How Do Doctors Diagnose a Traumatic Brain Injury (TBI)?

Any type of accident can cause a traumatic brain injury (TBI). It can happen in a major car accident or  from bumping your head in a fall. Whatever the circumstances, trauma to the head should be attended to by a doctor immediately. That will allow them to check for symptoms and diagnose whether you have a TBI or not. If the TBI is moderate to severe, hospitalization and emergency surgery may be needed.

Sustaining a TBI because of someone else’s actions seems particularly unjust. But you aren’t powerless. You can sue the person who caused your traumatic brain injury. At The Dominguez Firm, our personal injury lawyers have over 30 years of experience helping TBI accident victims. We’ll make sure you receive the crucial medical attention you need while fighting for every penny of the compensation you’re entitled to.

Call The Dominguez Firm today for a free consultation at 800-818-1818. Below you’ll find out more about TBIs and how they’re diagnosed.

What is the Definition of a Traumatic Brain Injury?

A traumatic brain injury is generally defined as changes to a person’s brain function because of an external blow to the head. An open TBI means the skull has been penetrated. The impact can be violent or a bump. Either way, if the victim’s brain function is affected, it’s considered a TBI.

TBIs can cause swelling, bleeding and damage to brain tissue. As with other types of injuries, TBIs can be mild, moderate or severe. In some cases, it can lead to the person’s death.

What are the Most Common Symptoms of a TBI?

A person’s symptoms will depend on the severity of their TBI. Here are some of the most common mild TBI symptoms:

• Anxiety
• Blurred vision
• Changes in personality
• Depression
• Drowsiness
• Feeling disoriented for short periods of time
• Headaches
• Light sensitivity
• Loss of consciousness
• Loss of memory
• Nausea
• Problems concentrating
• Problems sleeping
• Problems speaking
• Ringing in the ears
• Vertigo

Those who have suffered a moderate to severe TBI will usually have most or all of the symptoms above and some of those listed below:

• Agitation
• Chronic headache
• Chronic nausea
• Clear fluid draining from the ears or nose
• Coma
• Convulsions or seizures
• Dilated pupils
• Lack of coordination
• Loss of consciousness
• Persistent disorientation
• Slurred speech
• Trouble waking up
• Weak or numb fingers and/or toes

What Are the Most Common Causes of a TBI?

Something as commonplace as tripping on an uneven sidewalk can cause a fall and a TBI. For those over the age of 75, slip or trip and fall accidents can be deadly. They consistently rank highest of any age group for TBI deaths from falls according to the CDC.

Other common causes of TBIs are:

• Car accidents
• Physical assaults
• Assaults with a firearm

Employees in certain job sectors such as construction, manufacturing and warehouse work are more at risk of a TBI.

Are There Different Types of Traumatic Brain Injuries?

There are several types of TBIs and they are graded as either mild, moderate or severe. Doctors rely on several markers to determine the severity of a patient’s brain injury. They are: any loss of consciousness and for how long, whether the patient is disoriented and for how long, and the Glasgow Coma Scale which measures a person’s level of consciousness after a TBI.

• Mild TBI – Concussions are the most common type of mild TBI. With a mild concussion the person may feel disoriented for about a day. They may even lose consciousness, but for less than 15-30 minutes. According to the FDA, about 75% of the TBIs that happen every year a re mild.
• Moderate TBI – A person who feels dazed for several days and up to a week most likely has a moderate TBI. They may also have lost consciousness for more than 30 minutes and up to several hours.
• Severe TBI – The person has suffered a prolonged state of unconsciousness or has fallen into a coma. For both moderate and severe TBIs an object may have penetrated the skull. There can also be bleeding in the brain which will require emergency surgery to alleviate.

Even though concussions are usually classified as mild, multiple concussions are not. They are considered a serious health concern which can lead to permanent brain damage, depression, memory loss and the progressive brain disease CTE (chronic traumatic encephalopathy).

Is a TBI the Same as a Head Injury?

A TBI is a kind of head injury. “Head injury” is an umbrella term for any damage to the brain, skull, and head. Some head injuries like TBIs are caused by an external force, such as a car accident. Another type of head injury is an ABI, or acquires brain injury. These aren’t caused by any force to the head. Instead, internal factors cause the damage. An example of an ABI would be a stroke or aneurysm.

How Are TBIs Diagnosed?

Traumatic brain injuries are usually diagnosed via a medical evaluation by a doctor followed by  diagnostic imaging tests. The initial evaluation may be performed by an emergency room physician or a neurologist, which is a doctor who specializes in disorders of the brain, spinal cord and nervous system. They will first monitor the patient’s vital signs and state of consciousness to make sure they aren’t in any immediate danger. Then they will use the Glasgow Coma Scale, which is discussed in greater detail in the next section.

