Traumatic Brain Injuries

Motor vehicle crashes are among the leading causes of traumatic brain injury in the United States, according to the CDC, and the leading cause of TBI-related death among young adults. A TBI does not require striking the head: rapid acceleration and deceleration can injure the brain inside the skull. California’s high-speed freeway crashes, pedestrian collisions and motorcycle crashes produce the full spectrum, from concussions that resolve in weeks to severe injuries requiring lifelong care.

How crashes cause brain injury

• Contact injuries: the head strikes the window, pillar, steering wheel or ground, causing bruising (contusion) and sometimes skull fracture or bleeding.
• Acceleration injuries: the brain moves within the skull during sudden deceleration, stretching and shearing nerve fibers (diffuse axonal injury) even without contact.
• Coup-contrecoup: injury at the point of impact and on the opposite side as the brain rebounds.
• Bleeding: subdural and epidural hematomas and subarachnoid hemorrhage, which can develop over hours and are the reason emergency departments observe head-injured patients.

Severity classification

Clinicians classify TBI as mild, moderate or severe using the Glasgow Coma Scale, the duration of loss of consciousness and the duration of post-traumatic amnesia. “Mild” TBI—concussion—accounts for the large majority and is discussed separately on our concussions page. The label describes the initial presentation, not the outcome; a meaningful minority of “mild” injuries produce persistent symptoms, and moderate and severe injuries commonly cause permanent deficits.

Why normal imaging does not rule out TBI

CT scans in the emergency department detect bleeding and fractures that need surgery. They do not show diffuse axonal injury or the microscopic damage underlying most persistent symptoms. Standard MRI is more sensitive but can also be normal. Diagnosis of mild TBI is clinical, based on the mechanism, immediate symptoms (confusion, amnesia, loss of consciousness) and the pattern of later symptoms. Neuropsychological testing documents cognitive deficits objectively. Insurers frequently equate a normal CT with no brain injury; medicine does not.

Symptoms and long-term effects

• Headaches, dizziness, sensitivity to light and noise, sleep disturbance.
• Memory problems, slowed processing, difficulty concentrating and multitasking.
• Irritability, depression, anxiety and personality changes noticed by family.
• Fatigue and reduced tolerance for work and social activity.
• In moderate and severe injury: motor deficits, speech and language problems, seizures, and the need for supervision or care.

Trauma care in California

Severe head injuries are routed to designated trauma centers. Level I centers in the region include LAC+USC, Ronald Reagan UCLA, Cedars-Sinai and Harbor-UCLA in Los Angeles County; UCI Medical Center in Orange; Loma Linda University Medical Center in the Inland Empire; and UC San Diego Health Hillcrest in San Diego. Rehabilitation after serious TBI often continues at specialized facilities such as Rancho Los Amigos in Downey or Casa Colina in Pomona. The trauma and rehabilitation records are the backbone of a serious TBI claim.

What a TBI claim involves

Serious brain injury claims require evidence beyond medical bills: neuropsychological evaluation, life-care planning for future needs, vocational analysis of lost earning capacity, and testimony from family and co-workers about changes in the person. Damages routinely exceed the at-fault driver’s policy limits, making every potential source—underinsured motorist coverage, employer liability, commercial policies, public entity liability—important. California places no cap on compensatory damages in motor vehicle injury cases. Children with TBI need particular care in settlement, since deficits may not become apparent until later developmental stages and minors’ settlements require court approval.

Collisions that commonly cause TBI

Pedestrian and motorcycle collisions, head-on and T-bone crashes and truck collisions produce the most serious brain injuries. See also our Los Angeles brain injury page.

Local guides

City-specific pages for traumatic brain injuries in California.

Common questions

I never lost consciousness. Can I have a brain injury?

Yes. Loss of consciousness is not required for concussion or more serious TBI. Confusion, not remembering the crash, or feeling “dazed” are sufficient indicators of a brain injury mechanism.

My CT scan was normal but I still have headaches and memory problems months later. What should I do?

Ask your physician for referral to a neurologist or a concussion clinic and for neuropsychological testing. Persistent symptoms after concussion are recognized and treatable; documenting them objectively matters for both care and any claim.

How is a TBI claim different from other injury claims?

It depends more on expert evidence (neuropsychology, life-care planning, economics), on lay witnesses who knew the person before and after, and on future needs. It also takes longer, because the trajectory of recovery must be understood before the claim can be valued.

Sources and official resources

• CDC — traumatic brain injury and concussion
• NINDS — Traumatic brain injury

Links go to official government, court and public-health sources. Laws change; verify current text before relying on it.