Have you Suffered a Traumatic Brain Injury Without Even Knowing It?

By Joanna Sacavitch, Esq. and Erika Vargas, Esq.
Gordon, Edelstein, Krepack, Grant, Felton & Goldstein, LLP

Help us help you. You may have a traumatic brain injury as part of your workers' compensation case and not even know it. You're probably asking yourself, how is this even possible? How can I tell if I have brain damage? How did my doctor not realize this? How did I not realize this? How did I miss the signs? Were the signs or symptoms obvious?

Consider These Possible Signs:

• You didn't realize that a brain injury can result by a jolting of your head without ever striking it.
• Your symptoms manifested as a psychiatric injury, i.e., depression, confusion, agitation, anger, combativeness, moodiness, memory loss, lack of concentration, etc.
• You struck your head but you never lost consciousness.  You "barely" hit your head.
• While you do have headaches, you associated them with your existing orthopedic and/or psychiatric injuries.
• While you have sleep issues, you, again, associated sleep loss with your existing psychiatric or orthopedic injuries.
• You did explore the possibility of a brain injury but your MRI or CT proved normal.
• You may have been on medications that suppressed your symptoms.

If you have (or think you have) suffered a brain injury on the job, it is important to medically establish an industrial basis for it. Discuss all of your symptoms with your doctor. And, remember that it is vital to keep records documenting the injury and the subsequent treatment in order to receive the full range of workers' compensation benefits to which you are entitled.

What is a Brain Injury?

Brain damage is an injury that causes the destruction or deterioration of brain cells. In the United States, about 2.6 million people suffer some type of brain injury every year, resulting from  trauma, stroke, tumor or other illnesses, according to the Brain Injury Association of America.

Brain injuries come in different forms and severity.  Moderate to severe closed-head injuries often result from accidents that force the soft tissue of the brain into contact with the hard, bony skull. Long-term effects and poor prognosis turn these injuries into major, often life-long, problems.

Physical Symptoms of Traumatic Brain Injuries

• Persistent headaches
• Extreme mental fatigue
• Extreme physical fatigue
• Paralysis
• Tremors
• Seizures
• Sensitivity to light
• Sleep disorders

The severity of brain damage varies  with the type of brain injury. A mild brain injury may be temporary, whereas in a moderate brain injury, the symptoms can last longer and be more pronounced. In both cases, most patients make a good recovery. However, even in mild brain injury cases  15 percent of people will have persistent problems after one year.
With a severe brain injury, the person may suffer life-changing and debilitating problems, including cognitive, behavioral, and physical disabilities.

What are Concussions?

Mild traumatic brain injuries (MTI) – otherwise known as concussions – may share features with the more severe brain injuries that can also lead to longer-term problems.  As such, these types of injuries are often overlooked.

People suffering a simple concussion are typically confused and may  have memory loss (amnesia), which is often—but not always-- accompanied by a loss of consciousness. These symptoms may be apparent immediately after the head injury or may appear several minutes later.

The amnesia almost always involves loss of memory about the accident/injury, but may also include loss of recall for events immediately before and after the head trauma. Details regarding the presence and the duration of loss of consciousness, confusion, and amnesia are considered potentially important to understanding the severity of the injury. (Getting a card from the ambulance team or from the first responder(s) is extremely helpful. They can later be interviewed or through your case we can obtain those medical records.)

Other signs and symptoms of a concussion may immediately follow the injury or evolve gradually over several minutes to hours.   Signs observed in someone with a concussion may include the following:

Minutes to Hours after Injury:

• Headache
• Dizziness, vertigo or imbalance
• Lack of awareness of surroundings
• Nausea and vomiting
• Vacant stare (befuddled facial expression)
• Delayed verbal expression (slower to answer questions or follow instructions)
• Inability to focus attention (easily distracted and unable to follow through with normal activities)
• Disorientation
• Slurred or incoherent speech
• Gross observable incoordination

Hours to Days after Injury:

• Sleep disturbances
• Emotionality out of proportion to circumstances
• Memory deficits

What Happens if a Concussion Goes Untreated?

It is not uncommon for people to underestimate the seriousness of a concussion. However, an untreated head injury may lead to persistent symptoms. These include sensitivity to light, sore eyes, and blurry vision, headaches, fatigue, and interrupted sleep, which could lead to emotional and cognitive issues.

What to Look for When Diagnosing Moderate to Severe Brain Injuries

The signs and symptoms of moderate to severe traumatic brain injures can mimic those of milder injuries, and can also include the following in the first hours to days after the head injury:

• Loss of consciousness lasting for several minutes to hours
• Convulsions or seizures
• Loss of coordination
• Weakness or numbness in fingers and toes
• Inability to awaken from sleep
• Clear fluid draining from the nose or ears
• Dilation of one or both pupils
• Confusion, agitation, combativeness
• Coma

Evaluation and Treatment

For clinical and medical/legal purposes, it is essential for physicians from several different specialties to evaluate a patient for long-term consequences of a brain injury. A good starting point is a neurologist, who can screen a patient for the signs and symptoms of brain injury, including a brain scan to check for abnormalities in the brain structure.  Additionally, it may be beneficial for an injured worker to have an evaluation by a neuropsychologist who can identify changes in the person's behavior and cognitive mental abilities, even if they are subtle.  The behavioral changes may also necessitate seeing a psychiatrist for diagnosis and management of the symptoms.

Brain injuries are serious business. Consult your physician if you believe you have suffered a brain injury, on or off the job. If you would like to speak with an attorney about your legal options, please call 213-739-7000 or click here.