The ‘Mild’ Traumatic Brain Injury is Not So Mild

This article has been adapted from Richard Duquette’s podcast Bicycling and the Law, episode ‘Proving Mild Traumatic Brain Injury (MTBI) Part I: Field Diagnostic Tools‘ recorded on 
February 22 2017.

When bicyclists are involved in crashes, they can receive a variety of injuries ranging from scrapes and bruises, to broken bones and soft tissue damage, to traumatic brain injuries (TBI). This series of articles discusses the diagnostic tools available for proving a subset of a TBI, what is termed, a ‘mild traumatic brain injury’ (MTBI).

Definitions

But first, what is an MTBI? It’s partially a misnomer in that the use of the term “mild” implies it is not serious. The reality is that the word is used in a relative sense. A “mild” traumatic brain injury can still be permanent and debilitating.

A mild TBI is when an injured person loses consciousness for less than thirty (30) minutes. A moderate TBI occurs when a person loses consciousness for more than thirty (30) minutes. A severe TBI is when a person loses consciousness for six (6) hours or more, and is commonly associated with a vegetative state or severely altered consciousness.

By contrast, a mild TBI usually means that an individual can return to normal activities, but is hampered by lingering cognitive, emotional, sensory, and behavioral symptoms. Some examples include slower cognitive processes, confusion, diminished vocabulary or sequencing abilities, mood swings, social anxiety, difficulty making casual conversation, sensitivity to light and sound, nausea, and motion sickness.

Field Diagnostic Tools

Often, MTBI is not detected at the hospital during emergency treatment because treatment is focused on diagnosing and treating broken bones and other injuries. So long as the person is conscious and not hemorrhaging, emergency room physicians will probably not diagnose a TBI immediately. Signs of ongoing impairment often begin to manifest themselves later in recovery. This is where other diagnostic tools become essential.
The Glasgow Coma Scale

One of the fundamental and primary tools for assessing a head injury is the Glasgow Coma Scale (GCS), often used by first responders to assess the need for further evaluation. This test collects observable facts about symptoms and the injury itself, assigning a risk score to the patient based on factors such as eye response, verbal response, and motor response.

For each category, the more severe symptoms are assigned the lowest score. Therefore, a lower total score on the GCS will indicate a greater risk of severe brain injury. However, as noted above, not all traumatic brain injuries are immediately apparent, and often hemorrhages can develop after the fact.

The GCS is an emergency assessment measure that only accounts for immediate symptoms observable by the naked eye. It does not replace a full neurological or psychological evaluation. For this reason, imaging tools are essential for a full diagnosis of the brain.

A Peak Inside

The types of imaging can roughly be divided into “anatomical” imaging and “physiological” imaging. Anatomical imaging reveals structural symptoms, while physiological imaging reveals
functional symptoms.

In any brain injury case, it is helpful to be able to prove not only a structural symptom such as a lesion or a hemorrhage, but also a functional impairment such as diminished blood flow. Technologies your doctor may use to find these types of impairment or damage include:

• X-Ray Imaging
• Computerized Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Positron Emissions Tomography (PET)

Findings

Traumatic brain injury cases are some of the most complex civil personal injury cases today, both because of the amount of money at stake, and because of the scientific and medical complexity involved.

In trying a brain injury case, you need an attorney who not only has the legal experience to handle high-stakes complex litigation, but also with a broad network of expert witnesses, and the familiarity with the issues necessary to cross-examine the defense experts.

If you or a loved one has suffered a traumatic brain injury, don’t suffer alone. Contact the Law Office of Richard Duquette, bicycle attorney with experience litigating brain injury cases.

You can visit the Richard L. Duquette Law Firm blog to read more about bicycling and the law, and you can also hear more on his podcast, 911law.com Podcast.