MILD TRAUMATIC BRAIN INJURY AND THE FAMILY PHYSICIAN

From an article published in the July 2000 edition of The Verdict

by Michael Slater

One of the most difficult problems for lawyers involved in the presentation of MTBI cases is that some physicians are unfamiliar with MTBI. Johann Wolfgang von Goethe said, "We see what we look for. We look for what we know." If the physician doesn't know what to look for it is hardly surprising that he doesn't find it. Dr. Bernard makes the following observation in the preface to his book, Closed Head Injury: A Clinical Sourcebook published in 1994:

After spending many years in an active metropolitan academic neurologic practice, the author noted that many of his patients had characteristic histories and symptoms that appeared in patterns and formed a symptom complex...

Closed head injury was a single common denominator with these patients...

Mild to moderate head injury with post-concussion syndrome was a condition the symptom patterns revealed...

Medical schools do not teach the concept of mild to moderate head injury and many physicians do not understand the problem today.

If the doctor doesn't recognize a MTBI, what is the lawyer to do? If the lawyer does recognize that his client is suffering from symptoms consistent with a MTBI, the family physician will not always appreciate being educated by the lawyer.

The presentation of these cases before Judges and juries has been assisted in the last year by the attention given to sports related concussions in the media. The sports pages have been filled with stories of major sport figures forced to retire from their sport after experiencing a concussion or mild traumatic brain injury (MTBI). One such victim was described in an article in the November 19, 1999 edition of the Vancouver Sun:

Geoff Courtnall, unable to shake the effects of post-concussion syndrome after a month-long layoff, retired from the St. Louis Blues on Thursday.

Surrounded by family and teammates at a somber news conference, Courtnall, 37 broke down and cried.
...

Courtnall had ...missed most of the last two seasons due to concussions. He signed a three-year $10.5 million extension in 1998 after leading the team with 31 goals the previous season, but has played in only 30 games the last two seasons. Before giving up, Courtnall said he tried cranial massage, acupuncture and dietary and sensory treatment along with conventional rehabilitation. None of it worked.

Courtnall sustained his second concussion in less than a year on Oct. 16, when Toronto defenceman Bryan Berard elbowed him on the chin. After more than a month off, Courtnall, who had two goals and two assists in six games this season, said he still had concussion-related symptoms.

"Some days are hard, other days I don't feel so good," Courtnall said. "I still have headaches and some dizziness."

Last season, Courtnall suffered from exercise-induced headaches, nausea, dizziness and vision problems during a 58-game season.

In an article in the May 30, 2000 edition of The Vancouver Sun, Gary Mason describes the pain of Brett Lindross, who had earlier retired from hockey as a result of a brain injury, watching the same thing happen to his brother Eric:

You were a rising star with the New York Islanders. But you got hit a few too many times, just like your older brother, and had to call it a career after 51 games.

You had watched your older, more famous brother, cry when he talked about your injury-shortened career. Now you were the one who felt like crying.

Since leaving hockey you had become a national advocate for brain safety in sport. You were an expert on concussions. You knew what the studies said about the long-term effects of bruising to the brain:

• Poor concentration, attention, and memory; Difficulty with judgment and decision making; Sporadic bouts of dizziness; Emotional/behavioural outbursts; Constant fatigue;
• Depression

You also knew that brain injuries are for life. That is why you are so worried for your brother.

These stories and the television coverage surrounding the "hits" to Donald Brashear and Eric Lindross have increased the public's awareness and acceptance of the significance of concussive injuries.

Now it is time to educate of the family physician. An article just published in the May 2000 edition of The Canadian Journal of Diagnosis will do just that. The article, "Cracking Down on Mild Head Injury" was authored by Dr. Michel Rathbone, a neurologist and full professor of medicine at McMaster University. The article was intended as "a practical approach, for the family physician, towards the diagnosis of mild head injury and post-concussion syndrome." The Journal reaches the majority of family physicians in Canada.

The article is reproduced with the permission of Dr. Rathbone and The Canadian Journal of Diagnosis.

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