Undiagnosed Concussion Leaves a Lifetime of Disability
Undiagnosed Concussion Can Leave a Lifetime of Disability
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This story of an undiagnosed concussion could have been about me, instead of authored by me. I too was in a similar car crash. I too who was strapped to the board. I too was found to be fully oriented in the ER. I too treated and released. I too suffered an undiagnosed concussion. Not once, but twice.
But I, like the 85% of those who suffer concussions, had an “apparent full recovery.” While I can’t account for perhaps 10 seconds, perhaps a minute of time, I still clearly remember the events just before each crash. (In the first wreck when I was 21, I was unconscious for several minutes, see below video.) More importantly, my condition did not deteriorate over the next 12 – 72 hours in either case. I had no other abnormalities related to damage to the central nervous system.
I am representative of the 85% of those who suffered a concussion or mild traumatic brain injury and who get better. Bill is representative of the 15% of those who do not recover. He is representative of those whose ability to function is forever changed by an undiagnosed concussion.
There is no single explanation for this 15%. One famous neuropsychologist, Ronald Ruff, coined the “miserable minority.” to describe them. There is even some honest debate whether the 15% is the right number. Perhaps the size of the miserable minority is 5 or 10%. Regardless of what the number is, that there is a percentage of those with permanent brain damage from seemingly transient injury, is not open to honest debate.
I personally believe that our current thinking about concussion can offer a reasonable explanation for about half of the group with persisting problems. Poorly understood neurological conditions may someday account for perhaps another third of that total. But the precise biomechanics and neuropathology to explain the seemingly transient nature of the symptoms, which can so clearly disable, eludes our current science.
Any objective discussion of disability from routine undiagnosed concussion must discuss the emotional component of such diagnosis. Many would argue that the differential diagnosis of a psychiatric etiology must be considered before diagnosing permanent brain damage. Yet, any effort to label Post-Concussional deficits as caused by psychological factors is an intellectually dishonest effort to confuse cause and effect. Worse, it unfairly burdens those already most troubled with the added weight of doubting medical providers.
At what point does the story of the Bill diverge from that of my own? Is it a bit more force in the blow to the top of his head, a bit squarer of an impact with the truck or was it just looser and more limber neck muscles? Perhaps age was a factor, perhaps some previous damage had left him more vulnerable. Below we will discuss the separate disorders that make up the group of people who have permanent changes as a result of brain damage stemming from brain injury. We will also address those variables that our neuroscience has advanced to the level that we can comprehend.
Below is the story of my first undiagnosed brain injury.
 Ronald Ruff, Ph.D., neuropsychologist.