Subtle Brain Injury
- Does Concussion involve permanent brain damage? It can.
- Does Concussion disable? Often, but usually not for extended periods.
- Will I get better? In all likelihood.
- If I don’t have a full recovery, is it because I am nuts? No.
- Why is it that some people continue to have persisting problems? That is what this page is about.
Far too much of the focus in the study of what the researchers always call “mild” brain injury or subtle brain injury, is trying to predict how serious a brain injury will become, based upon the way in which the patient interacts with medical professionals in the acute stage. This misses the point. Certainly, if there was no concussion, there isn’t likely to be a brain injury. But once there has been a concussion, the focus should not be on categorizing how serious the concussion was, but on what deficits the person is left with, after a healing period, and what we can do to minimize the disruption of those deficits upon this person’s life.
Why do some people have apparent full recoveries, while others, are profoundly affected by a similar injury? To begin this discussion, we must summarize our theory of the pathology of subtle brain injury.
- Diffuse Axonal Injury. Concussion results in organic injury to the brain, in most cases, by the mechanism of diffuse axonal injury.
- Process not an Event. This injury is more likely as a result of strain to axons than actual tearing, which over a period of 12-72 hours results in a cascade of events which can disrupt a significant number of neural connections, either because of the death or damage to the axons which connect the neuron bodies.
- Regeneration isn’t Total Recovery. Our current research into neuropathology indicates that significant regeneration of these neural connections can occur, but that the extent of such regeneration falls off considerably with age (with over 40 being a meaningful line of demarcation) and that the regenerated neural connections are less efficient than premorbid.
- High Achiever Problems. For this reason, individuals in professions which place a high demand on processing speed, are more likely to experience deficits than others, and that most people who have suffered more than a Grade I concussion, will have some measurable deficits, if sufficient demands are made upon their brains.
Understanding Subtle Brain Injury
There is an overwhelming ignorance in the medical community that there is even the possibility of permanent brain injury in patients who may have suffered a concussion. To this day, a significant proportion of the medical community believes that there can be no permanent brain injury without a loss of consciousness or without a blow to the head. Perhaps more important, there is a poor understanding that subtle brain injury symptoms may escalate after the first couple of hours. Likewise, there is far too much confidence put in our ability to rule out brain injury through the use of CT and MRI. This page will focus first on the diagnostic issues and then move on to the subtle symptomatology that underlies these types of subtle brain injury.
Attorney Gordon Johnson
Past Chair Traumatic Brain Injury Litigation Group, American Association of Justice
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