How Are Brain Injuries Diagnosed?

I am a critical injury lawyer, not a physician. While I cannot provide medical advice, I can certainly tell you what I have learned after 30 years helping clients with brain injuries caused by car crashes, slip and fall events, falls from heights, assaults, sporting injuries, and in one memorable case, a hovercraft accident.

THE GLASGOW COMA SCALE

One of the medical records that I always order is the ambulance call report, available whenever paramedics were deployed to attend to an injured person.

All paramedics, as well as emergency room staff, are trained to administer the Glasgow Coma Scale (GCS) which is a scale of 15 points where 15/15 is normal and 3/15 is the lowest possible score.

The GCS evaluates three aspects of functioning — eye opening, verbal response, and motor response — to point towards a traumatic brain injury (TBI). Loosely, the scoring breaks down as follows:

• Mild TBI (Concussion): GCS score of 13-15
• Moderate TBI: GCS score of 9-12
• Severe TBI: GCS score of 3-8

This is one very useful, real-time measure of the immediate insult to the brain. Until 2016 it was also one of the specific measures used to determine whether a person had a "catastrophic brain injury" for the purpose of their statutory accident benefit entitlements.

It was arguably a poor predictor of outcomes in that someone with a very low GCS could have a good recovery and someone with a normal or near normal GCS could have a poor outcome.

While this test is still administered by paramedics, it no longer plays quite the same special role in motor vehicle accident benefit cases. It is still useful.

DIAGNOSTIC TESTS SHOWING EVIDENCE OF INTRACRANIAL PATHOLOGY

This is a mouthful, but what it really means is that there are several diagnostic tests available to someone who is examined in a hospital setting that may confirm a brain injury.

"Intracranial pathology" is also the specific term used in motor vehicle statutory accident benefit cases. In my experience, these tests do not definitely rule out a TBI, but they can help to confirm a moderate TBI.

The kind of diagnostic tests that I routinely see include:

• X-rays - which can show evidence of skull, nose, and jaw fractures
• CT scans - A Computed Tomography (CT) scan is often the first imaging test performed in cases of suspected brain injury. It uses X-rays to create cross-sectional images of the brain, revealing bleeding, swelling, fractures, and other abnormalities. CT scans are quick, making them ideal for emergency situations.
• Magnetic Resonance Imaging - An MRI provides more detailed images than a CT scan, using powerful magnets and radio waves to generate pictures of the brain's soft tissues. MRIs are particularly useful for detecting small or subtle injuries, such as diffuse axonal injuries (DAIs), which might not be visible on a CT scan. However, MRIs take longer to perform and depending on where you are in Ontario, they might not be as readily available.

DIAGNOSIS AFTER THE FACT OR WHERE THERE IS NOTHING ON A SCAN

Many of my clients would have nothing show up on an X-ray, CT scan, or MRI. They might still have significant problems that later get classified as post-concussion syndrome or a TBI. The diagnosis for this group would likely include:

NEUROLOGICAL EXAMINATION

A thorough neurological examination is essential for assessing the extent and impact of a brain injury. This examination includes evaluation of:

• Cognitive Function: Memory, attention, language, and problem-solving abilities are tested.
• Motor Skills: Muscle strength, coordination, and reflexes are assessed.
• Sensory Function: Vision, hearing, touch, and balance are evaluated.
• Cranial Nerves: These nerves control functions such as eye movement, facial expression, and swallowing.

NEUROPSYCHOLOGICAL TESTING

Neuropsychological testing involves a battery of standardized tests that evaluate various aspects of cognitive function, including memory, attention, language, and executive function (planning, organizing, and decision-making).

These tests help identify specific cognitive deficits and provide a baseline for tracking recovery over time. I wouldn't normally see one of these administered until six months has passed from the injury.

COMPLIMENTARY REHAB PROVIDERS

I am always prompted to further explore an injury as a potential concussion event if I hear symptoms such as headaches, dizziness, nausea, confusion, balance problems, and sensitivity to light or noise.

If not already arranged by the medical system (unfortunately a frequent challenge), on my own I might involve:

• A speech language pathologist.
• A physiotherapist with expertise in concussion.
• An optometrist trained in diagnosing the kinds of visual impairments that relate to brain injury.
• An occupational therapist with training in post-concussion protocols.
• A psychologist who might assist with the kind of mood changes that can occur secondary to a concussion or more serious brain injury.
• A headache specialist, if headaches are one of the predominant complaints.

I would be guided by their collective expertise in terms of a diagnosis, but also for treatment options and effective coping strategies. The goal is always to get someone back to their functional best, at work, at home, in their leisure past times, and socially. I always prefer a multi-disciplinary approach.

Diagnosing brain injuries is a complex process that involves multiple steps and the use of advanced medical technologies. Understanding these steps can help my clients and their families navigate the often-overwhelming experience of dealing with a brain injury.

Early and accurate diagnosis is crucial for effective treatment and better outcomes, underscoring the importance of seeking prompt medical attention following any head injury.

As an Ontario-based critical injury lawyer, I am dedicated to supporting individuals with brain injuries and their families. If you or a loved one has suffered a brain injury, seeking legal advice can help ensure you receive the appropriate compensation and support for your recovery journey.