Monday, December 10, 2018

Dr. Jeffrey Markham Details Evidence of Plaintiff’s Brain Damage En Route to $20M Verdict in TBI Trial

The Trial: Thompson v. Lamplight Village Homeowner’s Association, a 2018 Nevada premises liability trial in which plaintiff claims he suffered a traumatic brain injury when a swing set’s metal bar broke and struck his head.

The Expert: Dr. Jeffrey Markham, a radiologist from Texas, who testifies as to the extent of the plaintiff’s brain injury.

The Verdict: $20 million, including $10 million in punitive damages.


By Gary F. Gansar, MD, FACS; Senior Medical Director, AMFS

Standing before visual displays of MRI films during a 2018 Nevada premises liability trial against a homeowner’s association, Dr. Jeffrey Markham, a diagnostic radiologist from Dallas, Texas, testifies in support of a plaintiff who suffered a traumatic brain injury when a swing set’s metal bar broke and struck his head.

Markham, a witness testifying on the severity of the plaintiff’s injury, begins this video by demonstrating with a prop that the damage occurred to the adjacent posterior left frontal and the anterior left parietal lobes of the brain. Since the brain pathways cross to the opposite side at this level, it would be expected that the right side of the body would be affected by the trauma to the left side of the brain. Markham says he would anticipate the right upper extremity specifically to be disabled by a severe injury to this part of the left brain.

When asked about the discrepancy in the size of the two sides of the brain noted in the enlarged MRI film before him, the doctor addresses the mechanism of injury and the resulting long-term structural abnormalities within the brain tissue that would explain the difference in size between the right and left brain. He notes, the force of the steel bar was strong enough to crack the bone then send a shock wave into the brain tissue itself. This transmitted energy disrupted the nerves, supporting brain cells and blood vessels supplying nutrients to the brain. Their complex, intimate, structural relationships are changed fundamentally, he states, resulting in their deterioration and subsequent volume loss on the traumatized side.

In addition, in this case, there was bleeding not only around the brain, but within the tissue of the brain itself. This shows up as “metallic fragments” within the brain tissue on the MRI.

These metallic fragments are actually hemosiderin deposits that are a result of blood infiltrating into the brain tissue as it escapes the injured blood vessels. As the escaped blood cells are broken down, the iron that was within these cells cannot be totally removed by the brain and this iron shows up on imaging. The smaller, left side of the brain seen on the MRI is therefore composed of dysfunctional nerve cells, hemosiderin deposits, and damaged supporting cells compacted together. This, Markham concludes, is a long term result of the patient’s injury.

The radiologist further explains to the jurors that multiple views of the same injury are obtained by MRI in order to be certain that the findings are real and not artefactual. He demonstrates how the findings are confirmed by different views and by adjusting the magnetic resonance of the machine itself. As such, he can state unequivocally that “this is a big area and it is an important area that is involved.”

When asked about the significance of the injury being at the junction of the posterior frontal lobe and the anterior parietal lobe, the radiologist couches his answer by admitting that this would be better addressed by a neurologist. Nonetheless, he opines that there is likely to be disruption of both the sensory function and motor function of the right arm. This could be manifested as numbness, tingling, or pain in the arm as well as cramping, weakness, or spasticity.

The testifying expert’s graphic depiction of the traumatic brain damage as seen on the MRI, his description of the acute and chronic intracerebral physiologic results of this injury, and the characterization of expected clinical findings from this were certainly important, as the jury rendered a $20 million verdict in this case.

 

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Gary Gansar, MD, is residency trained and Board Certified in General Surgery. He previously served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Mercy Hospital and Touro Infirmary in New Orleans, LA. Dr. Gansar also served as Clinical Instructor and Professor of Surgery at Tulane University. He received his MD and served as Chief Resident at Tulane University Medical School. Dr. Gansar joined AMFS as a consulting medical expert in 2011 and has served as Medical Director since Nov. 2015. In this capacity, Dr. Gansar provides consultation, review and guidance to attorney clients.