Hello everyone! I need some help

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Hello everyone! I need some help

Postby daynthelife » Thu Mar 27, 2008 12:40 pm

Hi everyone....I know it's been awhile. I hope this finds my old friends and our new members of the board doing well today.

I need help!! I've been asked to research some things about post traumatic syringomyelia. I knew this would be the place to come. I've been asked how it happens in relation to whiplash injury. I had that info once but can't seem to find it now...it's been so long and what I need is an article that I can print out.

Also I need to find info on a lawsuit that was settled in the state of California or any state concerning post traumatic syringomyelia. I had that too but alas my computer took a dive and all info I had on it is gone.

In the meantime how is everyone? I'm sorry I've not been on at all but I've been under that black cloud we sometimes find ourselves under. I've had a hard time dealing with it and I've shut myself away from pretty much everyone. This little research project has me moving again though and that's a good thing. Any help would be appreciated.

much luv,

Kathy
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Postby Snoozie » Thu Mar 27, 2008 12:53 pm

Hi Kathy, long time no type ha ha

I think it was Sarah in Paradise who always posted that article. I bet Roz has a copy of it. Hopefully she will chime in here soon. I will look in my docs and see if I can find it though.

Sorry your still fighting that battle with your lawsuit. I had a copy of that plus several other articles that went into detail about SM and it really helped when I went to my deposition. Didn't have to go to court after that so I think it got my point across.

Don't be such a stranger around here, you have been missed...Sue
Seek peace, and pursue it. (Proverbs 34:14)”
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Postby SMLady » Thu Mar 27, 2008 1:00 pm

Yes, I agree with Snoozie. Roz might have it. Roz has more info and resources than anyone!

I hope you are doing well. I was just asking about you a couple of weeks ago.
Proud Mom of One Son
Idiopathic SM T1 - T9, DDD, Scoliosis, Pinched Nerves, Bulging Discs, Spondylosis, Stenosis
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Postby daynthelife » Thu Mar 27, 2008 1:00 pm

Hey girl!! I know...I've been really negligent about my communications lately. This has been a very long road and I'm tired of traveling if ya know what I mean. But I'm hearing now that there is light at the end of the tunnel so I am feeling encouraged and a little revitalized today.

Thanks for your response. I've missed everyone too.

much luv,

Kathy
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hello

Postby razzle51 » Thu Mar 27, 2008 1:01 pm

well Kathy it wasnt that long ago you were here just the 5th of March . Sorry I dont have that info you are looking for . Just keep googling everywhich a way , you will be bound to hit it. I have been trying to get to you on Your my space page but you havent been there either. Hope somebody can come thru with the info you need . Chat with you soon. Roz
Hope your email addy is the same . :D :D
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Postby daynthelife » Thu Mar 27, 2008 1:06 pm

Hi Glenna!! How have you been girl? I know Roz is a wealth of info isn't she? I think about everyone here often and I do hope everyone is doing well. I can't say I'm doing well but I can say that I'm still here hahahahahaha.

Have we seen Sarah in Paradise? Last I heard she was missing in action. But I think it had something to do with her computer being down...I don't quite remember...it was THAT long ago..

much luv,

Kathy
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Postby daynthelife » Thu Mar 27, 2008 1:08 pm

There you are Roz. Yes I did pop in a couple of weeks ago. I did a quickie!! lol...yes my email is the same...
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suit

Postby razzle51 » Thu Mar 27, 2008 1:09 pm

Ok I will do some looking and get back to ya . Good to hear from ya .
I choose not to place "DIS" in my ability.

There is a light at the end of every tunnel....just pray it's not a train!.

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Postby cash71 » Thu Mar 27, 2008 1:11 pm

Hey Kathy,

This law blog might be useful to you http://www.braininjurylawblog.com/about ... ion-4.html It is mostly about cm but does reference a lot of articles that are about both. Also there are personal stories from folks with sm that might be helpful to you.

HTH,

Caroline

ps great to hear from you :D
Be kind for everyone you meet is fighting a harder battle (Plato)

Syrinx C3-T9, CM zero, OTC, cranial settling, dysautonomia/POTS, and ?EDS

see my blog for more info: http://www.chiariandsyringomyeliaincanada.blogspot.com/
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Postby daynthelife » Thu Mar 27, 2008 1:41 pm

Hi Cash...nice to see you too! I guess the first thing I need is how post traumatic syringomyelia is acquired following whiplash injury. I know how it happens...but I need something more concrete then my "word" and something more than "layman's" terms lol. I have a print out of Dr. Tators conference in Canada but all that states is that it is possible to acquire PTSM following whiplash injury not the mechanics of it. The lawsuit info is important also but for some reason I feel the need to get the mechanics of ptsm out of the way first.

much luv,

kathy
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Postby cash71 » Thu Mar 27, 2008 1:53 pm

Kathy, did you see the 6 articles referenced at the bottom of the page? I thought one of those might be helpful.

Caroline
Be kind for everyone you meet is fighting a harder battle (Plato)

Syrinx C3-T9, CM zero, OTC, cranial settling, dysautonomia/POTS, and ?EDS

see my blog for more info: http://www.chiariandsyringomyeliaincanada.blogspot.com/
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Postby daynthelife » Thu Mar 27, 2008 5:52 pm

Yes I did Caroline...ty very much
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Postby cash71 » Thu Mar 27, 2008 5:59 pm

Oh good, just wanted to make sure you saw them. Best of luck getting this all sorted out. And keep us posted!

Caroline
Be kind for everyone you meet is fighting a harder battle (Plato)

Syrinx C3-T9, CM zero, OTC, cranial settling, dysautonomia/POTS, and ?EDS

see my blog for more info: http://www.chiariandsyringomyeliaincanada.blogspot.com/
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Postby birdlover3 » Thu Mar 27, 2008 6:34 pm

Kathy, good to see you, and the others here too. Below is part of SarahInParadise’s post. Sarah had ACM1 before she was in an accident. She won her lawsuit because her wreck exacerbated her Chiari. I’m going to see if I can find Don’s post. I can’t type much now, but my wonderful family is pasting this here for you. Good luck & God bless.


SarahInParadise ACM and Trauma: Greetings all -- I'm pasting here a post I sent to both wacma and ASAP in the past - so it will be at the CCI archives - any finding this discussion here below in the future - PLEASE remember it's several years old now -there may be MORE appeals court cases newer since I found this case below , and the list of articles is VERY out of date now too ( places such as conquer Chiari = and pub med have FAR more articles that can tie in now ) == but it is a good basic starting place still - LOL - that I don't want to loose as the archives may change anywhere - hence this post too .

