After hours of testimony by medical experts for both the prosecution and defense in the murder trial of George Huguely, and after hearing multiple possible explanations for the cause of Yeardley Love's death, it seems clear that for the jurors, all roads lead to one conclusion. The blunt force head trauma Love sustained on the night of May 3, 2010, ultimately killed her.
The fact that Love, who Huguely admitted to shaking until her skull struck a wall and her body began convulsing, was found to have bruising and bleeding on her brain on a medical examiner's autopsy report suggests she died due to traumatic brain injury (TBI). Love most likely suffered damage to her brain cells and vessels either during the process of being shaken, upon her skull hitting the wall, or a combination of both. Regardless of the exact timing, the other possibilities suggested by the defense -- suffocation due to lying face-down on her pillow after her altercation with Huguely, a rush of blood to the head following CPR attempts and a deadly combination of alcohol and the ADHD medication Adderall -- were not nearly as likely to have resulted in a fatal outcome.
TBI usually results from a violent blow or jolt to the head that causes the brain to collide with the inside of the skull. The degree of damage can depend on several factors, including the nature of the event and the force of impact. In the case of a mild injury, such as a concussion, damage to brain cells may be limited to the area directly underlying the point of impact on the skull. However, a more severe blow or jolt can cause multiple points of damage, because the brain may bounce back and forth inside the skull. If an individual endures a severe rotational force to the skull, tearing of brain tissue and vessels can occur, causing widespread damage. This may, then, result in bleeding in or around the brain, as well as swelling and blood clots, any of which can disrupt the oxygen supply to the brain and cause more widespread damage.
According to the accounts of several medical experts called to testify, Love's autopsy showed conclusively that she endured all of the above on the night of her death.
Signs or symptoms of TBI may appear immediately after the traumatic event, while others may appear days or weeks later. In the case of a severe injury, as in Love's case, the following symptoms may appear within the first hours:
Loss of consciousness from a few minutes to hours;
Repeated vomiting or nausea;
Convulsions or seizures;
Inability to awaken from sleep;
According to Huguely's statement to police, as well as testimony of witnesses during the trial, Love exhibited several of the above symptoms within minutes of the incident, making it all but certain the head trauma she suffered directly resulted in her death.
Huguely's defense team suggested a number of alternative explanations for Love's cause of death.
One expert witness, a neuropathologist, testified that Love, who was found to have a blood alcohol level between 0.14 and 0.18 (twice the legal limit in Virginia), was significantly intoxicated and could have died due to suffocation after being thrown onto her blood-soaked pillow. However, most studies indicate that this level, while likely to produce moderate neurological impairment, would be unlikely to make an individual unable to react appropriately to the oxygen deprivation associated with suffocation. In fact, alcohol-related death is typically not encountered until blood alcohol levels reach 0.4 or higher.
Another defense expert questioned whether the combination of alcohol and Adderall, a stimulant medication Love was taking for attention deficit-hyperactivity disorder (ADHD), could have caused an abnormal and fatal heart rhythm. But not only was Love's blood alcohol level inconsistent with a fatal outcome, her blood Adderall concentration of 0.05 was well below the 0.2-0.5 range associated with adverse outcomes.
Finally, the defense questioned whether CPR administered following the incident could have caused a sudden, fatal rush of blood to the brain. One medical witness testified that, with Love's brain in a precarious state following her altercation with Huguely, any sudden increase in blood flow could have stretched brain vessels beyond capacity and caused hemorrhaging. However, a review of the medical literature found no known cases of CPR-induced brain hemorrhage.
In the end, the one explanation that ties together all of the medical testimony heard by the jury on Love's death -- the specific injuries to the brain, her signs and symptoms following the altercation and speed with which her health deteriorated -- is that she died due to traumatic brain injury. And, sadly, for Yeardley Love, the most likely diagnosis is also the most painful for all of us to comprehend.