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Why Are the Symptoms of a Mild or Subtle Brain Injury Often Missed By Doctors?

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Malcom: I’m Malcolm Underhill and this is Simon Pimlott. We are both solicitors and we spend a lot of our time acting for individuals who have suffered a traumatic brain injury.

But it’s not just those who have suffered a very obvious and severe brain injury that comes to our attention, it those who also suffer a more subtle brain injury.

And what I’m interested to discuss with Simon today is ‘what are the signs of a subtle brain injury?’.

Simon:  Well brain injury itself is often difficult to diagnose because there is limited medical and scientific knowledge of the brain itself and its workings.   So particularly when the symptoms and the injury themselves are relatively mild, then it can be that much more difficult to diagnose. Particularly if the individual doesn’t go to hospital immediately or there is a delay in seeking medical attention.

And it’s for these reasons that a subtle or mild brain injury can often go undiagnosed.  And this can still be though a significant injury. It can be long lasting – it can have subtle but significant effects on an individual’s life.

The positive is that most people make a good recovery from a mild brain injury but there is the unfortunate minority who will go on to have long-term symptoms and repercussions.  

Malcolm:  Because those that suffer a very severe brain injury are immediately taken to hospital and therefore treated appropriately,  that’s not going to happen in a subtle brain injury so what are the signs that they – or particularly their family – should look out for?

Simon:  Well I think the first thing which might be noticed is that the individual might start saying certain things like – I don’t feel right, something is a bit unusual.

But then the family or friends will see that they are perhaps behaving slightly differently. They are not themselves.  There is a subtle personality change.. this might be in the form of a change in temperament,  where they become slightly more aggressive or they develop a temper.  Their mood might become affected, they might become slightly less interested in the activities they pursued before their injury.  Fatigue is often a problem. .even where there is a mild brain injury.. the individual may not have the energy levels they used to have.  They may need more sleep. And there is this overall sense that something is not quite right with them.  And that is really where the family can detect these things.

Malcolm:  And why is it do you think that the subtle brain injury can so often get missed?

Simon:  Well the reason why it gets missed is very often – as we have discussed – is the fact that the injuries aren’t visible necessarily. There won’t be trauma to the head, necessarily,  and therefore both the doctors and the sufferer won’t recognise the fact that they have got a subtle brain injury immediately. Because it’s relatively mild, the individual may not go to hospital straight away, and if they do, their brain injury may be masked by other physical injuries they have suffered which are the focus of medical attention.

But then after that, they may then be discharged and released from hospital and there won’t be any follow up because the treatment, for the injuries that they thought had been sustained, had been dealt with,  but the injuries from the brain injury are slowly becoming apparent.  And at that stage it may have missed and only picked up once family member s become aware of the situation.

Malcolm: So how do clinicians determine the severity of a brain injury?

Simon: Well there is a widely used method called the Glasgow Coma Scale which is a means by which clinicians can measure the level of consciousness of an individual. And that goes up to a scale of a maximum of 15 where an individual is fully conscious and so a mild brain injury would normally fall into the range of 13 – 15. But it is important to note that even with a Glasgow Coma Scale reading of 15 that does not mean to say that there hasn’t been a subtle brain injury.

In addition to the Glasgow Coma Scale, clinicians will also look at the scans to see if there are any signs of brain injury or quite often that may not be the case with mild brain injury. A mild brain injury will also be typically categorised with loss of consciousness of less than 30 minutes, as a maximum, and in addition to that there would be memory loss of no more than a day after the actual accident itself.  But even if those features are not present, again I must emphasise, it does not mean to say that there hasn’t been a subtle brain injury.

Malcolm:  So as you say – the very serious injuries are obvious and dealt with appropriately, the subtle injuries are less clear and you are saying that if those signs become apparent it is important that the individual – if they haven’t already been to hospital – get back to hospital as soon as possible in order to get the best possible treatment.

Simon: Absolutely.  I think that’s why I emphasise the importance of trying to recognise where a mild brain injury has been suffered.  Because the sooner there has been intervention,  and some treatment, and the right sort of support can be put in to place, the better the outcome for the individual.  Not just in their personal life, but also at work as well, because even a subtle brain injury at work, can still have an effect on their effectiveness as an employee.

Malcolm: Yes. I agree. Thank you

Contact our legal experts for more information

At IBB, our personal injury team, led by Malcolm Underhill, has the expertise and knowledge to advise and represent you if you wish to make a compensation claim following a brain injury. To talk about how we might be able to help, please phone us on 0333 123 9099, email us at or fill in our contact form.  Any discussions you have with us will be in the strictest of confidence.

Why Are the Symptoms of a Mild or Subtle Brain Injury Often Missed By Doctors?

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