Changes Needed in Diagnosing Brain Injury

Diagnosing Brain Injury – Changes in Protocol Needed

By Gordon S. Johnson, Jr.

Improving the diagnosis of brain injury is one of the missions of my life. Since I am not a doctor, that might seem an unrealistic goal.  But because of the internet, my words of brain injury advocacy reach hundreds of thousands of people. In contrast, the best selling brain injury textbooks sell only a few thousand copies. In addition to being a brain injury attorney, I am also the survivor of a moderate brain injury, an injury that went undiagnosed.  Thus, I continue to tilt at these windmills.

Changes are needed in the diagnosing of brain injury, particularly mild brain injury in the ER. Key is next day followup and detailed inquiry into amnesia. If diagnosing brain injury is not done acutely, the time to intervene may be lost. Thus, we will start our treatment of diagnosing brain injury, with a discussion of amnesia.  We start with amnesia not because it is the most permanent of conditions, but because it is the most transient. Identifying and documenting amnesia’s existence is the single most important step in identifying the severity of all brain injuries.  Identification of the existence of amnesia can help to distinguish the disabling brain injury diagnosis, from a ding or simple concussion. Within our operating manual for the mind analogy, amnesia is the clue that you are about to lose what you have not saved.

Yet if we think about the brain strictly like a desktop computer, we will not grasp the subtleties of amnesia.  Unlike a power cord dependent computer, the brain can save islands of memory, in seas of amnesia. The brain’s Save Button is not an all or nothing process like it is on our computer.  Physiological and emotional processes around the time of an event may be intense enough to push the memory through a bottle neck of cognitive inefficiency to the long term storage device.

Assume that your memories were coming to your hard drive, through a slow internet connection.  We know that when the connection slows down, all data transfer is delayed.  But assume that Google, in its mighty power, found a way to prioritize Google data so that its search results would jump in front of all other demands on the bandwidth.  That is what certain memory stimulants can do, even when your brain’s ability to record memories is severely impaired by concussion.

After we cover amnesia, this treatment of diagnosing brain injury will focus on how the brain works. We will do this as a prelude to understanding how injury pathologically changes brain function. Our effort at to improve diagnosing brain injury will then focus on diffuse brain injury, primarily injury to the brain’s white matter, the brain’s axons and axonal tracts. The impact of such injuries can be the equivalent to a dramatic drop in speed and reliability of the way in which a computer would process information.

Understanding Focal Injury – the Big Stuff

Elsewhere on we have focused on severe brain injury.  That focus is on the “big stuff”, focal brain damage impacting large and specific brain structures. But the mild brain damage actually impacts many times the number of people that severe brain damage does. There are probably 50,000 severe brain injuries a year in the United States in contrast to millions of mild TBI’s. Thus even if only 10% of those have mild brain damage that persists, that is several times more disability than results from severe brain injury.


Gordon Johnson

Attorney Gordon Johnson is one of the nations leading brain injury advocates. He is Past-Chair of the TBILG, a national group of more than 150 brain injury advocates. He has spoken at numerous brain injury seminars and is the author of some of the most read brain injury web pages on the internet.

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