Is there such a thing as “late-onset” Traumatic Brain Injury (TBI)?

Our Answer:

We just completed a head injury case that hinged on the fact that for the first 12 months after the accident the client had no reports of TBI symptoms in the voluminous medical records.

Defense doctors & attorneys opined that since there were no notes regarding TBI until 12 months after the injury, the TBI symptoms observed by doctors and reported by the client were not injury related. 

We opined rather that the client sustained an immediate TBI in the accident and we further opined there were at least two medically reasonable explanations to justify the lack of notes during the first 12 months of medical evaluation and treatment.

It must be understood the client was a very high functioning person. The client was a Ph.D. chemist in a very responsible job. He was engaged to be married. He had several close relationships. He was doing well financially, owned his own home and enjoyed outdoor activities & some hobbies.

Recent medical literature reports it is not uncommon for a patient to under report cognitive loss in the days, weeks or even months after a traumatic brain injury. In fact, patients can be so confused by TBI symptoms that they do not report them to their health care professionals. There is excellent evidence in the medical literature both patients and doctors may misconstrue TBI symptoms and patients often underreport symptoms as the symptoms are alien to them. It was our opinion the client was unable to articulate his symptoms immediately after the accident and for some months thereafter. As noted, these kinds of symptoms can be confusing to the patient and are easily misinterpreted by patients and doctors alike.

The plaintiff attorney got eyewitness accounts from the client’s (now former) fiancé and close friends reporting the client’s obvious impaired behavior, drastic personality change, history of poor work performance (including getting fired from a job he had for years) and behavioral symptoms that started immediately after the accident. To a trained clinician, these reports could only be interpreted as evidence of TBI starting immediately after the accident.

Late-onset TBI symptoms also account for the 12-month absence of brain injury notes. There is, in fact, medical literature to support the presentation of late-onset symptoms.  Symptoms such as noise sensitivity, problems with concentration and memory, irritability, depression, anxiety, fatigue and poor judgment may be called late symptoms because they generally do not occur immediately after the injury, but rather present days or weeks and in some cases even months after the accident. The medical literature discusses the role of past medical history, injury-related, environmental and personality factors that contribute to late-onset symptoms. 

In summary, it was our opinion the client was unable to clearly articulate his TBI symptoms for the first year after his head injury. The client’s TBI symptoms, however, were evident in his behavior, his mood disorder and general low level of functioning immediately after the accident. He could not carry on with his “normal” life which was dependent upon his full intelligence, social skills, level of education and high level of executive functioning. In addition, the client presented with late-onset symptoms as part of his head injury. The combination of these two factors made it appear as if the client had no immediate symptoms after the accident but rather a progressive course of central nervous system symptoms starting 12 months after the accident. The only thing that was “progressive” was his doctors slowly dawning understanding that this client had indeed sustained an immediate head injury in the accident.

It is critical to note, the report of symptoms in the medical record was “late”, however the onset of the client’s symptoms was immediate.

Unfortunately, this kind of presentation is seen all too often in traumatic brain injured patients. If you are worried that your client may have suffered a traumatic brain injury, please contact me to discuss your case.