(This post is long - but I hope will help anyone who's in a legal situation with trauma and preexisting Chiari OR SM ECT .)

I'm responding to the full group here about your Questions relating to trauma -- You'll find some files I've saved including an appeals court level full case decision below - that I gathered up during a court experience I had following an accident where my Chiari situation changed in BOTH structural issues – and symptoms . --There ISN"T a huge body of legal cases ect . yet - the actual EVIDENCE Chiari CAN be exacerbated developed through research in just the last FEW YEARS --but there IS clear evidence now , folks are winning settlements - and I hope these bits of info are helpful to you and others . It's been awhile since I posted them /- about three years now since I DID any current
research to ADD to them as well - so you may find there are now MORE cases you could add .

To search for cases - you can go to any law library ( most will allow the public in -and the law librarian will gladly help you do searches via Findlaw ect . -then show you how to pull the legal records from their stacks and photocopy the cases too . Another option is to ASK your attorney to use Findlaw or Westlaw ect . - checking to see if there is something more recent .

This is long == but worth printing to share with your attorney and us in mediation . Before I paste them in - Let me add that Dr. Milhorat's " acm 1 redefined " study linked at wacma - was the FIRST large study of Chiari to include Trauma as a precipitating factor in EXACERBATION of a preexisting Chiari . The doctors had long felt in THEORY that this could happen --but empirical EVIDENCE wasn't in existence .

SINCE about 1997 on - a SMALL NUMBER of cases - with a growing body of MRIs done prior to trauma - then compared with studies done AFTER trauma, have started SHOWING some anatomical /structural changes occur in SOME folks following trauma. FEW folks had a large number of MRIs done to allow comparison /so this ISN"T common , but is clearly recognized as documented in some cases now too .- In my situation the neurosurgeons at NIH helped untangle what had changed / and found my tonsils dropped an additional 6-8mm BELOW the stable level of 5-7 mm they'd been seen to be over a 10 year monitoring of Chiari timeline. BY the time I got to surgery - they were at 11-13 mm herniation - they'd changed SHAPE going from rounded to pointed - and repeated CINE MRI’S done several times during the year post head blow /trauma until surgery showed WORSENING occlusion and greater
blocked flow WHILE my symptoms got worse too. I was among the first patients found with this EVIDENCE that trauma could cause structural changes -- there are some other cases like mine that have now been found too .

So here are a list of cases - ( the first a full appeals court case that OTHER attorney's are using as a model now ) - then a list of cases at the appeals court level with my brief notes about the focus of each case by ID Number -- then last a list of interview segments with leading acm specialists discussing trauma impacts /and articles that related to MY case . I also have multiple sclerosis -so please ignore the articles with an ms focus . I hope this is a small help - IF you loose this post = I’ve also posted all this info at ASAP's support board under the disabilities section . == BEST wishes - DO know the courts require insurance ( INCLUDING workman's comp ) to cover EXACERBATION (made worse in a timeline BEFORE it would perhaps naturally have occurred ) - it's VERY clear you are entitled to compensation! I'll add that I got /brought /and discussed ALL of these sources of info with my TREATING physicians - that was important too because you've got to have GROUNDS to get these in front of a
judge /jury -- by discussing them with my treating doctor they became admissible - talk to your attorney about this aspect too. My BEST wishes to you and anyone who'd battling the insurance industry - it HELPS to have a partner attorney who's a specialist in neurotrama law in MY opinion too! I'm also glad to discuss this by phone with anyone or any attorney -just write me
Sarah in Paradise ( cases and info below )
Cite as :2002 WL 31492570 ( Cal. App.1 Dist. )

California Rules of the court , Rule 977(a) prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published , except as specified by rule 977(b). This opinion has not be certified for publication or ordered published for purposes of rule 977 .

the case number is No. A096657 ( San Francisco Super. Ct. No.307591 Court of Appeal, First District , Division 5 California Angee ADAMs , plaintiff and respondent VS City and County of San Francisco
Angee Adams filed a personal injury complaint against the city and county of SF (CCSF ) seeking damages for injuries she sustained while riding as a passenger on a city bus. After Adams obtained a jury verdict in her favor, CCSF filed a motion for partial judgment notwithstanding the verdict ( JNOV ), arguing that Adams had failed to prove the most serious injuries she suffered were caused by the accident. The court denied the motion and entered a judgment in Adam's favor. CCSF now appeals, contending (1) the trial court should have granted its motion for a partial JNOV, and (2) the judgment must be reversed because the court committed to evidentiary errors. We reject these arguments and affirm the judgment .

1. FACTUAL and PROCEDURAL BACKGROUND
On the morning of Nov. 10 1998 , Adams was traveling to work on a bus owned and operated by San Francisco Municipal Railway ( MUNI ) when it was struck from behind by a streetcar also operated by MUNI . Adams flew forward and struck her head against the head of another passenger . Adams then bounced back into a railing and into her seat. Adams and 16 other passengers were injured in the crash .

Adams was taken to a hospital. Doctors there gave her pain medication and sent her home . The following day, Adams felt much worse. She was vomiting and had intense pain everywhere. She was also dizzy and had pain in her shoulder and throat .Some of the symptoms Adams was experiencing lessened after about one month . Others, including pain in her neck , head and arms, and a tingling sensation in her left arm persisted . Adams went to a series of doctors in an effort to get treatment for the pain she was experiencing. Eventually, in the spring of 2000, a neurologist , Dr Michael Sheinberg, diagnosed Adams as suffering from a condition known as Chiari malformation , type 1 (CM -1 ) with a syrinx .

CM-1 is a congenital condition in which the tonsils that are attached to the bottom of a person's brain extend into the cervical spinal cord region. This causes overcrowding and compromises the spinal fluid that bathes the spinal column.
One of the primary symptoms of CM-1 is headaches. A syrinx is fluid -filed cyst of the spinal cord. The syrinx disrupts nerve cells that flow through the spinal cord and causes negative symptoms

Dr. Sheinberg performed brain surgery on Adams to relieve the overcrowding and to lessen the painful symptoms she was experiencing. Adams filed complaint against CCSF seeking damages for the injuries she had sustained. The case proceeded to jury trial, where CCSF conceded it was negligent and that Adams probably suffered neck strain due to the accident. The primary issue for the jury to decide was whether the accident had caused Adams previously asymptomatic CM-1 condition to become symptomatic .

