Sam Harding Law Firm

Pathophysiology of Brain Injury

Brain function most likely be immediately impaired by direct damage (eg, crush, laceration) of brain tissue. Further damage may happen shortly thereafter from the cascade of events triggered by the initial injury.

TBI of any sort can produce cerebral edema and decrease blood flow to the brain. The cranial vault is fixed in size (constrained by the skull) and filled by non compressible CSF and minimally compressible brain tissue; consequently, any swelling from edema or an intracranial hematoma has nowhere to go and thus increases ICP. Cerebral blood flow is proportional to the cerebral perfusion pressure (CPP), which is the difference between mean arterial pressure (MAP) and mean ICP.. So, as ICP increases (or MAP decreases), CPP decreases. When CCP falls below 50 mm Hg, the brain may become ischemic. Ischemia and edema may trigger various secondary mechanisms of injury ( release of excitatory neurotransmitters, intracellular Ca, free radicals, and cytokines), causing further cell damage, further edema, and further increases in ICP. Systemic complications from the trauma (eg, hypotension, hypoxia) can also contribute to cerebral ischemia and are called secondary brain insults.

Excessive ICP initially causes global cerebral dysfunction. If excessive ICP goes untreated, it can push brain tissue across the tentorium or through the foramen magnum, causing herniation (see Coma and Impaired Consciousness: Pathophysiology) and increased morbidity and death. If ICP increases to equal MAP, CPP becomes zero, resulting in complete brain ischemia and brain death; absent cranial blood flow is objective evidence of brain death (see Coma and Impaired Consciousness: Brain Death).

Hyperemia and increased brain blood flow may result from concussive injury in teens or children. Second impact syndrome is a very rare and debated entity defined by sudden increased ICP and death after a second traumatic insult that follows a usually minor head injury. It is attributed to loss of autoregulation of cerebral blood flow that leads to vascular engorgement, increased ICP, and herniation.

At Sam Harding Law Firm, we want our client to be aware of the physiology of Brain Injury. We understand the problems suffered by people who have sustained "mild" Traumatic Brain Injuries. We know that insurance companies often try to take advantage of unrepresented clients. We work hard for our clients to get them the money they deserve without their having to go to court. We work to get medical bills, lost income and money for pain and suffering. However, should your case require us to litigate, we are prepared to take your case to court. We are an ABOTA and AV rated Martindale Hubbel law firm.


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Sam Harding


Sam Harding
Caring, Dedicated and Committed to Justice

Since 1975, Mr. Harding has practiced in the area of personal injury litigation in Nevada. He has represented clients in personal injury cases including but not limited to wrongful death cases, brain injury cases, product liability cases, automobile accident cases, aircraft crash cases, dog bite cases, slip and fall cases, nursing home abuse cases and defamation cases.


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About Sam Harding

Mr. Harding is a member of the Nevada Trial Lawyers Association and the American Bar Association. He has been lead trial counsel in over one hundred jury trials. Mr. Harding is a member of ABOTA (American Board of Trial Advocacy). Mr. Harding is an AV rated attorney in Martindale-Hubble.

Nevada Auto Accidents

The Sam Harding Law Firm knows Nevada motor vehicle law. Our proven track record of court settlements is one of the best of any firm representing the injured from car crashes, motorcycle accidents, trucking and big-rig accidents and other motor vehicle related accident related injuries.

Catastrophic Injury Cases

For over three decades The Sam Harding Law Firm has been helping victims of serious injury in Nevada. From nursing home abuse and neglect to serious injuries such as traumatic brain injury (TBI), spinal cord injuries and more. Let Sam Harding go to work for you. We handle all cases on a personal level. We are caring, dedicated and committed to justice.

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Sam Harding Law Firm

500 South 8th Street

Las Vegas, Nevada 89101

tel 702.333.7777 fax 702.384.5731