Changes Needed in Diagnosing Brain Injury

Changes in Procedure Needed in Diagnosing Brain Injury

By Gordon S. Johnson, Jr.

Improving the diagnosis of brain injury is one of the purposes of my life. Since I am not a medical professional, that might seem misplaced.  But the internet has allowed my words of brain injury advocacy to reach many millions of users. In contrast, the best selling brain injury books sell only a few thousand. Further, I am the survivor of a moderate brain injury, a brain injury that went undiagnosed.  Thus, I continue to feel I must try to make a difference.

Changes are needed to improve the diagnosis of brain injury, particularly mild brain injury in the Emergency Room. Key to improved diagnosis is next day followup with those who are injured and detailed inquiry into amnesia, both on the day of injury and the next day. When the brain injury diagnosis is missed in the first 30 hours, the time to intervene may be lost. The best tool for increasing the diagnosis of brain injury in the first 30 hours is to improve the inquiry into the way the brain is saving memories. Thus, we will start our treatment of diagnosing brain injury, with a discussion of amnesia.

Better diagnosis starts with amnesia not because it is the most permanent of conditions, but because it is the most transient. Identifying amnesia’s existence is the single most important step in identifying the severity of all brain injuries and helps to distinguish the disabling brain injury diagnosis, from a concussion.   Amnesia is the clue that the injured brain is losing the memories because something is wrong with the save button.

But if we think about the brain strictly as a desktop computer, we will not miss the subtleties of amnesia.  Unlike a computer, the brain can save islands of memory, in seas of amnesia. The brain’s Save Button, the hippocampus, is not an all-or-nothing process.  Physiological and emotional processes around the time of an event may be able to force the memory through a bottle neck of cognitive inefficiency.  Some things may be remembered and others not.

Our treatment of diagnosing brain injury will focus on how the brain functions to aid in understanding how brain injury pathologically changes brain function. Our teaching will then focus on diffuse brain injury, primarily injury to the brain’s white matter, the brain’s axonal tracts.

Understanding Focal Injury – the Big Stuff

Other pages on have focused on severe brain injury.  That is zeroing in on the “big stuff”, as focal brain damage affects large and specific brain structures. But the mild brain injury actually affects significantly more people than severe brain damage. There are 50,000 severe brain injuries a year in the United States in contrast to millions and millions of mild TBI’s. If only 10% of those have mild brain injury that persists, that is several times more disability than results from severe brain injury. Though the initial injury may be less life threatening, the nature of the disability may impact future function as greatly as many severe brain injuries do.


Gordon Johnson

Attorney Gordon Johnson is one of the nations leading brain injury advocates. He is Past-Chair of the TBILG, a national group of more than 150 brain injury advocates. He has spoken at numerous brain injury seminars and is the author of some of the most read brain injury web pages on the internet.

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