Navigating the diagnostic gray area of TBI

Personal Injury LawExpert Witness InsightsNeurological Injury Assessment
Written By Brianna Rauchman

By: Steven H. Rauchman, MD

Traumatic brain injuries (TBIs) can dramatically alter a person’s life—and the legal cases surrounding them are often just as complex. For personal injury and civil litigation attorneys, understanding the nuances of mild traumatic brain injury (mTBI) diagnosis is essential for building a compelling case. While TBIs are frequently referenced in legal proceedings, they are notoriously difficult to define, diagnose, and quantify.

How do traumatic brain injuries manifest?

A traumatic brain injury occurs when an external mechanical force—such as a blow to the head, neck, or face—causes disruption in normal brain function. This primary injury often results in immediate neurological impairment, ranging in severity and symptom type. In mild TBI cases, the most common symptoms include:

  • Headache

  • Dizziness

  • Nausea

  • Poor concentration

More severe TBIs can present with aphasia, seizures, memory loss, behavioral disturbances, or even coma. These symptoms typically emerge within seconds to minutes of the incident, but their duration and impact can vary significantly.

The Glasgow Coma Scale (GCS): legal utility and limitations

he Glasgow Coma Scale (GCS) is the most widely used tool to assess TBI severity. It evaluates three areas of neurological function—eye response, verbal response, and motor response—and assigns a combined score:

  • Mild TBI: GCS 14–15

  • Moderate TBI: GCS 9–13

  • Severe TBI: GCS 3–8

Despite its broad use, the GCS has well-documented limitations in clinical and legal contexts. There remains considerable debate over how to classify a score of 13, with some experts categorizing it as mild and others as moderate TBI. This lack of consensus can complicate courtroom testimony and influence the valuation of a claim.

Key challenges in TBI diagnosis for legal cases

Attorneys representing clients with brain injuries must be aware of several diagnostic challenges that can affect the strength of their case:

  • Inconsistent clinical evaluation: TBI diagnosis can vary depending on the clinician, the tools used, and the timing of the assessment.

  • Symptom variability: There is no universal agreement on which TBI symptoms most accurately reflect injury severity, particularly for mild traumatic brain injury.

  • Diverse outcomes: Patients with similar GCS scores may experience different recovery trajectories due to genetic factors, mechanism of injury, and secondary injury responses—including biochemical processes that worsen the initial trauma.

What this means for legal practice

For legal professionals, these diagnostic challenges reinforce the importance of working closely with qualified medical experts who understand the nuances of TBI. Accurate documentation, comprehensive neurological evaluation, and expert testimony can be pivotal in:

  • Establishing causation

  • Proving damages

  • Explaining long-term prognosis to a judge or jury

Given the complexity of TBI, a surface-level diagnosis may not fully capture the extent of a client’s impairment. Attorneys should be prepared to advocate for in-depth assessments and be vigilant in translating medical uncertainty into a compelling legal narrative.

Ready to strengthen your TBI case?

Partnering with a qualified TBI expert witness can be the key to clearly establishing injury severity and securing a favorable outcome. If you're handling a case involving traumatic brain injury and need expert insight into diagnosis, prognosis, or symptom variability, I am here to help.

Brianna Rauchman