You have a motor accident matter where the client has sustained head injuries or you may have a medical negligence matter where a patient claims a neurosurgeon was negligent. You haven’t dealt with neurological issues prior or you are new to the field and feel overwhelmed with medical cases and don’t really know where to start. Firstly, you are advised by a more senior lawyer to obtain the patients medical records, clinical notes, operation report, consent form, medical correspondence and any associated radiology plus any other relevant medical documents from the hospital where the patient was admitted. You receive this documentation but what does it all mean? The forms and words are like a foreign language! How do you understand medical terminology and functions surrounding the brain and its “parts”? How to read and understand “neuro” documents so you feel like an expert? How to understand the medical limitations of clients who have a brain injury?
I was employed by two North Shore neurosurgeons where I had the opportunity to attend surgery and observe brain tumour removals and stereotaxic surgery. I became very familiar with neurological and neurosurgical terms, surgeries, clinical procedures and pathological conditions, which has become invaluable in cases involving medical issues. Here are some simple tips to assist you when you are faced with a “neuro” case.
Central Nervous System (CNS)
The brain and spinal cord make up the central nervous system.The part of the brain and its functions include:
- Cerebrum – largest part of the brain controls thinking, reasoning, sensations, vision, memory and hearing
- Thalamus – main relay centre of the brain
- Hypothalamus – controls body temperature, sleep appetite
- Cerebellum – posterior part of the brain which controls coordination of voluntary movements and balance
- Pons – bridge – controls connection of nerve fibre tracts
- Medulla oblongata – regulation of heart, blood vessels and respiratory system.
- Sulcus – depression in the surface of the cerebral cortex.
- Gyrus – elevation of the surface of the cerebral cortex; convolution
- Efferent nerves – nerves that carry impulses away from the brain to the muscles, glands and organs.
- Dura mater – outermost layer of the meninges (3 protective membranes that surround the brain and spinal cord)
- Cerebral cortex – outer region of the cerebrum i.e. gray matter
- Arachnoid membrane – middle layer of three membranes (meninges) that surround the brain and spinal cord 
Clients with Brain Injury
- poor body movements (balance, posture and muscular tone)
- thought processes (memory, perception, inhibition etc)
- difficulty forming words
- difficulty with speech (comprehension)
- hearing or vision
- angry, aggressive
One time, an elderly patient came in to see one neurosurgeon with his wife. He had lost all ability to filter words or actions, he had no inhibitions and his behaviour and words were out of character for this usually quiet and reserved man. After further procedures, it was determined this man had a brain tumour in his frontal lobe, the resultant behaviours were demonstrative of the part of the brain effected.
We need to consider when we are assisting people with brain injuries or traumas, if the person is “acting out” the person may be acting in accord with the brain injury (alternatively it may be their usual behaviour?) – sometimes difficult to determine…however, consider the effects of brain injury when interacting with effected clients.
Useful Medical Terminology
Cerebell/o = cerebellum (cerebellar, cerebellospinal, cerebellospinal fluid)
Cerebr/o = cerebrum (cerebrospinal fluid, cerebral cortex)
Dur/o = dura matter (subdural haematoma, epidural haematoma)
Encephal/o = brain (encephalitis, encephalopathy, anecephaly, encephalomalacia)
Mening/o = membranes (meningeal)
Meningi/o = meninges (meningioma, meningomyocele)
Neur/o = nerve (neuropathy, polyneuritis, neuroanastomosis)
Pont/o = pons (cerebellopontine)
Thalam/o = thalamus
Thec/o = sheath (refers to the meninges)
Phasia = speech (aphasia)
Paresis = slight paralysis (hemiparesis)
Kenesi/o, kines/o, kinesis = movement (bradykinesis, hyperkinesis)
Praxia = action (apraxia – movements and behaviour not purposeful)
sthenia – strength (neurasthenia) 
Cerebral angiography, CT Scan, Myelography, Ultrasound, MRI of the brain, Brain Scan, PET Scan, Electroencephalography (EEG), Stereotaxic Neurosurgery and Trephination
It takes time to become familiar with body systems, as I have “worked my way around the body“. The upcoming topics which will relate to terminology, body functions, procedures, surgeries, complications and risks. This blog cannot provide comprehensive information to fully run a “neuro matter”, however, it will assist you to start on the road to expert! You always have the option to ask for assistance, when necessary!
I will write further blogs on various body systems and invite you to subscribe at http://www.sydneybarrister.net.au so you are included in further medical “how to blogs” (amongst other topics).
Please email me at firstname.lastname@example.org to schedule a suitable day/time for me to attend your firm and speak on one of the following topics at a “lunch and learn“. Available dates until the end of the year are limited. My prior “lunch and learns” have received favourable responses from solicitors where reviews can be read at https://au.linkedin.com/in/louisemathias
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 The Language of Medicine: Davi – Ellen Chabner