The parties presented conflicting evidence on that issue. Adams presented testimony from two experts, Dr Sheinberg and Dr. Richard Rubenstein, both of whom testified that the accident had caused Adam's CM-1 condition to become symptomatic. CCSF countered with an expert who testified that trauma has no effect on CM-1 . The jury accepted the former testimony and rendered a verdict awarding Adam's $206,422.57 in damages.
.
*2 CCSF then filed a motion for a partial JNOV. AS is relevant here, it argued the experts presented by Adams had failed to establish there was a reasonable probability that the accident had caused Adams's CM-1 condition to become symptomatic. When the trial court rejected the argument , CCSF filed the present appeal .

ll . Discussion
A Judgment Notwithstanding the Verdict
CCSF contends the trial court erred when it denied its motion for partial JNOV .

"The trial court's discretion in granting a motion for judgment notwithstanding the verdict is severely limited. " (Teitel v. First Los Angeles Bank (1991 )231 Cal.App.3d 1593,1603. The motion may be granted only if the trial record , when viewed in the light of the most favorable to the prevailing party, fails to contain substantial evidence to support the verdict . ( Sweatman v. Dept of Veterans Affairs 2001) 25 Cal4th62, 68. The trial court may not reweigh the evidence, draw inferences contrary to the verdict, or assess the credibility of witnesses. ( Bengnal v Canfield &
Associates, Inc (2000) 78 Cal App.4th66,72.

On appeal , the same standard of review applies . We must view the record in the light most favorable to the judgment and determine whether any substantial evidence, contradicted or uncontradicted, supports the verdict . ( Sweatman v. Dept. of Veterans Affairs 2001)supra. 25Cal.App 4th at pg 68.

CCSF contends the trial court should have granted the motion for partial JNOV because the evidence Adams presented failed to establish that it was reasonably probable the accident caused her CM-1 condition to become symptomatic. "A plaintiff cannot recover damages based upon speculation or even a mere possibility that the wrongful conduct of the defendant caused harm ... Evidence of causation must rise to the level of a reasonable probability based upon competent testimony . " ( Williams v. Wraxall ( 1995 ) 33 Cal . App.4th 120, 133 ), internal citations omitted, ) "A possible cause only becomes 'probable ' when , in the absence of other reasonable causal explanations, it becomes more likely than not that the injury was a result of it's action ." ( Jones v. Ortho Pharmaceutical Corp. ( 1985 ) 163 Cal App.3d 396,403.)

In this case Adam's presented testimony from two experts, who said the accident had caused her CM-1 condition to become symptomatic. However, the parties focused their arguments primarily on Adam's second witness Dr Rubenstein . We will similarly limit our analysis .

Dr. Rubenstein had been a doctor for 27 years . He was board certified in neurology , and had been elected to the fellowship in the American Academy of Neurology, a level of certification higher that board certification . Dr Rubenstein had also written scholarly articles in the field of neurology .

Dr. Rubenstein testified unequivocally that the accident caused Adam's CM-1 condition to become symptomatic . He explained , "my opinion is that the necessity for the surgery was precipitated by the MUNI bus collision that occurred on November [10,1998]-****-my note here --[some funny symbols here I don't know how to type !]
Absent that collision I believe that Miss Adams would have continued to remain asymptomatic, certainly in terms of her major symptoms of throat pain, swallowing difficulties, shoulder pain, left arm pain and numbness .

#3 Dr Rubenstein based his conclusion on several factors . First, in the course of 27 years of practice, he personally was involved with two patients who had CM-1 and who became symptomatic after a traumatic incident .
Dr. Rubenstein also relied on many scholarly articles, two of which were of particular note.
The first , by Dr Tomas Mampalam et. all , described a 13 year old girl with CM-1 who became symptomatic after she was hit by a car. According to Dr. Rubenstein " (I)t was clear . And the conclusion of their study: that she was asymptomatic prior to this; that the accident, again, just as it did in Miss Adam's case, triggered a marginally stabilized condition to a very progressive condition, resulted in her situation."
The second article by Dr. Tomas Milhorat et. all, was even more definitive. The article studied 364 persons with CM-1 condition who had become symptomatic. Of that number "89 out of those 364 patients reported that the
inciting even that caused them to become symptomatic was trauma, the most common of which was a whiplash type injury.

Viewing the record in the light most favorable to the jury's verdict , we conclude there is ample evidence to support the conclusion that the accident caused Adam's condition to become symptomatic. CCSF contends Dr Rubenstein's testimony was inadequate . It relies on the following portion of Dr. Rubensteins testimony, where he admitted that there was no consensus in the scientific community as to HOW a traumatic event can adversely affect a person with CM-1. " I think there has been debate over decades about what is the exact anatomic configuration that results in the
Chiari Malformation . But I think that it is becoming clearer how a traumatic event could destabilize a Chiari malformation, because it is very clear ...that trauma can precipitate an asymptomatic Chiari malformation to a symptomatic Chiari malformation ."

CCSF also relies on a portion of Dr. Rubenstein's testimony where he admitted, during cross-examination, that because he did not have a brain scan of Adams prior to her accident, he could not provide a precise explanation for why Adams began experiencing pain after the accident. "Q. Okay Doctor on your description of what is going on anatomical, your opinion of what is happening anatomically, is that opinion speculation, possibility or probability? [*** that odd symbol I can't type here ]
A. I would think that it would be --obviously, because I don't have a pre-accident scan I can't say that is probable, i.e. 51% [** that odd symbol ] I can say that it is a distinct possibility that the accident destabilized this marginally stabilized condition, caused more tonsilar herniation . [ ** odd symbol ] And certainly the one thing I think is pretty definite is we know Miss Adams had no symptoms preexisting this accident that at least I saw in the
medical records or by history of left shoulder , left arm pain . She had them immediately post -accident time frame. [** odd symbol ] Clear to me that something happened as a result of the accident."

#4 Finally CCSF relies on the following portion of the Milhorat article that describes some uncertainty about how trauma causes CM-1 condition to become symptomatic. "As shown in Table 1 , approximately 25 % of patients cited trauma as the precipitating factor . The most common mechanisms were whiplash injuries and direct blows to the head and neck . ...which raises the possibility that certain types of trauma accentuate tonsillar impaction or result in subarachnoid hemorrhage that destabilizes a marginally compensated CSF system " ( Italics added by Westlaw )

CCSF interprets these passages as meaning that Adam's experts could only speculate that the accident had caused her
CM-1 condition to become symptomatic. According to CCSF, that speculation was insufficient to establish causation under the controlling legal standard which requires a "reasonable probability ." ( See Williams V Wraxall , Supra.33 Cal. App. 4th at P 133 .)

