By: Robert L. Shepherd, MS, Certified Medical Illustrator, President & CEO, MediVisuals Inc.
The fact that individuals sustaining traumatic brain injuries (TBIs) often exhibit delayed or worsening symptoms over time is well documented in medical literature (a narrated animation effectively demonstrating this process can be viewed here. Despite this fact, insurance company representatives and their attorneys frequently argue that symptoms should be immediately evident and at their most severe immediately following a traumatic event. They often claim that any delayed or worsening symptoms must be the result of an unrelated injury or disease process. They may even argue that the victim is malingering (faking the symptoms) because symptoms have developed or worsened after the initial incident. It is a challenge for attorneys representing TBI victims to overcome the jurors' and other decision makers' predisposition to believe that symptoms should be at their most severe immediately following a traumatic event and heal over time (like most other wounds).
Medical science has revealed that the initial stage of injuries to neurons, which results in immediate symptoms, is followed by a second stage of gradual death of neurons that progresses over a prolonged period of time and results in significant worsening of those injuries in scope and severity. The literature describes this progression and worsening of symptoms as continuing for months, years, or even for the TBI survivor's entire lifetime. Due to this long-term progression, TBI is more accurately referred to as a "process" not an "event".
Trauma to the head doesn't have to be particularly severe to begin the insidious chain of events that can devastate the lives of TBI victims and their loved ones. The process begins with tears of scattered axons (long extensions of neurons that carry chemical and electrical impulses to other neurons). A partial tear of just the outer membrane may heal, or it may allow an influx of calcium ions (necessary for transfer of impulses, but very harmful if allowed to uncontrollably flow into the axon through the membrane tears).