Question:
Studies show that between 1/3 to 1/2 of victims who were previously employed persons are still unable to return to work six weeks later. They are a group with high utilization of follow-up medical care in the months following the injury. So although the impact on each individual may not be as impressive as it is for more severely injured patients, the aggregate of life disruption and lost productivity is nonetheless inestimably costly to the individual, his family and his community. If minor head injury is not minor, then what is it?

Answer: These symptoms may occur alone or in combinations which may evolve with time after the original injury. Individual symptoms may subside and then recur with other life stresses -- making it seem to both patients and caregivers that the time of disability and poor health is both unpredictable and endless.

As we have learned more about this entity, hypotheses of the anatomic nature of injury have evolved. All involve the idea of a diffuse, microscopic level disruption of brain cell function. Trauma of the acceleration-deceleration type causes the brain to move suddenly within the skull -- but the forces are experienced unequally throughout the brain so that the brain undergoes distortion at various sites.' As a result, stretching or even tearing of millions of microscopic nerve pathways occurs throughout the brain matter. In the last 30 years, microscopic examination of brain tissue following this type of injury, seems to confirm this idea. Present technology and testing methods often fail to document any injury. But this failure reflects the limitations of the tools rather than the absence of actual injury. The tests available to us now are best designed to recognize abnormalities which are focal not diffuse. For example, the CAT scan (computerized axial tomography) is most useful for displaying discrete areas of damaged brain which appear different from surrounding normal tissue. The MRI (magnetic resonance imaging) though more sensitive than the CAT scan suffers from the same limitations. When the brain as a whole is uniformly injured these tests are not helpful. The clinical neurological exam also functions best when there are clearly focal abnormalities -- and its sensitivity is confounded if the patient cannot fully cooperate with the examination process, or when the examiner has little to no knowledge of the patient's prior capabilities