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“I’m fine”: the pervasive impact of undetected ‘subtle’ brain injuries

Posted: 15/03/2021

Suffering in silence

For those Friends fans reading, as we all know from Ross’ hysterical declaration that he is ‘fine’ (upon discovering that Rachel is dating Joey), being ‘fine’ is usually an indication that someone is precisely the opposite.

It has been impossible to avoid media coverage of the recent Oprah Winfrey interview of Prince Harry and Meghan Markle. In this interview, Meghan spoke candidly about the silent struggles she has faced with her mental health and on the dangers of assuming that someone is happy and healthy because they look, dare we write it, ‘fine’.

How true Meghan’s words also ring for many individuals suffering with ‘subtle’ brain and head injuries. A ‘subtle’ traumatic brain and head injury results from an injury to the head, many of which go undetected, undiagnosed and unseen and can have devastating and life changing consequences for those affected.

A lack of detection and diagnosis combined with no visible signs of injury makes living with such an injury very difficult, where there is no insight into the reason for changes in brain function, character and personality. Without insight or understanding, the injured person (and their loved ones) can feel frustrated and confused, perhaps even blaming themselves for not coping with life, whilst presenting a façade of being ‘fine’: a recipe for disaster.    

Undiagnosed and undetected

Upon presentation to Accident & Emergency following an accident, the most visibly acute injuries (such as broken legs or a punctured lung) are investigated first by the doctors and we can of course understand the necessity of doing so. In some cases, however, this can mean that a non-visible head injury goes undiagnosed and later symptoms are not connected to this incident. In other cases, those sustaining a head injury without other serious injuries may not seek medical advice on the basis of there being no visible injury.

Even when head injuries are investigated, the routine investigations undertaken are clinical assessment and, at best, a CT scan (which detects skull fractures and bleeding on the brain) and an MRI scan (which creates images of brain tissue to illuminate areas of damage).

Such scans are increasingly thought, by a significant number of neuroscientists, to be rudimentary in their ability to detect anything other than the most visible of brain injuries. Increasingly, there is a move to using DTI scanning, which creates far more detailed imaging of brain tissue and is believed capable of detecting more ‘subtle’ brain injuries.

Why ‘subtle’ – exploring the unknown?

The world of neuroscience is fast moving and the amount of information being gathered about the brain is growing at times, it seems, exponentially. However, accumulating information does not equate to understanding. The only consensus that seems to have been reached amongst neuroscientists in terms of understanding the brain is that, quite simply, we do not understand it.

With this in mind, there is an argument to be made that those ‘subtle’ brain injuries are so called more because we do not have scanning equipment capable of identifying such brain injuries, rather than because the word represents an accurate description of the often debilitating and life changing impact of such an injury. Perhaps in time, as detection and understanding of the brain and brain injuries continue to develop, subtle in the context of brain injury will become a redundant word.

Do I have a head injury?

From our experience of working with brain-injured clients, we know that brain injuries are unique to the person injured. However, there are some common symptoms that when manifesting together (or at least when a cluster of those listed are experienced) can be indicative of a subtle traumatic brain injury.

Below are ten of the most common symptoms associated with subtle brain injury and points to consider if you think that you or a loved one may be suffering from a brain injury:


Disinhibition is a lack of restraint that can be displayed in social settings following a head injury. This might include making inappropriate or even offensive comments to others when you would previously have been able to have controlled yourself.


It is normal to feel tired after a busy day. However, fatigue may be indicated if you have started to go to bed earlier regularly to deal with an increase in tiredness or you are finding it more difficult to get up on time.

Inability to organise and plan

Not all of us are gifted with skills of organisation, and that is not a problem: everyone has different strengths. However, some individuals are able to co-ordinate multiple diaries with ease and organise a busy work and home life schedule. Our clients will often report having lost this ability altogether, becoming easily confused over simple planning tasks, double booking themselves and getting disorientated by dates.

Covid-19 has hampered plans for everyone so it might be hard to identify if you or a loved one has been affected; perhaps you are hopeful of taking an elusive summer holiday this year but are finding the practicalities difficult to coordinate?


An increase in impulsivity can manifest itself in extravagant or unnecessary purchases or a disregard for money. Perhaps more importantly, ability to assess risk can be impaired, including when crossing the road or making outlandish and out of character life decisions, which can be dangerous.

Loss of concentration

We have acted for working professionals who were able to concentrate all day in high-pressured jobs before their accidents took place, who post-accident were not able to focus on a task for more than a few minutes before becoming distracted. Other clients have reported being unable to concentrate on reading or the TV post-accident, stating that they have been unable to focus and follow the storyline.

Loss of motivation

Often individuals with subtle brain injuries experience a total loss of motivation both in terms of their home life and at work, including a loss of interest in completing tasks or being seen to be doing well. Sometimes everyone feels a bit demotivated; think about if there has been a dramatic shift in this regard over a long period and you cannot explain why.

Memory difficulties and sequencing

A common symptom associated with subtle traumatic brain injuries is difficulties with short-term memory. We often represent clients who report having previously had a very good memory, who now cannot seem to retain information and this can be very confusing and frustrating. Individuals might develop a coping mechanism to assist them and to hide difficulties that they do not understand; this can lead to arguments with family members and friends, difficulty at work and missed appointments. We have clients who have reported leaving things in the oven or taps running and forgetting about them, which of course can be dangerous.

Changes in mood

Everybody experiences changes in their mood, even if pretending to be fine like Ross; this is perhaps especially so since Covid-19, and changed mood can be caused by myriad personal circumstances (as well as changes in hormones for women). However, more drastic mood swings, feeling depressed, explosive anger, uncontrollable tears, or a change in general demeanour over a longer period might be indicative of something more serious. Perhaps you have started to dramatically overreact or started feeling extremely overwhelmed in situations that previously would have been easy to manage?

Oversensitivity to light and noise

Finding the noise from the television to be suddenly painfully loud or the main lights in the kitchen and living room unbearable can be indicative of a subtle brain injury. We have experience of clients who started wearing sunglasses inside to cope, never turned the main lights on, are unable to watch or listen to the TV or can no longer stand the shouts of (their) playing children.

Stress and anxiety

Similarly to change in mood, Covid-19 has caused a spike in the numbers of people reporting feelings of stress and anxiety - although feeling stressed and anxious alone is not likely to be indicative of a brain injury. However, stress and anxiety is a common symptom associated with a head injury and so if you are suffering with this as well as some of the other symptoms, do not disregard it.

What to do next?

If you are feeling frustrated and confused about changes following an accident, but are finding it difficult to decide if the above applies to you, there might be someone close to you that you could ask for their thoughts; sometimes, those closest to us are able to identify changes in us better than we can ourselves. There may be a range of possible causes of your symptoms but it is important to seek medical attention if you are concerned you may have experienced a brain or head injury.

In our experience of dealing with brain injury claims, we have met and continue to meet individuals suffering in silence with undetected brain injuries. We are hopeful that as science continues to develop in this area, diagnosis and detection will improve.

If you are considering pursuing a brain injury claim, we would be willing to assess your options with you in an initial discussion with one of our specialist solicitors.

To see more of the team’s work, please follow us on Twitter @Penn_PIteam.

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