. A comprehensive analysis must account for these variables to ensure that conclusions regarding causation are both accurate and defensible.

In my experience, the most effective expert testimony is clear, objective, and firmly rooted in evidence-based medicine. My role is not to advocate for either side, but to provide a precise and impartial assessment that assists counsel, judges, and juries in understanding complex neurosurgical issues.

If you are handling a case involving traumatic brain injury, I would be pleased to assist with case evaluation, record review, expert reporting, or testimony.

Learn more at www.sarismedicolegal.com