Diffuse axonal injury lawyer

Diffuse axonal injury is damage to the white matter tracts that connect regions of the brain, caused by rapid rotational acceleration and deceleration rather than by a direct blow. It is among the most consequential brain injuries and among the hardest to demonstrate, because the damage is microscopic and distributed rather than a single visible lesion. Law Offices Of SRIS, P.C. handles brain injury claims in Virginia, Maryland, the District of Columbia, New Jersey and New York.

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What the imaging and records show

Routine CT is frequently normal in diffuse axonal injury, and that normal scan is the defense’s first exhibit. Conventional MRI is more sensitive, and gradient-echo and susceptibility-weighted sequences can reveal the small punctate haemorrhages at the grey-white junction, in the corpus callosum and in the brainstem that are characteriztic of the injury. Even these can be unremarkable where the shearing did not produce microhaemorrhage. Diffusion tensor imaging is used in some cases to assess white matter integrity, but its evidentiary acceptance varies by court and it supplements rather than replaces clinical evidence. The practical point is that in this injury, a normal scan is a known feature rather than a contradiction.

Why this injury meets the legal threshold

The threshold is not met by an imaging finding. It is met by evidence of a mechanism capable of producing rotational shear — a collision with significant rotational or angular forces, a fall from height, an ejection — combined with an immediate alteration of consciousness and a documented, persisting change in cognitive function. Where a person was unconscious at the scene, required intensive care, or emerged with a period of post-traumatic amnesia, that record does substantial work.

Typical treatment course and prognosis

Acute management is supportive and directed at preventing secondary injury: control of intracranial pressure, oxygenation and perfusion. There is no procedure that repairs sheared axons. What follows is rehabilitation — inpatient neurorehabilitation in severe cases, then outpatient cognitive, speech, occupational and physical therapy over months. Recovery in the first year is typically the most substantial, after which the trajectory flattens. Deficits that persist beyond the first year are commonly permanent, and a treating physician’s opinion on that point is central to the claim.

How insurance carriers attack this diagnosis

The arguments follow a pattern. The CT was normal, so there was no brain injury. The person was talking at the scene. The Glasgow Coma Scale recorded in the emergency department was reassuring. Symptoms are attributable to depression, sleep disturbance, medication or pain rather than to the brain. The person had a prior concussion, learning difficulty or psychiatric history that explains the testing results. And there was a gap between discharge and the first complaint of cognitive difficulty. Each of these is answerable from the medical literature and from the record, but the answers must be built in advance rather than improvised at deposition.

Proving the accident caused it

The chain runs from mechanism to outcome. Establish the forces involved, using the vehicle evidence and where necessary reconstruction. Establish the immediate neurological picture from the scene and emergency records, including any period of unconsciousness or amnesia. Establish the persistence of deficits through neuropsychological testing with validity measures. And establish functional change through people who knew the person before — an employer describing specific performance failures, a spouse describing responsibilities they have absorbed. Dated, specific third-party accounts are worth more here than any single test result.

Available insurance coverage

What can be recovered is limited by what coverage exists. The at-fault party’s policy is the starting point, but it is frequently not the only source: the injured person’s own uninsured and underinsured motorist coverage, household policies, employer coverage where a vehicle was used for work, umbrella and excess layers, and the coverage of any additional responsible party can all apply. Underinsured coverage typically requires notice and consent before any settlement with the at-fault party — settling first can forfeit it. Identifying every available layer is early work, not closing work.

How damages are categorised and proven

Damages are not a single number that gets negotiated. They are separate categories, each proven by different evidence. Past medical expense is proven by billing records and the reasonableness of the charges. Future medical expense requires a physician’s opinion that the care is reasonably certain to be needed. Lost income is proven by employment and tax records; lost earning capacity is a different and larger question requiring vocational and economic analysis. Non-economic loss — pain, limitation, and the effect on daily life — is proven through the medical record and through testimony from people who can describe specific changes rather than general decline. No one can responsibly tell you what a case is worth before that evidence exists, and any figure offered at the outset is a guess.