We reject the argument . The passages CCSF cites shows there may be some uncertainty how trauma causes a CM-1 condition to become symptomatic, but also "how (the) accident changed her underlying condition such that it produced different symptoms from before ." CCSF has not cited any authority that holds such proof is required, and we decline to adopt that standard . As Adam's argues persuasively in her brief , "medical science may not understand the physiological mechanism by which Agent Orange or other toxic agents cause a host of symptoms, including genetic damage, but the causative relationship can be demonstrated to a reasonable medical probability. Much of medical science is based on correlations between event and symptoms that are statistically very reliable,
without understanding the mechanism of the cause. To require probable scientific understanding of the physiological mechanism would render recovery impossible for many plaintiffs, when proximate causation can otherwise be clearly demonstrated ..."

We conclude the evidence of causation was adequate. While Rubenstein's testimony may have contained contradictions, Adam's evidence on this issue is not insubstantial . The trial court correctly denied CCSF's motion for a partial JNOV .

B. Evidentiary Rulings
Dr Rubenstein testified, on direct and cross-examination, that one of the factors he considered when determining whether the accident caused Adam's CM-1 condition to become symptomatic was the article by Dr. Tomas Milhorat . Near the conclusion of Dr. Rubenstein's testimony, the court asked the parties whether they intended to admit the article into evidence. When Adam's offered the article, CCSF objected . The court said it would admit the article . Faced with that ruling, CCSF asked the court to admit Dr Mampalam's article into evidence . The court agreed . According to CCSF, the Milhorat article was subsequently provided to the jury.

#5 CCSF now contends the trial court erred in two respects . First, it contends the court should not have admitted Dr. Milhorat's article into evidence because it was hearsay. We need not address the argument directly because CCSF never raised a hearsay objection in the court below . It simply objected without stating any specific grounds . "In order to preserve an objection on appeal, a party must state it in a timely fashion, and it must be accompanied by a reasonably definite statement of the grounds ....These requirements are designed to avoid unfair surprise to opposing parties and to prevent error by the trial court. The trial judge is given a concrete legal proposition to consider and the opposing counsel is sufficiently advised of the alleged defect to reframe the question, lay an additional foundation , or take other steps to minimize the likelihood of reversal " ( Simons on Cal. Evidence 2001) Relevant Evidence , 1:20, p 18, internal citations omitted .)
Alternately, CCSF contends the trial court violated Evidence Code section 721, [FN1] when it allowed the jurors to take the Milhorat article with them into the jury room. Again ,we reject this argument on procedural grounds. We find no place in the record where CCSF raised this issue in the trial court, or even raised a general objection to the jurors taking the Milhorat article into the jury room The issue is waived . ( Evid. Code& 353, subd. ( a) [Perry V McLaughlin (1931) 212 Cal. 1,6;Arreola v. County of Monterey(2002) 99 Cal. App.4th 722, 750.) FN1. Evidence code section 721, subdivision (b) states that scientific articles may be admitted into evidence in certain circumstances, and if admitted, "relevant portions of the publication may be read into evidence but may not be received as exhibits ."

lll. Disposition
The judgment is affirmed .
We concur : Simons and Gemello, JJ
2002 WL 31492570( Cal. App.1 Dist. ) Not Officially Published , (Cal Rules of Court, Rules 976, 977)

Second section -- the list of other appeals court cases on Chiari/sm Arnold Chiari and administrative judge/court cases
1.) 75 F. Supp 2d 446 ( ada and education access )
2.) 719 So. 2d 355 ( acm and sm aggravated /injury ..timelines and expert witness issues
3.) 584 N.W. 2nd 747 (acm and doctor negligence )
4.) 145 F. 3d 143
5.) 574 N.W. 2d. 451 ( ada and acm )
6.) 900 F. Supp 1137 (acm and ada )
7.) 893 P.2d 345 ( acm - prenatal dx and negligence , failure of the doctor to provide dx leading so pregnancy could be terminated )
8.) 638 So.2d.794 (acm and spina bifida /malpractice....related to peds and shunt infection ect )
9.) 510 NE. 2d. 1066 ( acm /malpractice conflicting testimony by doctors /expert witnesses )
10.) 444 A. 2d. 401 (acm and sm as preexisting /exacerbation/insurance issues of coverage)
11.) 170 A. 2d. 22 ( yellow (not sure what yellow means to a librarian ) ...but this one references # 10 as setting precedence in this case )
12. 167 A.2d.191 ( insurance coverage ...sets precedence for two other cases at least , that I read through) infant ...action on insurance policy issues when acm and accidental injury are involved .)

Third section - interview segments and journals articles
NOTE - this first article listed is Dr. Milhorat’s study that was the first Large study to include Trauma as a study factor - and is the article the ABOVE full appeals court case cites/and hinges upon .
'I’ve labeled it "A" here - you'll need the FULL ARTICLE including charts and graphs ect - some trauma impacts info is IN those .
Some online free versions of this article on the net DON"T have the graph's and charts - do get this FROM photocopy of the journal article/or a source that's complete !
A.
#1 Chiari 1 Malformation Redefined: Clinical and Radiographic Findings for 364 Symptomatic Patients
Neurosurgery, Vol. 44, No. 5, May 1999

Table 1 ( Page 1006) Variable CMI CMI/SM All Patients Precipitating Factors Trauma (e) 23 66
89 (E) Includes whiplash injuries and direct blows to the head or neck.

#2 See Dr. Milhorat " Chiari Malformation and Syringomyelia" Chiari Conference 1997 videotape regarding his findings with trauma and exacerbation of Chiari.

#3
Can spinal Surgery Really Help?
The CFIDS Chronicle, Nov/Dec 1999, Page 22 D. R. Daniel Heffez said " There is not one answer that holds true for everyone, but 71% of these patients said they had a head injury or had been in a motor vehicle accident close to
the time that the symptoms started".

#4
Can spinal cord compression cause the fibromyalgia syndrome?
Author: Dan S. Heffez, M.D. ect.
http://www.myalgia. com/nfra999b. htm

B.
#1
Http://www.pareras. com/neuroxxi/ xxi05/xxi05- 02.htm
Volumen: 2 Numero 2 seccion: Firma Invitada Articulo:2
Reproducido can permiso de Neurocirugia XXI.
Vanaclocha V: Syringomielia
Neurocirugia XXI 2(2):115-130, 1996
Seleccion del indice

Once produced the block of the subarachnoid space at the cisterna magna, the cranio-spinal pressure dissociation would self perpetuate the herniation (16,62,100,106) .

