Symptomatology Literature

The myriad of symptoms of brain injury are discussed throughout the literature, and the ACRM definition of Mild Brain Injury, discussed at http://www.tbilaw.com/tbilibrary.loc.php contains a good listing of these issues. However, the understanding of two constellations of symptoms is absolutely essential to understand, diagnose or represent those with subtle injuries: A) The interplay between attentional/processing speed problems and fatigue and B) Dizziness, balance, vertigo.

A. Fatigue.

Many sources talk about fatigue as an issue in brain injury. Yet, in terms of a comprehensive statement on the interplay between processing speed, divided attention and fatigue, Lezak says it all. Lezak’s treatment of fatigue at page 183 contains the following:

As a result of the slowed processing resulting from many microscopic sites of damage diffusely distributed throughout cerebral white matter and the upper brain stem, activities that were automatic now may only be accomplished with deliberate effort.

The activities that are normally automatic but become effortful after the injury, particularly during the first weeks or months, include many that are performed frequently throughout a normal activity day, such as concentrating, warding off distractions, reading for meaning, doing mental calculations, monitoring ongoing performances, planning the days activities, attending to two conversations at once or conversing with background noise, etc. … It is little wonder that by late afternoon, if not by noon, many of these patients are exhausted. Making matters worse, as they get fatigued their efficiency plummets to even lower levels so that activities that were difficult when they were most rested and competent become extremely labored and even more error prone; e.g., they become more distractible, make more mistakes when speaking, become more clumsy, etc.

See also Wrightson and Gronwall, Mild Head Injury, all of Chapter 5.

B. Disorders of the Vestibular System

Perhaps the most underdiagnosed aspect of brain injury are those which effect the inner ear, cranial nerves and brain stem. While this leading treatise in the field of neurootology does not address all of those issues, it does provide a very important treatment of those symptoms relating to balance, vertigo and dizziness. It is important to appreciate the symptoms of these conditions, as rarely will treating doctors have an appreciation for these symptoms, especially the subtle deficits associated with nystagmus. Yet, vestibular disorders can often be objectively established, tangentially adding credibility to other symptoms which are hard to objectify. A further reason that it is essential that these disorders be identified is that they put your client at substantial risk of additional injury.

NEXT: Advocacy.

Understanding Subtle Brain Injury

The concussions that disable, are almost always more symptomatic at 24 hours, than at the 2-4 hour time frame when injured persons are evaluated in the emergency room. Brain injury symptoms escalate over the first 24 hours, because brain injury involves a cascade of events. It is critical that if you are still symptomatic the day after your injury, go back to the same Emergency Room, don’t wait for a doctors appointment. It is critical that the Emergency Room personnel see that the symptoms still persist or have gotten worse.

View Our Video Series on Concussions