Proving a Mild TBI: Legal Strategies When Symptoms Don’t Show on Imaging

Mild traumatic brain injuries (mTBIs) present one of the most challenging areas of personal injury law. Unlike moderate and severe TBIs, which often show clear abnormalities on CT scans or standard MRI, mild TBIs frequently produce symptoms without visible imaging findings. Yet their impact can be significant—affecting memory, attention, mood, balance, and overall quality of life. For attorneys, the question becomes: how do you build a compelling case when the injury is essentially invisible? Effective legal strategy requires a combination of medical insight, expert testimony, thorough documentation, and a clear narrative that links the mechanism of injury to the client’s lived experience.

Understanding Why Imaging Often Appears Normal

Standard imaging is designed to detect major structural damage, not the subtle cellular or microstructural changes associated with mTBI. Diffuse axonal injury—one of the most common mechanisms of mild TBI—may not appear on CT or routine MRI despite causing significant cognitive or emotional symptoms. Educating the court and jury on this medical reality is the first strategic step. Attorneys often rely on medical experts to explain why a normal scan does not rule out a brain injury and how the brain can be injured at the microscopic level without leaving a detectable footprint.

Leveraging Advanced Neuroimaging and Testing

While traditional imaging may fall short, advanced modalities can strengthen the case. Diffusion tensor imaging (DTI), susceptibility-weighted imaging (SWI), and functional MRI (fMRI) can demonstrate microstructural changes, white matter disruption, or altered brain activity. Neuropsychological testing is equally important. A skilled neuropsychologist can document deficits in memory, attention, processing speed, and executive functioning—deficits that correlate strongly with mTBI even when imaging is unremarkable. Together, these tools create a medically supported picture of injury.

Expert Testimony Is Crucial

Because mild TBIs are invisible to the eye, expert witnesses play a central role. Neurologists, neuropsychologists, and neuroradiologists help establish diagnosis, explain symptom patterns, and connect the injury to the specific incident. Experts should be prepared to testify about the biomechanics of the injury—how whiplash, rotational forces, or impact can disrupt neuronal connections without causing bleeding or swelling. Their testimony also helps counter common defense arguments that the symptoms stem from stress, pre-existing conditions, or psychological factors.

Documenting Symptoms and Functional Changes

A strong mTBI case relies on detailed documentation from the earliest moments after the accident. Attorneys should gather:

• Emergency room records
• Reports of confusion, disorientation, or loss of consciousness
• Statements from family, coworkers, or friends noting behavioral changes
• Therapy notes and follow-up medical appointments
• Employment or academic records showing declines in performance

These real-life observations reinforce the presence and severity of cognitive changes, providing a timeline that supports causation.

Establishing a Clear Before-and-After Narrative

Perhaps the most persuasive tool in an mTBI case is the personal story of the client. Jurors respond strongly to clear comparisons between the client’s life before the injury and the challenges they face now. Demonstrating changes in personality, cognitive ability, or daily function helps humanize the medical testimony and shows the true impact of the injury.