Filing deadlines

Every injury claim is governed by a statute of limitations, and the periods differ by state and by claim type. For personal injury actions the period is two years in Virginia under Va. Code § 8.01-243(A), accruing at the date of injury; three years in Maryland under Md. Code, Cts. & Jud. Proc. § 5-101; three years in the District of Columbia under D.C. Code § 12-301(8); two years in New Jersey under N.J.S.A. 2A:14-2; and three years in New York under N.Y. C.P.L.R. § 214(5). These are general periods. Discovery rules, tolling for minors and incapacity, claims against government entities — the District imposes a six-month notice-of-claim requirement for claims against the District government — and claim-specific statutes can shorten or extend them. Do not rely on a general period for your own case; have the deadline confirmed on your facts.

Frequently Asked Questions

My CT scan was normal. Can I still have diffuse axonal injury?

Yes. A normal CT is a recognized feature of this injury rather than evidence against it. CT is designed to detect bleeding and fracture requiring urgent intervention, not microscopic shearing of white matter tracts. Dedicated MRI sequences detect it more often, but can also be unremarkable. The diagnosis rests on the mechanism, the clinical picture and documented persisting deficits, with imaging as supporting rather than determinative evidence.

What causes diffuse axonal injury?

Rapid rotational acceleration and deceleration of the head, which causes the brain to move within the skull and stretches the long axonal fibres connecting brain regions. It does not require a direct impact. High-speed collisions, particularly those with a rotational component, falls from height and ejections are the usual mechanisms. This is why the absence of a visible head injury does not rule it out.

What is diffusion tensor imaging?

An MRI technique that measures the movement of water along white matter tracts and can indicate loss of tract integrity. It is used in some diffuse axonal injury cases to provide objective support for a diagnosis that conventional imaging misses. Its admissibility and evidentiary weight vary by jurisdiction and by how the study was performed, so it should be treated as one component of the proof rather than as the answer.

How is the severity assessed?

Through the clinical course rather than a single measurement: the depth and duration of any loss of consciousness, the length of post-traumatic amnesia, the intensity of care required, and the deficits documented on formal neuropsychological testing. Duration of post-traumatic amnesia is generally regarded as a useful indicator, which is why the emergency and inpatient records covering that period matter so much.

Will I recover fully?

That is a question for your treating physicians and it varies considerably. Most recovery occurs within the first year, and deficits persisting beyond that point are commonly permanent. Because a settlement is final, the claim generally should not be resolved before the treating physicians can express an opinion on whether the deficits have stabilised and what future care is anticipated.

Who should evaluate me?

Ordinarily a neurologist or physiatrist for the medical picture and a clinical neuropsychologist for formal cognitive testing. The testing should be administered and interpreted by a qualified clinician using batteries that include validity measures, because a defense examiner will scrutinise both the selection and the interpretation. Your treating clinicians should be chosen for care, not for litigation.

My family says I have changed but I do not notice it. Is that normal?

It is common and clinically recognized. Impaired self-awareness is itself a feature of injury to certain brain regions, which means the people around you are frequently better witnesses to the change than you are. This is why third-party accounts from employers, colleagues and family carry particular weight, and why they should be gathered while recollection is fresh.

How long do I have to bring a claim?

It depends on the state and on the claim type — two years in Virginia and New Jersey, three years in Maryland, the District of Columbia and New York for personal injury actions, subject to tolling, discovery rules and shorter notice periods for claims against government entities. A late diagnosis does not automatically extend the deadline. Have it confirmed on your own facts rather than relying on a general period.

About Mr. Sris

Mr. Sris is the owner and founder of Law Offices Of SRIS, P.C., which has practiced since 1997. He is a former prosecutor and is admitted in Virginia, Maryland, the District of Columbia, New Jersey and New York. Of Counsel attorneys contract directly with the firm and handle matters alongside him. In 2019 Mr. Sris testified before the Virginia House Courts of Justice Committee on House Bill 635.

Speak with Mr. Sris

Injury claims are governed by filing deadlines that vary by state and by claim type, and evidence degrades quickly. Request a consultation. Reach our location at (888) 437-7747. Consultations are by appointment.

Last reviewed: August 22, 2026.

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