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The Expert: Dr. Enrico Fazzini, a New York-based neuorologist, detailing the symptoms of plaintiff’s brain injury, including loss of smell, and their effects.
Testifying in a 2016 Nevada premises liability trial, Dr. Enrico Fazzini, a New York-based neurologist, details the symptoms of the brain injury plaintiff suffered when she slipped on a wet floor and struck her head. After discussing the various areas of the brain that were damaged and how those injuries would affect her abilities, the doctor focuses on the damage to the olfactory sense, the sense of smell, and how that would be a detriment for both pleasure and survival.
Testimony in the clip begins by defining a contrecoup injury where the brain is injured on the side opposite to that which was actually struck. This occurs as the brain bounces back and forth within the skull, striking the bone of the skull so hard that the brain itself is damaged. In this case a skull fracture was associated with bleeding within the brain and this then defined a coup-contrecoup injury where both the site of the impact and its opposite site were injured.
The expert then discusses MRI findings which would confirm the traumatic brain injury. Dilated perivascular spaces in the basilar ganglia deep within the brain and bilaterally in the parietal lobes are signs of brain damage on an MRI. Damage further demonstrated in the left posterior parietal lobe was particularly relevant as this area is important in language generation. This was correlated with language deficits that had been elucidated in testing performed by a different doctor.
Fazzini goes on to report his review of what another neurologist noted about the patient shortly after her fall. She had vertigo causing balance impairment as well as loss of taste and smell. He explains that the latter can be correlated to olfactory bulb hemorrhage, which would damage the ability to smell. Taste is also hampered by this deficit. The doctor goes on to explain that with traumatic brain injury, one frequently sees damage to the inner ear mechanisms involved with balance. This could affect the ability to sense movement, acceleration, and spinning. As well, the plaintiff has some facial weakness on one side, which Fazinni believes is related to accident-related bleeding in the Sylvian fissure of the brain.
The testimony then focuses on damage to her sense of smell. Fazzini explains that the damage was so severe, that beyond losing the ability to taste or smell, the plaintiff experienced “smell hallucinations”. These are smells that are not really there. Sometimes these smells are particularly unpleasant and cannot be avoided since they are generated by the damaged brain itself. He compares this to phantom limb syndrome, or continuing flashes from retinal stimulation in a sightless person. The loss of the sense of smell is highly significant. This could have survival implications if one is unable to discern a gas leak or a fire for instance. There are things in life that we are constantly smelling that become familiar to us, and the sudden inability to smell turns the world “black and white.” For example, the taste of food that is lost when smell is lost not only deprives one of the pleasure of eating, but can present a danger when one is unable to tell that the food is contaminated or rotten. In other words, this sense of smell is “hard wired” into us to inform us of possible danger around us so that we might avoid it.
The doctor’s testimony likely played a significant role in the $16.43 million verdict for the plaintiff.
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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