#2
http://www.co- cure.org/ chiari.htm
Spine, skull surgery may help many with CFIDS, FMS: Chiari malformation or cervical stenosis may be common in
CFIDS & fibromyalgia

"When you hyperextend the neck backward," Dr. Rosner explained, "the spinal canal narrows. This happens in the case of whiplash in an automobile accident, extended dental work in which the head is bent back, coughing severely for an extended period of time, even something like painting a ceiling."

#3
http://www.csn. ca/smconf97. htm
Dr. Charles Tator, Neurosurgeon, at the Canadian Syringomyelia Conference. September 1997.

Does added trauma (whiplash etc) bring trouble for the ACM/syringo patient?
"I never like to hear about my patients being involved in car accidents or falls or other mishaps because it can cause
problems for them. Trauma, even the slightest mishap can produce inflammation or even a slight bleed in the head causes further inflammation and this reaction can block CSF pathways. Pressure problems, and worsening of symptoms can result. This is in addition to affects of the mishap itself. So please, avoid trauma! "

#4
Reb Med Suisse Romande 1995 Nov;115(11): 901-903 [Minor cranio-cervical injuries, cerebral malformations and chronic headaches].

"We have presented two cases of chronic disabling exertional headaches following a minor head trauma. MRI studies of the cranio-cervical junction showed Chiari Type 1 malformation, without bony occipito-cervical dysplasia. Headaches after a mild trauma are a common finding. The exertional character of the headache can lead the clinician to this diagnosis in cases involving long-term complaints.


#5
PMID 818 9267 UI 94246452
Authors: Huang P.P., Constantine S.
Progressive decent of tonsils ect.

#6
Presentation of type 1 Chiari Malformation after trauma
Authors: Mampalan T.J., Andrews B.T., Gelb D., Ferriero D., Pitts I.H.
PMID 3216976 U.I. 89112502
Neurosurgery 88 Dec. 23(6): 760-2

#7
Acute Paraparesis secondary to ACM 1 malformation and hyperextension
Authors: Vkck B.W., Ito B.
PMD 3827208 VI 87155197
ANN neurology Jan 21:1:100-1

#8
Headache in type 1 Chiari malformation
Authors: Julio Pascual, M.D.; Agustin Oterino, M.D.; and Jose Berciano, M.D.
August 1992 Neurology 42 1519
" The aggravation of occipital-suboccipital pain by cough or effort in these patients can be explained by further tonsillar herniation occurring with these maneuvers".

#9
SBM MEETING: Stress Linked To New Brain Lesic
Multiple Sclerosis
http://www.pslgroup .com/dg/67e66. htm
"What we found was that major stressful as well as small daily hassles were relative to development of new brain lesions in the brain two months later"
"While brain lesion are not necessarily a sign of increased impairment, they do point to in disease activity.

#10
Oculocephalic sympathetic dysfunction in post-traumatic headaches
Author: Khurana R.K.
PMID: 8550360, UI 96127714
Headache 1995 Nov;35(10):614- 620
"This study documents serious injury to the cervical sympathetic nerves in patients with posttraumatic
headaches following whiplash injury....oculocephalic sympathetic dysfunction as a direct cause of head pain, but it may exert an effect on cephalic pain through the trigeminovascular system"

#11
Minor Cranio-Cervical injuries, cerebral malformations and chronic headaches
Author: Foletti G., Regli F.
PMID: 8525246, UI: 96097476
"Headaches after a mild trauma are a common finding."

#12
Whiplash, postural control, and the inner ear
Author: Chester J.B.
PMID: 1925743 UI: 92022758abstract

#13
Cerebral autoregulation following minor head injury
Author: Elizabeth C. Junger M.D., ect.
http://www.aans. org/journals/ online j/jan97/2-1- p1.html

#14
Cervical spinal cord trauma
Author unknown
http://www.sahlgren ska.se/su/ div c/neuro/fakta/ wad/cervcord.htm

#15
Chiari Malformation: Classification & management
Author: Bindal A.K. ect.
Journal-Neurosurgery y
Dec 1995, Vol 37, Issue 6 Page 1069-74
ISSN: 0148-396x

#16
Spontaneous intercranial hypertension: headache
reversible Chiari
Author: Kasner S.E.
Oct. 1995 abstract available

#17
Ireland- ISSN 0379-0738
Sudden or unexpected deaths in the context of minor
Coincident trauma

#18
Germany ISSN:0028-2804
Author: Basedow-Rajwich B. Ect.
Address: Marianne Strauss-Klinik, Berg.
Source: Nerverarzt Aug. 1995,66:8,630- 3

#19
Chiari Malformation to M.R. Imagery Editorial
Comment
Author: Ball W.S. JR, Crone K.R.
June 1995,195:3 602-4
Unique Identifier 95273548
ISSN: 00338419

#20
Spontaneous Intercranial Hypotension With Reversible ACM
Author: Kasner S.E.
Dept. Of Nuero Hospital of Penn. Philadelphia 19104
Source: Headache Oct. 1995, 35;9,557-9

#21
Syndrome of Orthostatic Headaches and diffuse Pachmenigeal gadolinium enhancement
Author: Mokri B., Piepgras D.G, Miller G.M
Address: Dept. of Nuero Mayo Clinic Rochester MN.
Source: Mayo Clinic May 1997, 72:5-400-13
CSF fluid leaks, Low pressure

#22
Minor Cranio-Cervical Injuries-Cerebral Malformations and Chronic Headaches
Author: Foletti G, Regli F.
Address: service of source Rev Med Suisse Romande
Nov. 1995, 115:11,901-3
Headaches following minor head trauma

#23
Adult ACM with triminial headache
Author: Storrs J.J
Unique I.D: 97039274
Value of MRI in DX , Question of appropriate findings

#24
Syndrome of Orthostatic headaches & Enhancement
Author: Mokri B., Piepgrass D.G, Miller G.M
Dept. of Neuro- Mayo 55905 USA
Source: Mayo Clinic Proc, May 1997, 72:5 400-13
26 Pt. Postural Headache - all relived with recumbency.
CSF Licks Unique I.D. 97292141

#25
Spontaneous Spinal CSF leaks & Intra Cranial Hypertension
Author: Schievink W.I, Mayer F.B
Source: J Neurosurgery April 1996, 84.4 598-605
Unique I.D 96180233

