Traumatic Brain Injuries Without Skull Fractures

A traumatic brain injury does not require a fractured skull. In fact, some of the most serious traumatic brain injuries occur without any visible damage to the skull. A person can suffer a concussion, contusion, diffuse axonal injury, or another form of brain trauma even when the skull appears completely intact on imaging. This fact can make these injuries particularly difficult to recognize and document. A person involved in a car accident, bicycle crash, pedestrian accident, fall, or other traumatic event may initially appear alert and capable of communicating while still having suffered a significant brain injury. Symptoms may emerge or worsen over hours, days, or even longer.

At Kalfayan Merjanian, LLP, our California personal injury trial lawyers represent people who have suffered traumatic brain injuries and understand that the absence of a skull fracture does not mean that an accident caused only minor injuries. Proper diagnosis, medical documentation, and evaluation of the injury’s long-term consequences are essential when pursuing compensation.

Can You Have a Brain Injury Without a Skull Fracture?

A skull fracture and a traumatic brain injury are separate conditions. The skull is designed to protect the brain, but the brain can be injured when the head experiences a sudden impact, acceleration, deceleration, rotation, or other force. The brain can move within the skull, causing stretching, shearing, bruising, or other damage to brain tissue. Consequently, a person can have a significant TBI even when X-rays or other imaging do not show a fractured skull. This distinction is important after accidents because people sometimes assume that a normal CT scan or the absence of a fracture means that there is nothing seriously wrong. That conclusion is not necessarily medically justified.

What Is a Concussion?

A concussion is generally considered to be a form of mild traumatic brain injury. It can result from a blow to the head or from a force that causes the head and brain to move rapidly. A concussion does not necessarily involve loss of consciousness. Someone can remain awake and talking throughout an accident and still sustain a concussion. Symptoms may include headache, dizziness, confusion, nausea, sensitivity to light or noise, fatigue, memory problems, difficulty concentrating, balance problems, and changes in mood or sleep. Most people with concussions improve over time. However, some experience persistent symptoms that interfere with work, school, relationships, and daily activities.

Is Every Concussion a Minor Injury?

The term “mild traumatic brain injury” can be misleading because “mild” generally refers to the initial clinical classification of the injury rather than the person’s eventual experience or prognosis. A concussion can produce symptoms that persist for weeks, months, or longer. Some individuals develop persistent post-concussive symptoms that affect cognitive function, physical comfort, sleep, and emotional well-being. A person’s ability to walk, talk, or perform basic tasks shortly after an accident does not necessarily establish that the brain injury was insignificant.

What Is the Spectrum of Concussion Injuries?

Concussions exist on a spectrum. One person may experience a relatively brief headache and dizziness and recover quickly. Another may experience persistent headaches, cognitive difficulties, fatigue, memory problems, balance issues, anxiety, or sensitivity to light and noise. Symptoms can also fluctuate. Someone may feel better one day and experience significant symptoms the next, particularly when attempting to return to demanding physical or cognitive activities. The impact on an individual’s life is therefore more important than simply labeling an injury as a “mild” TBI.

What Is a Traumatic Brain Contusion?

A cerebral contusion is essentially a bruise of brain tissue. It can occur when the brain strikes the inside of the skull during an impact. Contusions may occur without a skull fracture. Depending on their location and severity, they can cause headaches, confusion, neurological deficits, seizures, or other symptoms. More serious contusions can involve bleeding and swelling within the brain, potentially requiring close monitoring, hospitalization, or surgery.

What Is a Diffuse Axonal Injury?

Diffuse axonal injury, or DAI, is a particularly serious type of traumatic brain injury associated with rapid acceleration, deceleration, or rotational forces. The brain contains long nerve fibers called axons that transmit signals between different areas of the brain. Severe forces can stretch or tear these structures, disrupting communication throughout the brain. DAI can occur without a skull fracture and may not be obvious on conventional imaging. In severe cases, diffuse axonal injury can cause prolonged unconsciousness, coma, profound cognitive impairment, physical disability, or death.

Is Diffuse Axonal Injury Hard to Detect?

DAI can be challenging to diagnose because the injury involves microscopic or microscopic-scale disruption of axons rather than necessarily producing a large, obvious structural abnormality. A conventional CT scan may therefore fail to reveal the full extent of the injury. MRI and other neurological assessments may provide additional information, depending on the circumstances. The clinical picture also matters. A neurologist or other qualified medical professional may consider the mechanism of the accident, the person’s neurological symptoms, level of consciousness, examination findings, and imaging results when evaluating a possible diffuse axonal injury.

Can a Normal CT Scan Rule Out a Brain Injury?

