The Problems with Misdiagnosis or Missed Diagnosis
Evidence of minor cerebral injury is typically absent from the standard neurological examination, CT scans, and standard EEGs. But . . . absence of evidence is not always proof of absence.
Neuropsychology has been previously discussed as an important component in the comprehensive evaluation of the MTBI individual. Studies have shown that despite evidence of brain damage in 31% of admitted MTBI cases only 3% were referred for a neuropsychological evaluation.
In most first-time MTBI's, the immediate symptoms will often resolve themselves within three months. However, it can be expected that when MTBI is undiagnosed, misdiagnosed, or ignored, a lingering nightmare can unfold. Individuals with repeated MTBI also have an increased potential for persistent symptoms. Without appropriate treatment these individuals will experience:
- Functional difficulties when trying to return to previous living patterns
- Depression and anxiety, which has an impact on the person's capacity to function
- A tendency to isolate and significantly limit themselves to the comfort of familiar surroundings and routines
- Activity avoidance
- Estrangement from his/her spouse, children, family, and friends. Tempers flair, fears build, and the family structure may gradually deteriorate
- An increased frequency of anger at "the system." This includes physicians and insurance personnel who are not knowledgeable and, therefore, are not providing education or guidance as to appropriate assessment and beneficial treatment
- Suicidal ideations and attempts
- Problems with the law
- A tendency for re-injury
A return to the normal patterns of daily life and safe, independent living requires a practical, individualized application of therapeutically-based treatment. This includes the assessment and reestablishment of structured routines in daily activities, community involvement, marriage/family dynamics, educational activities, and vocation.
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