It is not uncommon for a person to suffer a mild traumatic brain injury (TBI) in connection with an auto accident, a slip-and-fall incident, or other traumatic event. Unfortunately, it also is not uncommon for this type of injury to go undiagnosed and untreated for months or even years. The fact that a person does not need to hit his head or even lose consciousness to sustain a TBI is counterintuitive to many people, who may fail to report, or ignore or dismiss their symptoms as unrelated to the accident. Objective tests (e.g., MRI, CT scan) may not be sensitive to milder TBIs that still can be quite disabling. Only when you can identify the symptoms of a TBI can you begin to help your clients get the care and compensation they deserve. To determine whether your client is dealing with a possible TBI, gather and evaluate the following information. Make this determination as early as possible in the case, so you can plan your discovery and settlement strategy accordingly.
1. Information from Your Client
At the initial consultation, ask your client about the accident or other injury event:
- Did you hit your head on anything?
- Was your head thrown backward? Forward?
- Did your face hit anything?
- Did you have any bleeding from your ears or nose?
- Was your face bleeding?
- Did you experience nausea or vomiting?
- Did you lose consciousness after the accident?
- If you did not lose consciousness, did you feel dazed? Confused? Were you “seeing stars”?
- What is the last thing you remember before the accident?
- What is the first thing you remember after the accident?
Ask about your client’s experience since the accident or other injury event:
- Have you had recurring headaches? How Often? Location?
- On a scale of 1-10, with 10 being most severe, how would you rate the pain of your headaches?
- Did you have headaches before the accident? If so, how often?
- Have you experienced any of the following:
- Difficulty remembering things?
- Problems with balance?
- Impaired judgment?
- Problems with attention?
- Difficulty concentrating?
- Sensitivity to light?
- Blurred or double vision?
- Other problems with your eyes?
- Fatigue? Drowsiness?
- Sensitivity to loud noises?
- Ringing in your ears?
- Difficulty sleeping?
- Difficulty performing routine tasks?
- Difficulty learning new tasks at work or at home?
- Have you noticed any gaps in your memory?
- Are you having problems related to social skills?
- Has your thinking been confused?
- Are you repeating yourself?
- Have you had any changes in your mood (e.g., depression or anger)?
- Have you experienced any changes in your ability to hold items in your fingers or hands?
2. Information from Family Members and Third-Parties Present at the Scene
People who suffer some sort of TBI will be poor historians of the events before and after the accident. Therefore, it is important that you ask detailed questions of all witnesses at the scene of the accident, as well as your client’s family members. Your questions should include:
- Describe the scene immediately before/after the accident.
- How was [injured party] behaving immediately after the accident?
- How has he behaved since the accident?
- What changes (in behavior, personality, mood, etc.) have you noticed?
- Did [injured party] lose consciousness at the scene?
- Did he hit his head on anything?
- Was his head jarred severely back and forth?
- Did [injured party] have any bruising to his head?
- Was he dazed or confused after the traumatic event?
- Did he experience any amnesia soon after the traumatic event?
- Did [injured party] complain of neck pain after the traumatic event?
- Did [injured party] appear nauseous after the event?
- Did he complain of a headache soon after?
- Did he mention “seeing stars” or feeling dizzy soon after the event?
- Is there a gap in [injured party’s] memory after the event?
3. Other Sources of Information
Obtain and review the following:
- Your client’s medical records.
- The police report and EMS run sheets.
- Emergency room records and all test results. Caution: Emergency room doctors often do not spend enough time questioning the patient about TBI symptoms and may not properly diagnose the possibility of a TBI. Other emergency room doctors will order a CT scan to rule out a bleed on the brain, and if that comes back negative, will totally dismiss TBI from their differential diagnosis. Emergency room physicians frequently ask patients if they think they lost consciousness in the accident, but then fail to ask what their first memory is after the accident. Many TBI patients will report that they did not lose consciousness; upon further inquiry, however, they may not remember anything until they were outside of the vehicle or perhaps in an EMS unit.
- Clinical tests and scans, including:
- CT scan of the head.
- Skull X-rays.
- Cervical X-rays, CT scans, and MRIs.
This post is excerpted from Litigating Neck & Back Injuries, by Michael J. Morse. Mr. Morse is a personal injury trial attorney who specializes in auto, truck and motorcycle accident cases. His practice is dedicated almost exclusively to first- and third-party Michigan no-fault claims. Mr. Morse is an executive board member of the Michigan Association for Justice. In addition to serving as legal counsel to his clients, Mr. Morse serves as a case evaluator and arbitrator in Wayne, Oakland and Macomb counties.