I recently attended an excellent solicitor training day hosted by Headway (South East London and North West Kent branch). One of the speakers Dr Lidia Yaguez-Hervas, consultant clinical neuropsychologist gave a presentation on the warning signs of hidden brain injuries.
A decent personal injury solicitor will always ensure that clients are compensated properly for the physical injuries they sustain: these injuries are often fairly obvious. But it is imperative that a solicitor is also alive to the possibility that, if a client has suffered a knock to the head, experienced a period of unconsciousness, or is confused and disorientated in the aftermath of the accident, they may also have sustained a brain injury.
The length of time that someone remains unconscious or in a coma, or suffers from post-traumatic amnesia will give an indication of the likely extent of any brain injury. Where someone loses consciousness for less than 15 minutes or has post-traumatic amnesia for less than an hour, they are classed as having sustained a mild head injury, and if any brain injury has occurred, it will more often than not be “mild”.
But the term “mild brain injury” can often be a misnomer. For the sufferer and those closest to them, the resulting array of cognitive, emotional and behavioural symptoms feel anything but “mild” and can infiltrate all aspects of their life from work, to domestic to social activities.
Even before symptoms start to show, it may not be immediately obvious that the brain has been damaged. Brain injuries can be acquired a number of ways, the most obvious being when brain tissue is damaged by a direct blow to the head. But injury can also result from a lack of oxygen to the brain (hypoxia) caused by extensive bleeding in another part of the body which lowers blood pressure (so oxygen fails to reach the brain effectively), or a heart attack, or damage to the chest and/or windpipe. In addition, bleeding, bruising, swelling and blood clots to the brain may often appear days after the initial accident.
Given the complexity of the brain, it is unsurprising that brain injuries will differ markedly and will depend on the mechanism of the initial injury. For example, injury to the front part of the brain (the frontal lobe) can result in cognitive impairment. Often cognitive damage is not immediately obvious: symptoms may include impaired concentration, attention and memory problems, difficulty processing new information and problems with planning and organising. Similarly damage to the frontal and temporal lobes can cause personality changes: increased irritability, a bad temper, rapid mood changes, or a sufferer may become less motivated, apathetic and lacking in drive.
Often these symptoms are reported by friends and family members rather than the injured person themselves and it is extremely important that these are not overlooked as they may indicate a “hidden” brain injury. Sometimes attention is focused on recovery from the more obvious physical injuries, or any change in behaviour or mood is wrongly attributed to the psychological fall out of the accident, for example, anxiety resulting from a road traffic accident, or depression linked to the effect of the physical injuries. As cognitive impairments may be subtle, they may also not become obvious until the sufferer attempts to return to their normal life, returning to work and finding they are unable to cope.
According to Dr Yaguez-Hervas, most patients with mild traumatic injuries make a good recovery within 3 months, but around 10-15% will have ongoing symptoms including headaches, nausea, memory difficulties and emotional abnormalities that can persist for months or years. In some cases, a failure to diagnose the injury can result in isolation for the sufferer who is accused of malingering or imagining symptoms.
Where clients or their friends and family report continuing symptoms, a solicitor should give careful consideration to instructing an expert specialised in traumatic brain injury to establish the level of often subtle impairment. As well as ensuring the client is compensated properly for their injuries, early diagnosis of a brain injury is critical to ensuring the client accesses the most appropriate rehabilitation to reach optimum recovery.