• The following is an excerpt from Richard H. Adler’s book, Understanding Traumatic Brain Injury: A Guide for Survivors and Their Families published in 2021.  Click here to order a free copy.

    Traumatic brain injury (TBI) and its causes, symptoms, treatments, and prognosis are often misunderstood. This can lead to an incomplete medical evaluation and treatment recommendations.

    Traumatic brain injury is a public health issue. Traumatic brain injury occurs eight times more frequently than breast cancer, AIDS, spinal cord injury, and multiple sclerosis, all combined. Despite its widespread impact, there remains several myths and misunderstandings. Here are 4 common myths:

    MYTH #1
    “You cannot have a TBI without loss of consciousness.”

    The issue of TBI and loss of consciousness has been misunderstood far and wide for years, even among physicians. That misunderstanding has been exploited by insurance companies looking to avoid responsibility and deny payment for medically needed healthcare services by claiming that, “since the person did not lose consciousness, there is no treatment needed for this alleged brain injury.” However, medical organizations have now clearly stated and concluded that a traumatic brain injury does not require a loss of consciousness. In fact, the Centers for Disease Control and other leading medical authorities are clear that a head injury leading to a change of a person’s mental state or awareness without loss of consciousness is, in fact, a concussion; and a concussion is a traumatic brain injury.

    MYTH #2

    “If there is no brain bleed visible on the MRI or CT scans, then there is no TBI.”

    When a CT scan is taken and the radiologist notes it as “normal,” it simply means there is no skull fracture or visible brain bleed.

    The same is true for an MRI. A negative CT or MRI does not rule out brain injury. Both the CT and MRI are looking at the structure of the brain, not the function of the brain. Also, a CT or MRI scan may lack the sensitivity, specificity or strength to record what is happening on the microscopic level of brain cells. For example, a “diffuse axonal injury” (a type of TBI) will be too subtle to detect with standard CT and many types of MRI scans. It’s important to re-emphasize that CTs and MRIs are looking for changes to the structure of the brain and not the brain’s function. There are other types of tests that will evaluate function, but those are usually not done right away following a traumatic brain injury.

    MYTH #3

    “Symptoms of TBI must immediately show-up after the traumatic event.”

    Insurers responsible for the individual or group that caused the TBI will try to avoid financial responsibility by arguing that if TBI symptoms do not immediately appear following the traumatic event, such as a fall or a motor vehicle crash, then the person must not have a TBI. However, following an injury, the brain, like many other parts of the body, may or may not respond with immediate symptoms. There may be a delayed onset of symptoms. When there is a disruption of the actual brain cells and their connections to other brain cells, symptoms such as headaches, dizziness, fogginess, etc., may take many hours, days or weeks after an injury to first appear. Also, an individual may not realize the full effects of those symptoms because of initial shock-like experience following trauma or until they engage in their usual activities at school, work, or home that require their usual thinking abilities.

    MYTH #4

    “All doctors are equal in their understanding of how to evaluate and treat traumatic brain injury, even Emergency Room physicians.”

    All doctors do not have the same training or understanding of traumatic brain injury and do not have the same skills in its proper evaluation and treatment. A 2018 research paper on brain injury found that the diagnosis of mild traumatic brain injury (the most common form) was frequently absent from the emergency room records and discharge instructions even when patients reported symptoms of brain trauma.


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