What Is "Mild" Brain Injury?

David L. Goldin, J.D., M.B.A.

"Mild" or "minor" brain injury can be a tragic misnomer because these injuries often cause lifelong disabilities. Typically, the diagnosis of mild brain injury is given where there is trauma to the brain, but the trauma results in only brief unconsciousness, or none at all, and the brain injuries do not show up on imaging studies such as an MRI or CT scan. The condition is sometimes called "post-concussion syndrome" or "post-traumatic syndrome," with the latter term including those cases where there is no concussion. Various statistics estimate that two million people suffer traumatic brain injury each year in the United States of whom 400,000 are hospitalized. Tragically, while most of those suffering "mild" traumatic brain injury recover, there is a "miserable minority" who suffer lifelong consequences, sometimes involving profound disability. 

Unfortunately, medical professionals sometimes ignore or discount mild brain injury as an ongoing problem because the patient outwardly appears normal: he or she walks, talks and looks normal and the medical imaging studies are negative. In fact, it may be the lawyer, if knowledgeable in brain injuries, who is the first professional to take the time to fully evaluate and appreciate the nature and extent of brain injuries in these cases. Typically, the client is embarrassed and confused and has been told that he or she will fully recover from what was a minor trauma. Psychological reasons are given for ongoing confusion and disability and the client may feel guilty he or she has not been able to fully recover. Nonetheless, the brain injuries are very real and have a physical basis which, although producing psychological effects, are rooted in the microscopic disturbance of cells in the brain.

It has been proven in autopsies conducted after death (from whatever cause), that microscopic changes can occur from "minor" brain trauma not diagnosable by imaging studies. Axons may shear or be cut, bruise, swell and/or detach, and the damage can be diffuse or widespread throughout the brain affecting multiple functions.  Many brain functions require a lot of brain cells to work properly, such as attention, memory, behavior, executive functions (such as planning and organizing), emotions (such as depression, anxiety and anger), and even sexual performance. Though looking and sounding normal, the survivor of mild brain injury often reports that he or she feels like a different person.

It is incumbent upon the lawyer handling brain injury cases to fully investigate each case in which the client reports symptoms which may be explained by traumatic injury to the brain. Even though there is no concrete evidence of brain malfunction, if the survivor or his or her family reports ongoing fatigue, confusion, frustration, difficulty thinking, planning and organizing, memory loss and attention deficits, among other problems, it is important to fully consider whether these symptoms are caused by trauma to the brain. See "Recovery of Damages for Traumatic Injury to the Miraculous Brain."

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