There is Nothing Mild About a Mild Traumatic Brain Injury

The information that you are about to read is not known by approximately 90–95% by all physicians, psychologists, neuropsychologists, and neurologists in this country. Mild Traumatic Brain Injury (mTBI) is one of the least known entities in the neurological spectrum.

The primary neuropathology of mTBI is diffuse axonal injury (DAI) caused by shearing forces generated in the brain by sudden deceleration. This may be due to contact forces or to acceleration/deceleration trauma. The brain is bounced around by the skull, which causes damage. Within 24–48 hours after the injury, a cascade of chemicals is released into the brain, which only makes matters worse.

While the symptoms of an mTBI are difficult to see, when looking at the patient, there is a significant negative impact on cognitive functions such as attention/concentration; memory; executive functions (organizing, planning, and problem solving); accessing words; fatigue; vision; headaches; sensitivity to light and/or sound; and tinnitus (ringing in the ears). It also can impact sleep, appetite, emotional reactions, and overall personality.

Most people who are experiencing mTBI, will be told by others—spouse, kids, friends, co-workers—that “you seem to be fine, I can’t SEE anything wrong with you. It must all be in your head.” Others think that the patient might be making up these symptoms to get attention, money (from insurance companies), or is seen as trying to “not do what they are supposed to do.”

The good news is that 95% of these injuries usually recover completely within a year to two years after the injury, although many resolve within weeks, if not days. The “miserable minority” are those people who experience permanent brain damage. There is an estimated 2 million mild Traumatic Brain Injuries that occur each year in the United States. Because many people do not report this injury to medical professionals, it is likely that this number is much higher.

However, even if we are looking at 2 million mTBIs a year, 5% of that is 100,000 people who are experiencing permanent brain damage each year, and probably even more.

Mild Traumatic Brain Injuries affect the person’s ability to work, to do certain daily functions, and impacts marriages, families, and friendships. If you take all of this into consideration, there is nothing mild about a mild traumatic brain injury.

The patient experiences a “changed sense of self,” that he or she is not the same person as before the injury. On some level, this is very true. People with mTBI cannot do what they used to do. It is not that they are “less intelligent,” it is that they are now processing information differently, and always in the negative direction.

A great deal of frustration that individuals with an mTBI experience has to do with professionals who are well intended, but are not trained in the field, and therefore don’t know what symptoms to look for. Therefore, many patients are misdiagnosed, and sent home without the correct recommendations for follow up treatment.

Patients are typically given a CT scan and/or an MRI, which just about all of the time comes out negative. The problem with these types of scans is that an mTBI causes microscopic tearing and shearing of the connective tissues in the brain, and is not picked up by a CT scan or an MRI. More improved techniques like PET Scans or fMRIs (functional MRIs), will pick up the injuries in the brain, but unfortunately many facilities do not have these, and they tend to be very expensive.

An mTBI (or concussion) causes at least one of the following:

  1. Loss of consciousness (seen in only about 10% of the cases).
  2. Post-Traumatic Amnesia: memory problems with information either after the injury or before the injury.
  3. Change in mentation: feeling dizzy, dazed, or confused.
  4. Focal neurological impairment: stuttering, problems with balance and/or dizziness, problems walking, numbness and/or tingling in the body.

A person needs to experience only one of the above symptoms to accurately be diagnosed as having a mild Traumatic Brain Injury.

Concerning evaluations, it is crucial that you go to a neuropsychologist who has training and experience in mild Traumatic Brain Injury. There are many neuropsychologists who evaluate mTBI who, unfortunately, do not have the training and/or the experience to accurately diagnose this.

Treatment is typically a combination of psychotherapy and cognitive rehabilitation. The therapy can include marital counseling and family counseling. Educating the spouse and family is very important so that they can understand what the patient is going through. Therapy for the patient should include help with the emotional trauma that this person has experienced, leading to depression, confusion, anxiety, and withdrawal.

The final piece of this would be the cognitive rehabilitation. This usually involves teaching the patient compensatory strategies that will help them cope with the cognitive impairments that they are experiencing.

The overall treatment can go anywhere from a few months to years, depending on how long it takes the brain to heal, and if there is permanent brain damage.

Finally, it is crucial that if you, or someone that you know, experiences what appears to be a mild Traumatic Brain Injury (concussion) it should be immediately checked out by a physician who has knowledge and expertise in this field. Otherwise, further and more dangerous problems might happen.


Kenneth W. Gilstein, PhD

Kenneth W. Gilstein, PhD, is a licensed psychologist, with a subspecialty in neuropsychology, and an expertise in mild Traumatic Brain Injuries. He graduated from Cornell University, with a major in neurobiology and behavior, and obtained a Ph.D. from Utah State University, majoring in Professional – Scientific Psychology (a combination of clinical, counseling and school psychology). In 2003 he received an award from the Connecticut Psychological Association for “Distinguished Contribution to the Science of Psychology” for his work in mild traumatic brain injury.

Dr. Gilstein has had over 40 years of experience working with children, adolescents, adults, families and couples, both doing therapy and psychological evaluations, including ADHD and learning disabilities. He also specializes in family and marital therapy.