A CT scan is an important diagnostic tool, particularly for identifying certain types of bleeding, swelling, and other acute problems. But a normal CT scan does not necessarily rule out a concussion or other traumatic brain injury. Some forms of brain injury are functional or microscopic and may not appear clearly on conventional imaging. This is one reason a person who continues experiencing neurological symptoms after an accident should follow up with appropriate medical professionals even if initial imaging was described as normal.

What Symptoms Can Occur After a TBI?

Symptoms vary depending on the type and severity of the injury. Physical symptoms can include headaches, dizziness, nausea, balance problems, sensitivity to light or noise, visual disturbances, and fatigue. Cognitive symptoms may include difficulty concentrating, memory problems, slowed thinking, difficulty finding words, and problems processing information. Emotional and behavioral changes can include irritability, anxiety, depression, mood swings, impulsivity, or changes in personality. Sleep disturbances are also common after traumatic brain injuries. Importantly, symptoms may not all appear immediately after the accident.

Why Are TBI Symptoms Sometimes Delayed?

Immediately after an accident, adrenaline, pain, shock, and the circumstances of the event can make it difficult for a person to recognize changes in cognitive or emotional functioning. Some symptoms can also develop as swelling or other physiological effects evolve. A person may initially tell emergency responders that they feel fine and later develop headaches, dizziness, confusion, memory problems, or other symptoms. That possibility makes medical evaluation important after a significant head impact or other event capable of producing a traumatic brain injury.

Can a TBI Affect a Person’s Personality or Behavior?

Depending on which areas of the brain are affected, a traumatic brain injury can contribute to changes in mood, behavior, impulse control, emotional regulation, or personality. These changes can be particularly difficult for family members to understand because the injured person may look physically healthy while behaving very differently from before the accident. In more serious cases, cognitive and behavioral changes can interfere with employment and relationships and may require long-term neurological, psychological, or rehabilitative care.

Can a Brain Injury Affect Someone’s Ability to Work?

A person does not have to be physically disabled to experience significant employment consequences from a TBI. Memory problems, reduced concentration, slower processing speed, fatigue, headaches, difficulty multitasking, and emotional changes can interfere with even highly skilled professional work. Someone may be capable of performing basic tasks but unable to maintain the same productivity, hours, responsibilities, or career trajectory as before the injury. For a catastrophic or permanent TBI, these effects can substantially reduce future earning capacity.

How Are Traumatic Brain Injuries Documented?

Medical documentation is particularly important when there is no skull fracture or obvious structural injury. Medical records may document the mechanism of the accident, symptoms reported at the scene or emergency department, neurological examinations, imaging studies, diagnoses, treatment recommendations, and changes in symptoms over time. Follow-up care can also establish how symptoms affect the person’s daily life. For example, documentation showing persistent headaches, cognitive problems, missed work, difficulty completing familiar tasks, or changes observed by family members may help demonstrate that the injury had consequences beyond the immediate aftermath of the accident.

What Evidence Can Help Prove a TBI After an Accident?

Medical evidence is only one component of a TBI case. Other valuable evidence may include accident-scene photographs, surveillance or dash-camera footage, eyewitness accounts, police reports, vehicle damage, medical records, imaging, neuropsychological testing, employment records, and testimony from family members or coworkers. Evidence about the person’s functioning before and after the accident can also be important. A person who was consistently working full time, managing a household, and participating in normal activities before an accident may have a very different level of functioning afterward.

What Compensation Can Be Available for a TBI?

A traumatic brain injury can result in both economic and noneconomic damages. Economic damages may include emergency treatment, hospitalization, rehabilitation, medications, therapy, future medical care, and lost income. For a permanent injury, the claim may also involve diminished future earning capacity and the cost of long-term assistance or specialized care. Noneconomic damages, meanwhile, may include physical pain, emotional distress, cognitive impairment, loss of enjoyment of life, and other consequences recognized under California law. The potential value of a TBI claim depends heavily on the severity and permanence of the injury and its effect on the person’s life.

What Effect Does the Absence of a Skull Fracture Have on an Injury Claim?

The absence of a skull fracture can sometimes lead insurance companies or other parties to underestimate the seriousness of a traumatic brain injury. But the skull is only the outer protective structure. The brain itself can suffer substantial injury from forces that leave the skull intact. A thorough investigation should therefore focus on the actual neurological injury and its consequences rather than treating the presence or absence of a fracture as a measure of severity.

Contact Kalfayan Merjanian, LLP

A traumatic brain injury does not have to leave a visible mark on the skull to have lasting consequences. Concussions, cerebral contusions, diffuse axonal injuries, and other TBIs can occur without a skull fracture and may affect memory, concentration, behavior, physical functioning, employment, and quality of life. Kalfayan Merjanian, LLP represents people throughout California who have suffered traumatic brain injuries and works to investigate both the cause of the injury and its long-term effects. Contact Kalfayan Merjanian, LLP today to discuss your injury and learn about your legal options.