It is now five weeks since my middle son suffered a concussion in wrestling. He was flipped onto his head by one of his practice partners. He felt a headache and was a little dizzy but continued to practice. He did not lose consciousness. On his way home, he noticed that he could not look at the street lights as it would hurt his eyes. We took him to his family doctor who immediately gave him an ImPACT test. My son had never had a baseline ImPACT test but nonetheless this test was helpful to see that he performed well below his expectations. We were referred to a neurologist and were soon in the able hands of Dr. Emil Materese. Dr. Materese spent over ninety minutes with my son asking him questions, watching him move and physically examining him. My son was diagnosed with a mild traumatic brain injury (“mild TBI”). It was this diagnosis that was key to everything else that happened thereafter.
How many people suffer a head injury, a mild traumatic brain injury, to have it go undiagnosed? The Mayo Classification System for traumatic brain injury severity was published in the Journal of NeuroTrauma, 24:1417-1424 (September 2007). Classification of a symptomatic or possible traumatic brain injury can be made if one or more of the following symptoms are present: blurred vision, confusion (mental state changes), dazed, dizziness, focal neurologic symptoms, nausea, headache. The problem of diagnosis may start in the emergency room. As noted in the article entitled Accuracy of Mild Traumatic Brain Injury Diagnosis published in the Archives of Physical Medicine Rehabilitation, Volume 89, August of 2008, emergency department (“ED”) personnel focus on ruling out a more severe brain injury for patients who arrive in the emergency department with a likely mechanism for traumatic brain injury. It was noted that emergency department personnel put great weight on negative CT Scan findings followed by a determination that there was no loss of consciousness to rule out brain injury. As was pointed out in the article, “Although this may reflect prudent ED guidelines given the serious medical and legal consequences of not identifying a more severe brain injury that may require intervention or additional monitoring, it appears that once a more severe brain injury was ruled out, findings of … other mild TBI related findings did not necessarily lead to a written diagnosis of mild TBI. And clearly the primary mission of the ED is to stabilize and treat serious injuries and illnesses. However, persons with no frank clinical signs of TBI by the time they arrive to the emergency department are less likely to be diagnosed. Lack of diagnosis may also reflect reduced recognition by medical providers and the lay public of the potential for prolonged effects of a brain injury when the presenting symptoms appear to be minor or even resolved by the time of medical assessment.
A lack of diagnosis or non-diagnosis is significant. Non-diagnosis often times will lead to lack of treatment or education about the possible consequences and expected course of recovery of a mild TBI. This may result in anxiety and a complicated recovery for patients that continue to experience difficulties after leaving the emergency department. Further, a lack of diagnosis could lead to a person participating in activities of life that make it dangerous for them or others such as participating in contact sports, operating automobiles or heavy equipment.”
In my son’s situation, diagnosis was significant because it allowed us to tell our son’s school that changes needed to be made in his curriculum to accommodate his difficulties. He was having difficulty reading without getting headaches. He continued to have sensitivity to light and was unable to concentrate for any extended period of time. However, he looked fine and his teachers were not well versed to the consequences of a mild traumatic brain injury.
Therefore, with a diagnosis of mild traumatic brain injury and with Dr. Materese’s assistance, we were able to convince the school to make appropriate accommodations so that my son could ease his way back into his school curriculum. Without that original diagnosis having been made, this would have been an impossible task. Without the diagnosis, my son would not have received the medical treatment he so desperately needed and to receive the necessary assistance to allow his brain to heal before he resumed his normal activities.
It is therefore of utmost importance that when your loved one suffers a trauma in which there is no loss of consciousness or diagnosable finding on a film study such as a CT Scan, that symptoms of blurred vision, confusion, being dazed, dizziness, focal neurologic symptoms, headaches or nausea not be discounted and instead be treated. It is important that you find a medical provider who will take seriously the symptoms and understand how to deal with them.
