The Expert: Dr. Richard Perrillo, a neuropsychologist, who testifies for the plaintiff concerning the nature of traumatic brain injuries and ultimately concludes the plaintiff suffered symptoms consistent with a TBI.
Dr. Richard Perrillo, a California neuropsychologist, testifies during a 2016 trial in a DeKalb County, Georgia in which the plaintiff claims that she sustained a mild traumatic brain injury [TBI] when her car collided with a car driven by a Papa John’s pizza delivery driver. Dr. Perrillo addresses the nature of traumatic brain injuries and ultimately concludes that the plaintiff’s symptoms were consistent with a TBI.
The expert begins by explaining the three main classifications of TBI. A mild TBI has symptoms with no obvious physical findings, but the classification does not imply that the injury is minor. A moderate TBI has abnormalities noted on CT scan or MRI. A severe TBI results in coma. Manifestations at the time of trauma such as loss of consciousness, which may not be even realized by the victim, portend a much more serious injury. However, it may take up to fourteen days after the trauma for the manifestations of a concussion to appear. Axonal disruption or intracranial hemorrhage may be delayed like that.
There are some myths about concussions. Loss of consciousness is not required, but if this does occur, it is automatically a grade 3 concussion. A strike on the head is not necessary for a concussion. Rotational forces or a sudden momentum shift can lead to this TBI. Mild TBI does not imply insignificant. Fifteen percent of people with a mild TBI will have long term problems that get worse over time. It is not true that emotional problems are not related to TBI. Emotional and cognitive issues are both mediated through the same injured brain. A normal appearance does not imply that brain function remains normal. Speech and comprehension are housed as “hold functions” of the brain, and can continue as usual despite significant brain damage.
Victims of TBI can be considered the “walking wounded” because they often carry on with their lives without realizing how damaged they have become due to their injury. Later in life, up to 40% of TBI patients may develop suicidal ideation without realizing why. Dr. Perrillo points out that the plaintiff in this case may not manifest her difficulties to the jury, but to those who know her well, or the neurologist who has studied her, will observe significant changes that may not be apparent to those who do not know her. He gives examples: she is not able to choreograph the dance and drama at the church, she is much slower, she loses her purse and phone constantly, she is irritable over little things, and she just seems to be a different person. None of this would be apparent to the jury or those unfamiliar with her.
The doctor testifies that he is certain that the plaintiff suffered a TBI. She had symptoms immediately after the accident including cognitive dysfunction and emotional difficulties. He confirmed this by surveying those close to her and comparing their answers with mathematical quantification. There was little variability in what they observed.
Finally, Dr. Perrillo utilizes the prop of a human brain and skull to demonstrate how the skull is made of hard boney ridges which suddenly halts the momentum of the soft brain during a deceleration event such as the plaintiff experienced. This results in tearing of the nerves at the microscopic level, the traumatic brain injury. Jurors awarded the plaintiff $11 million.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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