For moderate to severe TBIs where the patient is nonresponsive, the objective is to keep them alive. Vital signs need to be stabilized quickly. If there’s bleeding in the brain, emergency surgery must be performed to drain any excess fluid and relieve any pressure. This will also help stabilize the patient’s blood pressure and ensure the brain is getting enough oxygen.

If the TBI penetrated the skull, any fractures must be set. Bone fragments and foreign objects also need to be removed. The patient may also be given intravenous diuretics to alleviate pressure in the brain. In extreme cases, a doctor may put the TBI patient into a medically-induced coma. This slows down brain function and allows it to heal.

Once a patient is evaluated and/or stabilized imaging tests are performed::

Computerized tomography scan – More commonly called a CT scan, this is usually performed in the emergency room. CT scans utilize x-rays and computers to capture cross sections of the brain. It quickly and effectively shows:

• Fractures
• Hemorrhaging
• Blood clots, known medically as hematomas
• Bruising to brain tissue, known as contusions
• Brain swelling

Magnetic resonance imaging – MRIs provide very clear and defined images of your brain by way of a large magnet, radio waves and a computer. They’re also better for capturing more detailed images of the brain. They’re not usually performed until the patient’s condition has stabilized. 

MRIs are effective in detecting small contusions and diffuse axonal injuries of the brain. The latter injury happens when the connective nerve fibers or axons in the brain tear due to abnormal or violent movements in the skull. According to some studies, MRIs catch about 10-20% more injuries and damage than CT scans.

Electroencephalogram – Also known as an EEG test records brain activity. Small electrodes are attached to the scalp. It looks for any abnormalities which could make the TBI patient more prone to seizures. They’re often done at the same time as an MRI.

In some cases, a doctor may insert an intracranial pressure monitor through the skull to check the patient for increased pressure on the brain. This is done to avoid any additional damage to the brain.

One final note on a TBI diagnosis. Mild TBIs are sometimes diagnosed late or completely overlooked. One reason is because they mimic certain other health issues. Another reason is because signs of a TBI may not initially show up on an imaging test. Finally, if the patient has multiple injuries, as often happens with car accident victims, a mild TBI may go undiagnosed because the patient has say, multiple arm and leg fractures that need immediate attention.

What is the Glasgow Coma Scale?

The Glasgow Coma Scale (GCS) was created in 1974 to help physicians and other medical professionals evaluate the severity of a patient’s traumatic brain injury. The initial GCS is done immediately, then generally every four hours to monitor the patient’s condition.

The GCS measures three functions:

• Eye Opening
  • Spontaneous–open with blinking at baseline – 4 points
  • To verbal stimuli, command, speech – 3 points
  • To pain only (not applied to face) – 2 points
  • No response – 1 point

• Motor Response
• Follows all movement commands – 6 points
• Purposeful movement to painful stimulus – 5 points
• Withdraws in response to pain – 4 points
• Involuntary flexion of the limbs in response to pain – 3 points
• Involuntary extension of the limbs in response to pain – 2 points
• No movement in the limbs – 1 point

• Verbal Response
  • Oriented – 5 points
  • Confused conversation, but able to answer questions – 4 points
  • Incoherent words – 3 points
  • Sounds but no speech – 2 points
  • No response – 1 point

Each function is given a score from 15 to 3. Generally speaking, a score of 15 indicates a mild or no TBI while a 3 is reserved for patients in a coma. The GCS test has been shown to reliably test a person’s state of consciousness after a TBI. Children are given a slightly modified version of the GCS when evaluating them for a TBI.

Are TBIs Diagnosed Differently in Children?

For the most part, TBIs are diagnosed similarly in children and adults. Nonetheless, there are some differences. For one, children are given a slightly modified version of the Glasgow Coma Scale when evaluating them for a TBI:

• Eye Opening
  • Spontaneous – 4 points
  • Responds to voice – 3 points
  • Responds to pressure – 2 points
  • No response – 1 point
  • Not testable – NT

• Motor Response
• Moves spontaneously or purposefully – 6 points
• Withdraws from touch – 5 points
• Withdraws from pain – 4 points
• Involuntary flexion of the limbs in response to pain – 3 points
• Involuntary extension of the limbs in response to pain – 2 points
• Makes no movements – 1 point
• Not testable – NT

• Verbal Response
  • Smiles, is oriented to sounds, follows objects, interacts – 5 points
  • Cries but consolable in response to pain – 4 points
  • Cries in response to pain – 3 points
  • Moans in response to pain – 2 points
  • Makes no sounds – 1 point
  • Not testable – NT

The emotional symptoms can be different from those of an adult too. What’s more, if the child is very young, they may not be able to state what they’re feeling. Instead, changes in behavior have to be closely monitored.

Some common emotional TBI symptoms in children are:

• Lack of interest in activities they once enjoyed such as playing with a favorite toy.
• Getting angry or crying more than before they were injured.
• Being more irritable.
• Loss of appetite.
• Reverting to infantile behaviors, such as soiling themselves instead of using the toilet.
• Changes in personality. For instance, a child that was obedient becoming defiant and having outbursts.
• Not being motivated to take part in daily activities.

