Loss of Consciousness: Myths and Misunderstandings about Brain Injuries

There are multiple myths and misunderstandings about loss of consciousness and brain injuries.  After virtually any head trauma, ambulance or emergency room staff will ask the injured person if they have had a loss of consciousness (abbreviated “LOC” in the medical records), and the injured person will often say “no.”  Many emergency medical technicians will record a Glasgow Coma Scale that relates to a person’s level of consciousness after a trauma such as a motor vehicle crash.  Insurance companies and their lawyers almost always ask an injured person if they lost consciousness.

Asking a person who has suffered a brain injury if they lost consciousness is similar to asking a moviegoer if they saw the entire movie.  The moviegoer experiences the movie as a continuous whole, and is unaware of sections of the movie that the editors have deleted from the film.  A person who has lost consciousness is often unaware of that fact, or unsure whether that happened or not.  Someone whose next memory after a crash is becoming aware of a hospital room can figure out that they lost consciousness.  Someone whose next memory is minutes after a crash often is unaware that minutes passed and that there are events missing from their memory.  Simply stated, we have no memory of what we do not remember.  In one of our recent trials, the injured person was not sure if he lost consciousness, while the Good Samaritan who stopped to offer assistance knew that the injured person was unconscious for about ten minutes after they arrived at the scene.

The Glasgow Coma Scale (GCS) is a scoring system scale from 3 to 15 that was intended to classify level of consciousness based on eye opening response, verbal responses, and motor responses, but later became used to classify brain injuries as mild, moderate, or severe.  One problem is that a person’s GCS score may improve significantly between the time of the injury and the time the ambulance crew makes an assessment.  Immediately after a crash, a person whose eyes open to pain only, has no verbal response, and has motor responses to painful stimuli only, would have a GCS of 5-6, which would be rated as a “severe” head injury.  By the time they are assessed, that same person may by then have spontaneous eye opening, be confused but can answer questions, and can obey movement commands, for a GCS of 14, which would be rated as a “mild” head injury.  Not surprisingly, medical studies have shown that GCS scores have limited value in predicting individual outcomes.  While people with lower GCS scores tend to do worse, many people with GCS scores of 14-15 have permanent brain damage. 

Insurance company adjusters often ask an injured person after a crash if they lost consciousness.  They know that injured people often say “no” because they do not know, and that a “no” answer minimizes the seriousness of the injured person’s claim.   There is a common belief that if a person did not lose consciousness, they could not have suffered a brain injury, or at least not a serious one.  Medical definitions do not agree; a brain injury may cause an alteration in consciousness without a loss of consciousness.  Perhaps the most famous brain injury patient in American history, one studied by every medical student, never lost consciousness.  Phineas Gage was working on a railroad construction project when an explosive charge accidentally detonated, slamming an iron rod through his skull, through his brain, which came out of the other side of his skull.  Mr. Gage remained conscious throughout his ordeal. After his brain injury, his personality and behavior were dramatically changed, and he died just 11 years later at age 36 after suffering a series of seizures.