#26
Minor Cranio-Cervical injuries, Cerrebral Malformation and headaches
Author: Folletti G., Regfi F.
Source: Rev. Med. Suisse Romande
Unique I.D. 96097476

#27
Headache
Author: Kasner S.E, Rosenfield J, Farber R.E.
Dept. of neurology, Hospital of Univ. of Penn, Philadelphia
19104
Source: Headache 1195 Oct. 35.9 557-9
Unique I.D : 96084489

#28
Pulsile Tininintus as manisfestation of congenital CNS
Wiggs W.J. JV Malform
Dept. of Otolaryngology- Head Neck surgery- Medical College of Virginia
Source: AMJ OTO 1, March 1996
Unique I.D 96312611

#29
Acute paraparesis secondary to Arnold-Chiari type I malformation and neck hyperflexion.
AUTHORS: Vlcek BW; Ito B
SOURCE: Ann Neurol 1987 Jan;21(1):100- 1
CITATION IDS: PMID: 3827208 UI: 87155197
birdlover3
 
Posts: 564
Joined: Thu May 17, 2007 4:54 am

Postby birdlover3 » Thu Mar 27, 2008 6:44 pm

Don, I hope you don’t mind me putting your old post here.

Don’s post had reposted some of what SarahInParadise had posted, but with extra notes that might be very helpful. Here’s Don’s old post:



donbr
Registered User
Posts: 501
(3/21/07 11:36 am)
Re: Hello! New to board. Millions of questions!?!?!?!

Hello,
Welcome to the board,
Sarah in paradise just posted she would be gone for a short period of time. computer problems.
I have copied/pasted the court case someone was referring to and a little bit of info that I learned through a case my wife and I just finished.

Hi everyone,
I believe there a lot of people that are involved in legal issues due to car accidents and Chiari or syrinx related symptoms. My wife and I have just ended our case and won without ever hiring an “expert witnessâ€￾. I would not suggest this to anyone but because of the circumstances we didn’t think one would be necessary. After she had decompression surgery a short time later they the defense hired a well known acm/sm specialist that knows how trauma can aggravate a Chiari malformation. We knew who he was so didn’t hire an expert.
After he was retained a deposition was scheduled but this was done before he had a chance to review medical records. After he did review them he told them that the accident caused the need for surgery.......they conceded and was settled without him ever giving a deposition.
Winning a case such as such as this is not as difficult as it may seem. You will just need some sort of expert in acm/sm go through medical records.

OK some NS/NL don’t understand these disorders as we think they should. This is true.
I’m going to tell a little story that a Dr. told me, I can’t confirm whether or not this is true but it does make sense.:
About 4-5 years ago a person went to court because he had to have brain surgery after an accident. The defense hired an expert as did the claimant, the defense witness expert lied through his teeth and the defense won. The plaintiffs expert knew he lied and turned him in to the AMA or the proper authorities concerning expert witnesses it was not the court. They looked at his testimony and realized he did in fact lie so they took his board certification away from him for 6 months and if it happens the second time the board certification gets taken away for life. This is their policy and does not have anything to do with the courts. They also sent their opinion to the plaintiff attorney the defense attorney and the judge residing over the case. It finally got settled out of court. He also said that expert witnesses in neurology must testify using published material and medical records and base their opinion on this.
In other words If an expert says a 4mm herniation can’t cause problems we all know this is not true there is published material that says it can---or the size of your syrinx can’t cause problems when published material says size is not a factor it’s the location---
With this said it does not mean you will automatically win because he can still base his opinion using your medical records and published material and say in his opinion the accident didn’t aggravate the condition.
I would also like to get into something else........WATCH what you say on the internet, it can and will be used against you if they think they can. Also I know acm/sm causes a certain degree of disability if not a full disability. Don’t over exaggerate your condition, the insurance companies have the resources to hire investigators and they will if they think your case is worth very much and when you claim a car accident caused a disability that alone can prompt an investigation.
Never tie yourself to an answer or I can’t do something, for instance driving a car it’s just as easy to say I don’t drive because I feel its unsafe for me to drive, because I lose concentration.
Last but not least, I know you have or will be tempted to give your pcp information from the internet to educate them, if you do this MAKE SURE your pcp understands that you don’t want this information disclosed because the defense will ask for anything you have given your Drs. This type of situation is coaching your Dr. Into certain opinions and would effect his/her testimony.
Below is a court case that was won. This info was posted previously by SarahInParadise

1.) 75 F. Supp 2d 446 (ada and education access )
2.) 719 So. 2d 355 (acm and sm aggravated /injury ..timelines and expert witness issues
3.) 584 N.W. 2nd 747 (acm and doctor negligence)
4.) 145 F. 3d 143
5.) 574 N.W. 2d. 451 (ada and acm)
6.) 900 F. Supp 1137 (acm and ada)
7.) 893 P.2d 345 (acm - prenatal dx and negligence , failure of the doctor to provide dx leading so pregnancy could be terminated )
8.) 638 So.2d.794 (acm and spina bifida /malpractice ....related to peds and shunt infection ect )
9.) 510 NE. 2d. 1066 (acm /malpractice conflicting testimony by doctors /expert witnesses)
10.) 444 A. 2d. 401 (acm and sm as preexisting /exacerbation/insurance issues of coverage)
11.) 170 A. 2d. 22 ( yellow ( not sure what yellow means to a librarian ) ...but this one references # 10 as setting precedence in this case )
12. 167 A.2d.191 (insurance coverage ...sets precedence for two other cases at least , that I read through) infant ...action on insurance policy issues when acm and accidental injury are involved .)
journals articles

A.
Cite as :2002 WL 31492570 ( Cal. App.1 Dist. )
California Rules of the court , Rule 977(a) prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published , except as specified by rule 977(b). This opinion has not be certified for publication or ordered published for purposes of rule 977 .

the case number is No. A096657 ( San Francisco Super. Ct .No.307591
Court of Appeal, First District , Division 5 California
Angee ADAMs , plaintiff and respondent VS City and County of San Francisco

Angee Adams filed a personal injury complaint against the city and county of SF ( CCSF ) seeking damages for injuries she sustained while riding as a passenger on a city bus . After Adams obtained a jury verdict in her favor, CCSF filed a motion for partial judgment notwithstanding the verdict (JNOV), arguing that Adams had failed to prove the most serious injuries she suffered were caused by the accident. The court denied the motion and entered a judgment in Adam's favor. CCSF now appeals, contending (1) the trial court should have granted its motion for a partial JNOV, and (2) the judgment must be reversed because the court committed to evidentiary errors , We reject these arguments and affirm the judgment.

