Three Levels of Brain Injury
Understand the Differences between Mild, Moderate, and Severe Traumatic Brain Injury
Healthcare professionals use several tools to classify the degree of severity of traumatic brain injury (TBI). These tools include coma scales (such as the Glasgow Coma Scale (GCS)), neurodiagnostic imaging (MRI, CT, X-ray, etc.), neuropsychological examination, and other clinical findings.
The results of these tests and observations direct the classification of traumatic brain injury into three levels: mild, moderate, and severe. And these levels influence medical treatment decisions and prognosis (the likelihood of a full or partial recovery after the injury). In addition, insurance companies consider your TBI level when setting claim reserves and making settlement decisions in auto accident, occupational injury, construction site accident, and slip and fall claims.
This article discusses the signs and symptoms of the three levels of severity of traumatic brain injury. We hope you use this information to make informed decisions on your medical care and calculate a reasonable motor vehicle crash settlement or lump sum payment in your workers comp case.
Keep reading to learn more about TBI levels.
And call us at (804) 251-1620 or (757) 810-5614 if you want one of the best brain injury attorneys to help recover money under available tort, workers comp, and Social Security disability laws.
Brain Injury Signs, Symptoms, and Prognosis Based on the Severity Level
This section examines the three TBI levels in greater depth.
As you read about brain injury levels, remember that the terms “mild, moderate, and severe” do not always correlate with your permanent impairment level.
Indeed, we have spoken with medical professionals and advocates for TBI survivors who disfavor the terms “mild and moderate” because they imply the injury is minor and insignificant.
But even “mild” TBI can result in permanent disability, preventing you from returning to 100 percent of your pre-injury state.
This section examines the three TBI levels in greater depth.
Mild Traumatic Brain Injury
Most TBI victims present to the emergency room with mild traumatic brain injury (by GCS score). This category includes concussions.
Mild TBI signs and symptoms include the following:
- No loss of consciousness or unconsciousness lasting a few seconds or minutes (under 30 minutes).
- A GCS score from 13 to 15
- Normal brain scans (CT, MRI, EEG, X-ray)
- Confusion: Appearing stunned or dazed
- Headache
- Vision disturbance: Blurred vision, double vision, tired eyes, light sensitivity
- Tinnitus: Ringing in the ears
- Noise sensitivity
- Vomiting
- Nausea
- Memory loss (post-traumatic amnesia): Difficulty remembering the moments before the TBI or after (post-traumatic amnesia)
- Chronic fatigue
- Impaired sleep (either too much or too little sleeping)
- Dizziness
- Bad taste in your mouth
- Lack of motor coordination
- Trouble balancing
- Mood changes
- Impaired attention and concentration
- Irritability
The initial treatment for mild traumatic brain injury includes hospital discharge and home observation unless you have an abnormal examination or imaging.
However, you should return to the hospital if you develop decreased consciousness, deteriorating mental function, seizures, headaches, confusion, or vomiting.
Many mild TBIs heal within several weeks or months; however, you may have ongoing symptoms requiring time off from work or light-duty restrictions for 18 months or more after the accident. Prolonged disability after a mild TBI is known as post-concussion syndrome.
Moderate Traumatic Brain Injury
Moderate TBI is a catastrophic injury requiring hospitalization and the potential for long-lasting disability affecting your ability to care for yourself. Approximately ten to 20 percent of patients with brain injury presenting to emergency departments have moderate traumatic brain injury.
Signs and symptoms of moderate traumatic brain injury include the following:
- Unconsciousness lasting from 30 minutes to 24 hours
- A GCS score from nine to twelve
- Abnormal neuroradiology findings
- Seizures
- Convulsions
- Headaches that do not respond to over-the-counter medication or decrease in severity over time
- Loss of vision in one or both eyes
- Frequent vomiting or nausea
- Slurred speech
- Word-finding difficulties
- Difficulty waking up from sleep
- Pupil enlargement (dilation) in one or both eyes
- Intermittent loss of consciousness lasting a few minutes to hours
- Increased restlessness and confusion
- Clumsiness
- Memory loss from one to seven days (or more)
- Long-term emotional impairment (including inappropriate social behaviors)
- Muscle weakness
Observation is the main task during the initial hospitalization for moderate TBI; Intra Cranial Pressure (ICP) monitoring, intubation, or mechanical ventilation are usually unnecessary.
After your condition stabilizes in the hospital, your medical team may transfer you to a rehabilitation hospital or skilled nursing home to work on regaining basic skills. Then you will receive a home discharge and continue to follow up with your treating neurologist for medication and referrals to other medical providers.
As for the prognosis after a moderate traumatic brain injury:
One study found that almost 80 percent of moderate TBI victims had moderate-to-severe disability two weeks post-injury, meaning they needed help with basic activities of daily living. And by 12 months post-injury, roughly 75% could function at home independently for at least eight hours per day.
Other studies, however, show that moderate TBI can cause permanent disability.
In our experience, moderate TBI survivors who return to work can still not return to their pre-injury job. Instead, they take a part-time or less physically or mentally demanding position.
Therefore, you must seek treatment as soon as possible to give yourself the best chance of healing after a moderate TBI.
Severe Traumatic Brain Injury
Death or a coma (vegetative state ) are real possibilities with severe TBIs.
These injuries, often resulting from penetrating head injury or a crushing blow to the skull in a car crash or industrial accident, rip, crush, and shear brain tissue.
Signs and symptoms of severe traumatic brain injury include the following:
- Unconsciousness lasting 24 hours or longer
- A GCS score from three to eight
- Abnormal neuroradiology findings
- Memory loss lasting more than seven days
- Clear fluid (cerebrospinal fluid) draining from the nose or ears
- Impaired airway protective reflexes
- Swelling behind the ears or near the eyes
- Increased ICP
- A need for oral intubation
- Seizures
- Trouble communicating
- Difficulty learning skills
- Sadness and depression
- Impulse control problems
- Agitation
Recovering from severe TBI is tough.
The initial hospitalization may last months and involve brain surgery to reduce swelling, remove hematomas, and decrease pressure in the skull.
Then you may need speech, physical, occupational, vision, and cognitive therapy in an assisted living facility.
In addition, vocational and psychiatric counseling for PTSD and depression is standard in severe traumatic brain injury survivors.
Helping Accident Victims with Traumatic Brain Injury of All Degrees of Severity
Every traumatic brain injury is different.
And every TBI can change your life, regardless of its classification level.
If you suffered head trauma that changed your mental status or caused you to lose consciousness, seek medical attention immediately.
And then call my law firm to evaluate your legal rights.
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