San Francisco Brain Injury Attorney

Attorney Michael Rehm — (800) 978-0754

San Francisco Brain Injury Attorney

Traumatic brain injuries are among the most consequential and most contested claims in personal injury law. The injury is invisible on ordinary imaging, the symptoms are often delayed, and the long-term consequences — cognitive impairment, personality change, chronic headaches, disrupted sleep, loss of executive function — do not fit neatly into the categories insurance companies use to value cases. Attorney Michael Rehm represents people who have sustained traumatic brain injuries in accidents throughout San Francisco and San Francisco County. TBI claims are filed in San Francisco Superior Court, 400 McAllister Street.

What Constitutes a Traumatic Brain Injury

A traumatic brain injury occurs when an external force causes disruption to normal brain function. The force does not have to penetrate the skull. In closed-head injuries — the most common type in motor vehicle accidents and falls — the brain moves within the skull in response to sudden acceleration, deceleration, or rotational forces. The movement tears axons, disrupts neural pathways, and causes bleeding or swelling that can compound the initial injury over hours and days. TBIs are classified as mild, moderate, or severe based on the Glasgow Coma Scale score at presentation, the duration of loss of consciousness, and the period of post-traumatic amnesia. Mild TBI — commonly called concussion — does not mean minor. Repeated mild TBIs and poorly managed mild TBIs carry significant long-term risk including chronic traumatic encephalopathy.

Common causes in the San Francisco accident context include motor vehicle collisions, Muni bus and light rail accidents, bicycle and pedestrian knockdowns, falls on unsafe premises, and construction site accidents. The forces involved in a 30-mile-per-hour collision are sufficient to cause a clinically significant TBI even without direct head contact — the brain can sustain injury from the acceleration-deceleration forces alone.

Neurological and Surgical Intervention in TBI Cases

Moderate and severe TBIs frequently require acute neurosurgical intervention. The decision to operate turns on the nature of the injury, the degree of intracranial pressure elevation, and the imaging findings on CT and MRI. Understanding what surgery was performed — and why — is essential to building a damages case that reflects the full extent of the injury.

Craniotomy

A craniotomy involves removing a section of the skull to access the brain and address bleeding, swelling, or structural injury. It is performed when a subdural hematoma, epidural hematoma, or intracerebral hemorrhage requires direct surgical evacuation. The surgeon removes the blood clot or damaged tissue and controls the bleeding source. After the procedure, the bone flap is typically replaced and secured. Recovery involves weeks of acute inpatient care followed by months of neurological rehabilitation. The risks of craniotomy include infection, stroke, seizure, and neurological deficits related to the area of brain accessed.

Decompressive Craniectomy

When intracranial pressure from post-traumatic edema cannot be controlled with medication and positioning, surgeons may perform a decompressive craniectomy — removing a large section of skull and leaving it out to allow the swelling brain room to expand without fatal compression. The patient requires a second surgery months later — a cranioplasty — to replace the bone or insert a custom implant. The period between surgeries involves significant functional limitations and a heightened risk of re-injury to the exposed brain tissue.

Intracranial Pressure Monitoring

Patients with severe TBIs are frequently managed with an intracranial pressure monitor — a small sensor placed through the skull to measure pressure in real time. ICP monitoring is invasive, carries infection risk, and is used to guide medical management decisions including medication dosing, osmotherapy, and the decision to proceed to decompressive surgery. Its use in a case signals the severity of the injury and the complexity of the acute management.

Ventriculostomy and CSF Drainage

When hydrocephalus — abnormal accumulation of cerebrospinal fluid — develops as a consequence of TBI, surgeons may place a ventriculostomy catheter to drain CSF and reduce pressure. Some patients require permanent shunt placement connecting the ventricular system to the abdomen (ventriculoperitoneal shunt) for long-term CSF management. A shunt implant is a lifelong mechanical device requiring monitoring and eventual replacement.

Liability in San Francisco TBI Cases

Civil Code § 1714 imposes a duty of ordinary care on every person whose negligence causes injury to another. In a TBI case arising from a motor vehicle collision, the negligent driver and, where applicable, the driver's employer, the vehicle owner, and any third party whose conduct contributed to the crash all bear potential liability. Vehicle Code violations are evidence of negligence per se under California Evidence Code § 669. Claims against public entities — including SFMTA for Muni vehicle accidents — require a government tort claim under Government Code § 911.2 within six months of the incident. Missing this deadline can potentially bar a lawsuit against any public entity. Tolling may apply depending on the facts.

In fall-related TBI cases, premises liability under Government Code § 835 applies to public property and under Civil Code § 1714 applies to private property. The property owner's duty to maintain premises in a reasonably safe condition extends to conditions that create a foreseeable risk of the kind of injury that occurred.

Damages in San Francisco TBI Cases

TBI damages are among the most substantial in personal injury law because the injury is permanent, the future care needs are extensive, and the effect on earning capacity is profound. Economic damages include all past and future medical expenses — acute hospitalization, neurosurgery, ICU care, inpatient rehabilitation, outpatient therapy, neuropsychological evaluation, and anticipated future care. The cost of a severe TBI over a lifetime can reach into the millions. Future medical cost projections require a life care planner and, in complex cases, an economist to calculate present value. Lost wages and lost earning capacity require vocational assessment. Non-economic damages include pain and suffering, loss of enjoyment of life, and the cognitive and personality changes that the injury inflicts on every aspect of the person's daily experience.

Insurance companies frequently challenge TBI claims on grounds that the injury is not visible on imaging, that the symptoms are inconsistent with the mechanism of injury, or that pre-existing conditions account for the presentation. These defenses require experienced medical evidence — neuropsychological testing, diffusion tensor imaging (DTI), functional MRI, and expert testimony from neurologists and neuropsychologists.

Filing Deadlines for San Francisco TBI Claims

The personal injury statute of limitations is two years under Code of Civil Procedure § 335.1. Claims against public entities require a government tort claim within six months under Government Code § 911.2. Missing the six-month deadline can potentially bar a claim against a public entity defendant. None of these deadlines are self-executing and tolling may apply depending on the facts — contact Attorney Michael Rehm to assess the specific timeline in your case.

Attorney Michael Rehm represents brain injury victims throughout San Francisco on a contingency fee basis. No fee without a recovery. Call (800) 978-0754 to arrange a free consultation.

The information on this page is general legal information, not legal advice, and does not create an attorney-client relationship. Every case turns on its own facts. The law can change — statutes are amended, cases are decided, and regulations are revised; nothing on this page should be relied upon as a statement of current law without verification. Deadlines and legal bars discussed on this page are general guides — whether a particular deadline applies, has run, or is subject to tolling, and whether a particular doctrine bars or limits recovery in your case, requires individual analysis. Contact Attorney Michael Rehm to discuss the specific facts of your situation.

San Francisco Brain Injury Attorney

Attorney Michael Rehm — (800) 978-0754