1. FACTUAL and PROCEDURAL BACKGROUND
On the morning of Nov. 10 1998, Adams was traveling to work on a bus owned and operated by San Francisco Municipal Railway (MUNI) when it was struck from behind by a streetcar also operated by MUNI. Adams flew forward and struck her head against the head of another passenger. Adams then bounced back into a railing and into her seat. Adams and 16 other passengers were injured in the crash.

Adams was taken to a hospital , Doctors there gave her pain medication and sent her home . The following day , Adams felt much worse . She was vomiting and had intense pain everywhere , She was also dizzy and had pain in her shoulder and throat .

Some of the symptoms Adams was experiencing lessened after about one month . Others , including pain in her neck , head and arms , and a tingling sensation in her left arm persisted . Adams went to a series of doctors in an effort to get treatment for the pain she was experiencing . Eventually, in the spring of 2000 , a neurologist , Dr Michael Sheinberg , diagnosed Adams as suffering from a condition known as Chiari malformation , type 1 ( CM -1 ) with a syrinx .

CM-1 is a congenital condition in which the tonsils that are attached to the bottom of a person's brain extend into the cervical spinal cord region , This causes overcrowding and compromises the spinal fluid that bathes the spinal column. One of the primary symptoms of CM-1 is headaches . A syrinx is fluid -filed cyst of the spinal cord . The syrinx disrupts nerve cells that flow through the spinal cord and causes negative symptoms .

Dr Sheinberg performed brain surgery on Adams to relieve the overcrowding and to lessen the painful symptoms she was experiencing .

Adams filed complaint against CCSF seeking damages for the injuries she had sustained . The case proceeded to jury trial , where CCSF conceded it was negligent and that Adams probably suffered neck strain due to the accident . The primary issue for the jury to decide was whether the accident had caused Adams previously asymptomatic CM-1 condition to become symptomatic .

The parties presented conflicting evidence on that issue . Adams presented testimony from two experts , Dr Sheinberg and Dr Richard Rubenstein , both of whom testified that the accident had caused Adam's CM-1 condition to become symptomatic , CCSF countered with an expert who testified that trauma has no effect on CM-1 . The jury accepted the former testimony and rendered a verdict awarding Adam's $206,422.57 in damages .

*2 CCSF then filed a motion for a partial JNOV. AS is relevant here , it argued the experts presented by Adams had failed to establish there was a reasonable probability that the accident had caused Adams's CM-1 condition to become symptomatic , When the trial court rejected the argument , CCSF filed the present appeal .

ll . Discussion
A Judgment Notwithstanding the Verdict

CCSF contends the trial court erred when it denied its motion for partial JNOV .

" The trial court's discretion in granting a motion for judgment notwithstanding the verdict is severely limited . " ( Teitel v. First Los Angeles Bank (1991 )231 Cal.App.3d 1593,1603. The motion may be granted only if the trial record , when viewed in the light of the most favorable to the prevailing party , fails to contain substantial evidence to support the verdict . ( Sweatman v. Dept of Veterans Affairs 2001) 25 Cal4th62, 68. The trial court may not reweigh the evidence , draw inferences contrary to the verdict , or assess the credibility of witnesses . ( Bengnal v Canfield & Associates . Inc (2000) 78 Cal App.4th66,72.

On appeal , the same standard of review applies . We must view the record in the light most favorable to the judgment and determine whether any substantial evidence , contradicted or uncontradicted , supports the verdict . ( Sweatman v. Dept of Veterans Affairs 2001)supra. 25Cal.App 4th at pg 68.

CCSF contends the trial court should have granted the motion for partial JNOV because the evidence Adams presented failed to establish that it was reasonably probable the accident caused her CM-1 condition to become symptomatic .

" A plaintiff cannot recover damages based upon speculation or even a mere possibility that the wrongful conduct of the defendant caused harm ... Evidence of causation must rise to the level of a reasonable probability based upon competent testimony . " ( Williams v. Wraxall ( 1995 ) 33 Cal . App.4th 120, 133 ), internal citations omitted, ) "A possible cause only becomes 'probable ' when , in the absence of other reasonable causal explanations , it becomes more likely than not that the injury was a result of it's action ." ( Jones v. Ortho Pharmaceutical Corp. ( 1985 ) 163 Cal App.3d 396,403.)

In this case Adam's presented testimony from two experts , who said the accident had caused her CM-1 condition to become symptomatic , However , the parties focused their arguments primarily on Adam's second witness Dr Rubenstein . We will similarly limit our analysis .

Dr. Rubenstein had been a doctor for 27 years . He was board certified in neurology , and had been elected to the fellowship in the American Academy of Neurology, a level of certification higher that board certification . Dr Rubenstein had also written scholarly articles in the field of neurology .

Dr. Rubenstein testified unequivocally that the accident caused Adam's CM-1 condition to become symptomatic . He explained , " my opinion is that the necessity for the surgery was precipitated by the MUNI bus collision that occurred on November [10,1998] -****-my note here --[some funny symbols here I don't know how to type !]
Absent that collision I believe that Miss Adams would have continued to remain asymptomatic , certainly in terms of her major symptoms of throat pain , swallowing difficulties , shoulder pain , left arm pain and numbness .

#3 Dr Rubenstein based his conclusion on several factors . First , in the course of 27 years of practice , he personally was involved with two patients who had CM-1 and who became symptomatic after a traumatic incident . Dr. Rubenstein also relied on many scholarly articles , two of which were of particular note . The first , by Dr Tomas Mampalam et. all , described a 13 year old girl with CM-1 who became symptomatic after she was hit by a car . According to Dr. Rubenstein "(I)t was clear . And the conclusion of their study: that she was asymptomatic prior to this ;that the accident , again , just as it did in Miss Adam's case , triggered a marginally stabilized condition to a very progressive condition , resulted in her situation. " The second article by Dr. Tomas Milhorat et. all , was even more definitive . The article studied 364 persons with CM-1 condition who had become symptomatic . Of that number "89 out of those 364 patients reported that the inciting even that caused them to become symptomatic was trauma , the most common of which was a whiplash type injury.

Viewing the record in the light most favorable to the jury's verdict , we conclude there is ample evidence to support the conclusion that the accident caused Adam's condition to become symptomatic .

