The problem with mild brain injury is that it so often goes undiagnosed.
Many people walk away from sporting, work or car accidents and
do not go to their doctor or the hospital. Even when they do present
at the emergency department, they are often sent home with bland
assurances. Expensive scans (either CAT or MRI) are usually not
offered and a mild brain injury may not be evident in such scans.
If there are other observable injuries, such as a fracture, this
will take precedence. Another complicating factor is that repeated
injuries to the head can have a cumulative effect, so that a minor
injury can eventually have a major effect. Some hospitals screen
automatically for concussion, but the extent of record-taking
and follow-up can be variable.
A standard measure of the severity of the injury is the length
of time spent unconscious and post traumatic amnesia. Post traumatic
amnesia includes the period of time after a loss of consciousness
when a person may appear conscious but is confused, disorientated
and day to day memory is unreliable. A period of unconsciousness
of less than 30 minutes and post traumatic amnesia of less than
24 hours is typically defined as mild brain injury. Obviously,
if nobody is aware of a problem at the time, it may be difficult
to establish the length of post traumatic amnesia. These issues
mean that the causal link to the injury is often not established,
which has implications for compensation.
The subtlety of the symptoms associated with mild brain injury
mean that it may take three or four months before the person seeks
help for a bewildering array of problems and changes in behavior.
The symptoms can be cognitive, physical and emotional.
For instance cognitive indicators include: reduced concentration;
difficulty focusing attention; reduced ability to take in information
and slower processing; forgetfulness; tiredness from effort; planning
and decision making difficulties; recent memory affected whilst
remote memory is intact; reduced capacity to screen out unimportant
information; difficulty in finding appropriate words.
Physical signs can include: headaches; hypersensitivity to light
(photophobia); sensitivity to noise and to the hustle and bustle
of being in crowded or busy places (hyperacusis); dizziness and
nausea; tiredness; ringing in the ears; reduced coordination;
lack of sensation in limbs. Emotional factors include: irritability;
reduced emotional control; and a tendency to be more self-centered.
It is important when reading of these symptoms to remember that
there can be a variety of causes. However, it is equally important
not to dismiss changes that are evident to those closest to the
person with mild brain injury. Changes will be far more noticeable
to those who already knew the person and there are many buffering
effects that can make it difficult for others to understand the
changes. These buffering effects are caused by the capacity of
the person with mild brain injury to compensate for the deficits
that have been caused. Often the most intelligent people will
do the best job of hiding the effects of the injury, but this
comes at a cost and it does not mean they are not suffering from
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