In July, 2013 the Defense Centers of Excellence, serving the United States Department of Defense, issued important new guidelines for neuroimaging following “mild” traumatic brain injury. The guidelines begin with the well-accepted understanding that neuroimaging is not typically included in the diagnosis of mild traumatic brain injury(“mTBI”) because only 10-15% of people who sustain trauma resulting in mTBI will have an acute brain lesion on CT (computed tomography) scans. “The lack of positive imaging findings,” the guidelines emphasize, “does not invalidate a diagnosis of mTBI.”
What is significant about the guidelines is that they recommend imaging in mTBI cases where the victim has “new, persistent or worsening symptoms” 90 days or more following the injury (described as the “chronic stage.”) Read More
Concussion, or mild traumatic brain injury (TBI), typically produces no gross pathology, such as hemorrhage or abnormalities, that can be seen on conventional CT scans of the brain. It does cause rapid-onset neurophysiological and neurological dysfunction that in most patients resolves spontaneously over a fairly short period of time. Studies have shown, however, that approximately 15% of individuals with mild TBI develop persistent cognitive dysfunction and other symptoms. Researchers are starting to make progress on proving mild traumatic brain injury using the biomarkers that underlie such symptoms. Read More
Further evidence that the term “mild” should never be used in connection with brain injury can be found in a study published in the March 2013 issue of the Journal Radiology.
In the study, NYU medical school researchers measured changes in global and regional brain volume over a one year period in 30 patients with “mild” traumatic brain injuries and typical post-injury symptoms including anxiety, depression and fatigue, and other symptoms such as headache, dizziness and perceived cognitive problems.
We live in a world of “show me” juries, programmed to believe that most people bringing personal injury claims to trial are trying to get something for nothing. They want to be convincingly shown that a real injury exists—that the injured person can prove a brain injury or other debilitating condition.
Proving a Mild Traumatic Brain Injury to a Jury
For example, some brain injuries produce bleeding in the brain that clearly shows up on conventional diagnostic images like CT scans—computerized tomography that combines a series of X-ray views taken from many different angles and processed by a computer to create cross-sectional images of the bones and soft tissues inside your body—and/or MRIs—magnetic resonance imaging that uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body—or, that produce visible neurological signs like seizures, visual problems, speech problems, or motor problems.
Proving a brain injury to a jury where visible evidence is available is not difficult. However, we know that many mild traumatic brain injuries are “invisible” to these standard tests, yet are serious enough to greatly impact quality of life. In these cases, the challenge is to help the jury understand those long-term consequences, even when the injury is not visible.