CCSF contends Dr Rubenstein's testimony was inadequate . It relies on the following portion of Dr. Rubenstein’s testimony , where he admitted that there was no consensus in the scientific community as to HOW a traumatic event can adversely affect a person with CM-1. " I think there has been debate over decades about what is the exact anatomic configuration that results in the Chiari Malformation . But I think that it is becoming clearer how a traumatic event could destabilize a Chiari malformation , because it is very clear ...that trauma can precipitate an asymptomatic Chiari malformation to a symptomatic Chiari malformation ."

CCSF also relies on a portion of Dr. Rubenstein's testimony where he admitted , during cross-examination , that because he did not have a brain scan of Adams prior to her accident , he could not provide a precise explanation for why Adams began experiencing pain after the accident . "Q. Okay Doctor on your description of what is going on anatomical , your opinion of what is happening anatomically , is that opinion speculation , possibility or probability ? [*** that odd symbol I can't type here ] A. I would think that it would be --obviously , because I don't have a pre-accident scan I can't say that is probable , i.e. 51% [** that odd symbol ]I can say that it is a distinct possibility that the accident destabilized this marginally stabilized condition , caused more tonsilar herniation . [ ** odd symbol ] And certainly the one thing I think is pretty definite is we know Miss Adams had no symptoms preexisting this accident that at least I saw in the medical records or by history of left shoulder , left arm pain . She had them immediately post -accident time frame . [** odd symbol ] Clear to me that something happened as a result of the accident ."

#4 Finally CCSF relies on the following portion of the Milhorat article that describes some uncertainty about how trauma causes CM-1 condition to become symptomatic. "As shown in Table 1 , approximately 25 % of patients cited trauma as the precipitating factor . The most common mechanisms were whiplash injuries and direct blows to the head and neck . ...which raises the possibility that certain types of trauma accentuate tonsillar impaction or result in subarachnoid hemorrhage that destabilizes a marginally compensated CSF system " ( Italics added by Westlaw )

CCSF interprets these passages as meaning that Adam's experts could only speculate that the accident had caused her CM-1 condition to become symptomatic . According to CCSF , that speculation was insufficient to establish causation under the controlling legal standard which requires a "reasonable probability ." ( See Williams V Wraxall , Supra.33 Cal. App. 4th at P 133 .)

We reject the argument . The passages CCSF cites shows there may be some uncertainty how trauma causes a CM-1 condition to become symptomatic , but also "how (the ) accident changed her underlying condition such that it produced different symptoms from before ." CCSF has not cited any authority that holds such proof is required , and we decline to adopt that standard . As Adam's argues persuasively in her brief , "medical science may not understand the physiological mechanism by which Agent Orange or other toxic agents cause a host of symptoms , including genetic damage , but the causative relationship can be demonstrated to a reasonable medical probability. Much of medical science is based on correlations between event and symptoms that are statistically very reliable , without understanding the mechanism of the cause . To require probable scientific understanding of the physiological mechanism would render recovery impossible for many plaintiffs , when proximate causation can otherwise be clearly demonstrated ..."

We conclude the evidence of causation was adequate . While Rubenstein's testimony may have contained contradictions , Adam's evidence on this issue is not insubstantial . The trial court correctly denied CCSF's motion for a partial JNOV .

B. Evidentiary Rulings

Dr Rubenstein testified , on direct and cross examination , that one of the factors he considered when determining whether the accident caused Adam's CM-1 condition to become symptomatic was the article by Dr. Tomas Milhorat . Near the conclusion of Dr. Rubenstein's testimony , the court asked the parties whether they intended to admit the article into evidence . When Adam's offered the article , CCSF objected . The court said it would admit the article . Faced with that ruling , CCSF asked the court to admit Dr Mampalam's article into evidence . The court agreed . According to CCSF, the Milhorat article was subsequently provided to the jury.

#5 CCSF now contends the trial court erred in two respects . First , it contends the court should not have admitted Dr. Milhorat's article into evidence because it was hearsay. We need not address the argument directly because CCSF never raised a hearsay objection in the court below . It simply objected without stating any specific grounds . "In order to preserve an objection on appeal , a party must state it in a timely fashion , and it must be accompanied by a reasonably definite statement of the grounds ....These requirements are designed to avoid unfair surprise to opposing parties and to prevent error by the trial court . The trial judge is given a concrete legal proposition to consider and the opposing counsel is sufficiently advised of the alleged defect to reframe the question , lay an additional foundation , or take other steps to minimize the likelihood of reversal " ( Simons on Cal. Evidence 2001) Relevant Evidence , 1:20, p 18, internal citations omitted . )

Alternately , CCSF contends the trial court violated Evidence Code section 721, [FN1] when it allowed the jurors to take the Milhorat article with them into the jury room . Again , we reject this argument on procedural grounds . We find no place in the record where CCSF raised this issue in the trial court, or even raised a general objection to the jurors taking the Milhorat article into the jury room The issue is waived . ( Evid. Code& 353, subd. ( a) [Perry V McLaughlin (1931) 212 Cal. 1,6;Arreola v. County of Monterey(2002) 99 Cal. App.4th 722, 750.) FN1. Evidence code section 721 , subdivision (b) states that scientific articles may be admitted into evidence in certain circumstances , and if admitted , "relevant portions of the publication may be read into evidence but may not be received as exhibits ."

lll. Disposition

The judgment is affirmed .

We concur : Simons and Gemello, JJ

2002 WL 31492570( Cal. App.1 Dist. ) Not Officially Published , ( Cal Rules of Court, Rules 976, 977)

In this particular case Dr. R was one of the expert witnesses, We would have used him if we deemed necessary here is his web address
www.rrubenstein.com/
Here is a few good published articles on acm/sm and also one on just sm. This article classifies the syrinx. Whether it is congenital or acquired communicating non-communicating and so forth.
Anyway here is the link to Dr. Ellenbogens “toward a rational treatment of Chiari malformation and syringomyelia
www.aans.org/education/jo.../8-3-6.pdf

the redefined study you need to go to tci website and download that study for some reason I cant get it anymore.

If you type in “classifications of syringomyeliaâ€￾ on your web browser you should come up with articles on just syringomyelia.
Here is a link to the one I like best written by Dr. Milhorat

www.aans.org/education/jo.../8-3-1.pdf
One more link for a case that was won for an acquired syrinx.

www.bbplaw.com/decisions/000313.htm

That’s about all I can think of at this time hope this helps some of you
Take care
Don
Wife has:
acm with multi level ddd in cervical spine protruding disk in t-spine narrowing of the central canal in c and t spine bone spurs and possible tbi. better with the help of others
birdlover3
 
Posts: 564
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