An Invisible Injury

Physicians rely on various tests to diagnosis a TBI. The Glascow Coma Scale (GCS) measures three areas: ability to open eyes spontaneously, to speech, pain, or not at all. The ability to speak: is the patient confused, unable to speak coherently, or not able to speak at all? The ability to move: does the patient respond appropriately to painful stimuli? Are there abnormal movements?

Each area is scored. The best possible score is fifteen. Thirteen or greater indicates a mild TBI. Nine through 12 suggests a moderate TBI, and 8 or lower is likely a severe TBI. Since the GCS scores the initial injury, it is not a predictor of the patient’s recovery and functional ability. If a 13 is assigned to the initial injury, the patient may still exhibit long-term deficits like difficulty processing new information. My GCS score at the time of my injury occurred was fourteen.

Symptoms are also helpful in diagnosing a TBI, such as clear fluid (spinal fluid) draining from the ears or nose, irregular breathing, dilated pupils, coma, paralysis, numbness or tingling, vomiting, and loss of bowel and bladder control.

In TBI’s there may be brain swelling and bleeding, which can be seen on Computed Tomography (CT scan) or magnetic resonance imaging (MRI). CT scans are not as sensitive as MRI’s, but take less time to complete – the reason why they are taken in the acute phase of treatment. However, both techniques cannot detect torn neurons, or microscopic bleeding (see post: The Brain: A Delicate 3.4 Pounds). For those who sustain neuron damage, but no swelling or significant bleeding, it’s difficult to diagnose a TBI. This was the case in my injury. It’s easier to diagnose patients who show obvious signs of a TBI (see symptoms above). But in those that do not, physicians must rely on subjective input from patients. That’s why many people go years before being diagnosed. If you have heard of TBI’s referred to as an “invisible injury,” now you know why.

http://www.biausa.org/brain-injury-diagnosis.htm http://www.nlm.nih.gov/medlineplus/tutorials/traumaticbraininjury/nr289102.pdf