Subtle brain injuries

Often referred to as mild traumatic brain injuries or concussions, can occur due to a variety of incidents and mechanisms. Unlike severe brain injuries, subtle brain injuries do not always result in obvious symptoms, making them challenging to diagnose and treat.

There is a danger in everyday practice that consequently, the indicators of a mild brain injury can be missed by both practitioners and experts alike, thus leading to under settlement of a claim and potential serious long-term implications.

In the situation of a road traffic accident, it is a misconception that vulnerable road users such as cyclists, pedestrians or motorcyclists are most likely to see such injuries and indeed, a mild brain injury can occur just as readily to the occupant of a vehicle.

Subtle brain injuries are typically caused by a sudden jolt or blow to the head, which disrupts normal brain function. The brain is a delicate organ, encompassed by a protective structure and I find it helpful to think of the brain in terms of the following analogy; consider an egg in a jar of water. Should you shake the jar sharply, it stands to reason that there is likely to be damage to the egg. Therefore, any violent motion or impact inflicted upon the head has the potential to cause a mild brain injury.

Although these injuries are classified as mild, they can have significant and long-lasting effects on an individual’s cognitive, emotional, and physical wellbeing. It is crucial to recognise that the absence of visible symptoms does not equate to a lack of injury.

Symptoms

Symptoms of subtle brain injury can vary widely and may not appear immediately after the incident. This variability contributes to the difficulty in diagnosing the condition. Common symptoms include:

  • Cognitive impairments: Individuals may experience problems with concentration, memory, and attention. They might struggle with multitasking or find it challenging to complete everyday tasks that were previously straightforward.
  • Physical symptoms: Headaches, dizziness and nausea are common physical symptoms. Some people may also experience sensitivity to light or noise, balance issues and fatigue.
  • Emotional and behavioural changes: Changes in mood, irritability, and anxiety are frequently reported. Some individuals may feel unusually emotional or struggle with regulating their emotions.
  • Sleep disturbances: Difficulty falling asleep, staying asleep, or experiencing changes in sleep patterns can occur, further exacerbating other symptoms.
  • Sensory issues: Some individuals report visual disturbances, such as blurred vision or seeing ‘stars’. Hearing issues, such as tinnitus (ringing in the ears), may also occur.

It is essential to understand that these symptoms can be subtle and might be attributed to other causes, leading to underreporting and misdiagnosis. Moreover, symptoms can evolve over time, with some appearing days or even weeks after the injury.

Diagnosing subtle brain injuries involves a comprehensive evaluation, often starting with a detailed medical history and a physical examination. Medical experts may use neuropsychological assessments to evaluate cognitive function, which can help identify deficits in memory, attention and other cognitive areas.

In some cases, imaging techniques like MRI or CT scans are employed. However, these tools may not always detect subtle changes associated with mild traumatic brain injuries, as these injuries do not always cause structural changes in the brain that are visible on standard scans.

Raising awareness about subtle brain injuries is crucial. Misunderstandings about the severity and impact of these injuries can lead to insufficient support and treatment and are unfortunately, these injuries are often missed in practice. Furthermore, individuals who sustain repeated mild traumatic brain injuries are at risk of cumulative effects, including chronic traumatic encephalopathy (CTE), a serious neurodegenerative condition.

It is vitally important as practitioners that we stay alert to reports of such symptoms by clients and to return to experts for further clarification on opinion should such symptoms be missed or dismissed in a report. In practice, it is helpful to explore such symptoms with the client within the initial attendance, and then again at various stages in the claim.

Thereafter, if such symptoms present then the relevant discipline can be sought for an opinion. Quite often, where an expert has failed to identify a potential mild traumatic brain injury within a report, this can be remedied by questions put to the expert and a conference thereafter.

Subtle brain injuries, though often under recognised, can significantly impact an individual’s life. By understanding the symptoms and available treatments, individuals and experts can work together to manage the condition effectively.

Early intervention, rest and gradual re-engagement in activities are key components of recovery, ensuring that individuals regain their health and quality of life.