The child should avoid gym class and sports activities until a doctor feels it’s safe to do so again. For children who have a moderate to severe TBI, they may need some time away from school to recover.

Some children experience nightmares or display fearful behavior after their TBI. This can happen in the immediate aftermath. However, it’s important to seek the advice of your physician if these symptoms persist or worsen.

Which Groups Are Most at Risk of a TBI?

The oldest and youngest members of society are among those most at risk of suffering a TBI. As previously noted slip and fall accidents are a leading cause of death for the elderly. Conversely, newborns to children aged 4 are at higher risk as are adolescents between the ages of 15-19. Car accidents account for a sizable amount of TBIs for these two younger age groups.  

Men suffer TBIs at approximately twice the rate that women do. For racial groups, male Native Americans and Native Alaskans have the highest rates of TBIs across all racial and ethnic groups in the country. A higher incidence of car accidents, substance abuse and a lack of access to healthcare facilities all contribute to the increased risk of TBIs in the Native American and Native Alaskan communities.

Other groups with a higher chance of a TBI are:

• Military veterans
• The homeless
• Victims of domestic violence
• Adolescents who participate in youth sports

Children involved in sports such as football, soccer, lacrosse and cheerleading are at increased risk of a suffering a concussion. Of all the ER visits for TBIs in children between 2001 and 2018, 41% of them were due to contact sports. Fortunately, increased awareness and new safety measures helped stem the tide of emergency room visits by children aged 18 and under from 2012 to 2018. For example, USA Soccer no longer allows children under the age of 10 to head the ball during games. A sharp drop in the number of children taking part in tackle football has also contributed to the decrease.

Has Research Helped Improve Treatments for TBI Patients?

Our overall understanding of the brain has improved greatly over the last 50 years. In the past, scientists believed the brain did not grow past childhood. Today, we know the brain can and does grow and change throughout our lifetimes.

Other commonly held beliefs from the past:

• TBI patients only have about a three month time frame for recovery – FALSE
• TBI patients only have a two year time frame to improve their condition – FALSE

Both time periods have been proven to be false. Now doctors know the condition of TBI patients can continue to improve over a lifetime. Through the use of repetition, a patient’s brain can rewire itself, even after a major trauma. By using therapies that involve repetition, a TBI patient’s brain function will move from a damaged to an undamaged area. This isn’t science fiction, it’s known as neuroplasticity, or the brain’s ability to adapt and change.

These and other findings have successfully been applied to the treatment of TBI patients. Increased knowledge of the importance of sleep, diet and supplements have also helped. For instance, one major study found that Omega-3 fatty acid supplements promoted brain healing and improved cognitive function significantly.

No two traumatic brain injuries are the same. And of course, the severity of your TBI will also factor into your chances of recovery. But the science is very promising and new breakthroughs in the treatment of TBI patients continue to happen in 2022 and beyond.

How Much Can a TBI Cost?

A TBI can cost a person five, six and even seven figures in medical costs. The hospitalization costsalone for a TBI can range from $2,130 up to over $400,000 for a severe injury. This doesn’t factor in all of the other medical expenses the patient will have to deal with over a lifetime including physical therapy, mental health counseling, medications and in some cases, in-home care. An initial $100,000 offer from the insurance company won’t even cover the initial medical costs for someone who has suffered a moderate to severe TBI.

Plus, if you want any experimental or cutting-edge treatments or therapies, your medical insurance many not approve it. You shouldn’t need to worry about your finances at a time like this. You want to be able to pursue all of the medical help available for you or your loved one’s TBI.

The Personal Injury Attorneys at The Dominguez Firm Offer Free Consultations

TBI related personal injury cases are complex. They can be difficult to diagnose correctly, especially in the case of a mild TBI. Insurance companies know this, that’s why they’ll often try to settle a TBI case right away before symptoms have a chance to develop.

Whether you or a loved one suffered a TBI, don’t take the insurance company on by yourself. Hiring The Dominguez Firm automatically changes how their adjusters handle your claim. From there on out, they’ll have to deal with our award-winning attorneys to reach a fair settlement amount. You don’t have to put up with their phone calls, emails and correspondence urging you to take what they deem their “final offer” for your TBI. Instead, you and your family can concentrate exclusively on your recovery.

At The Dominguez Firm we have 35 years of experience successfully handling TBI cases. In that time we have helped thousands of injured clients obtain the maximum compensation for their accident injuries. And if you think you can’t hire the nationally-recognized attorneys at The Dominguez Firm, think again. We work on a contingency basis, which simply means we’re paid a percentage of your final settlement or verdict amount. You don’t have to worry about any hidden costs, legal fees or out-of-pocket expenses whatsoever.

Call The Dominguez Firm today at 800-818-1818 for a free consultation. We can travel to your home or hospital at a moment’s notice.