Finding Clarity After the Crash, Part 1: How a Concussion Happens, and How We Check for It

A patient guide from Dr. Verg Chiropractic, serving Vancouver, WA and Clackamas, OR

“You don’t have to hit your head to hurt your brain”

A concussion or mild traumatic brain injury occurs when rapid acceleration-deceleration forces cause the brain to shift rapidly inside the skull. Direct impact to the head is not required; the whiplash force vector alone generates sufficient linear and rotational shear strain across delicate neural pathways and blood vessels.

Dr. Verg explains it to patients this way: “We don’t have to hit our head or lose consciousness to hurt our brain. There are three ways people get a concussion. One is a solid object on the head. Next is an explosion: that vibration is so severe that it rattles the brain. It’s transfer of energy. The third way is coup-contrecoup, fast movement of the head on the neck. The brain is suspended in fluid, and it starts bumping against the skull.”

He also points out that many people lose consciousness for a moment without knowing it. When a patient remembers seeing the smoke from the airbag, that is a good sign they stayed conscious. “Many people don’t see the smoke, and they don’t even know that they’ve lost consciousness.”

Why is it called “mild”? The word refers to the score on the Glasgow Coma Scale that emergency teams use, not to how much the symptoms affect your life. A “mild” brain injury can still keep you off work for weeks and have permanent effects.

The signs we look for

In our office, these are the symptoms Dr. Verg treats as signs of a concussion after a crash:

• Feeling dazed, disoriented, “not myself,” or nauseous right after the crash
• Headaches, especially pressure headaches or headaches worse with screens and bright light
• Dizziness, unsteadiness, or feeling like you are “floating”
• Light and sound sensitivity, or blurry vision and trouble focusing the eyes
• Ringing or a plugged feeling in the ears
• Brain fog, slower thinking, slower reaction time, trouble finding words
• Forgetfulness: walking into a room and forgetting why, losing the thread of a conversation
• Irritability, anxiety, poor sleep, fatigue
• Nausea when driving or riding in a car

One patient, a nurse, noticed she was forgetting things at work after a rear-end crash. Dr. Verg explained why that matters: in a fight-or-flight moment, attention and memory should go up, so “the fact they are lower is abnormal and a sign of a brain dysfunction.”

Why brain fog and memory issues linger

It is common for collision survivors to feel frustrated when routine emergency room CT scans come back “normal,” yet persistent fatigue, delayed reaction times, and difficulty focusing continue for months. This cluster of lingering symptoms is often recognized as post-concussion syndrome (PCS).

• The scientific evidence: Dischinger et al. (2003) analyzed prospective data from the Crash Injury Research Engineering Network (CIREN) project published in the 47th Annual Proceedings of the Association for the Advancement of Automotive Medicine. The study tracked motor vehicle occupant mTBI outcomes and found that at 12 months post-injury, 39.3% of mTBI patients continued to suffer from persistent cognitive and behavioral impairments, while 57.1% reported post-traumatic depressive symptoms.

Dr. Verg on why some headaches keep going: “The reason why they started is not the reason why it continues. The reason why it continues is because the brain is not able to turn off certain signals, because tissues were injured, because the brain was inflamed, and now it learned that that signal should come. It’s called central sensitization.” The hopeful part, in his words: “If we are able to find a particular muscle that is strained and we relax it, there’s no headache. It gives the brain the power to relearn that pattern. So there is a curative possibility when we use the same system to guide the brain to health.”

Why standard scans look normal

Hospital emergency rooms use CT scans to rule out acute intracranial hemorrhage and skull fractures. However, standard imaging lacks the sensitivity to detect micro-vascular changes, localized hypoperfusion, or subclinical blood-brain barrier disruption caused by low-to-moderate speed crashes.

• The scientific evidence: A prospective neuroimaging study by Hofman et al. (2001) in the AJNR American Journal of Neuroradiology evaluated patients with acute mTBI (Glasgow Coma Scale 14–15). The researchers found that 77% of patients had abnormal structural or perfusion findings on acute FLAIR MRI or SPECT scans, even when initial neurocognitive testing fell within normal ranges.
• Korn et al. (2005) investigated post-concussion syndrome in the Journal of Clinical Neurophysiology. Despite normal CT and MRI findings at the time of diagnosis, specialized SPECT imaging revealed focal cerebral blood flow reduction in 85% of patients and blood-brain barrier disruption in 73%, confirming an organic and vascular basis for ongoing post-concussion symptoms.

Dr. Verg’s view: “On CT and even on MRI, we do not see what a concussion is. It shows up during the physical examination and in the symptoms.” He uses CT “only in extreme cases,” to rule out a brain bleed, because a head CT is “a lot of radiation.” When brain imaging is needed, he prefers an MRI with contrast. What he wants most for documenting a concussion is neurocognitive (neuropsychological) testing.

Keep in mind: most concussions will never show any abnormality on a CT or MRI, even an MRI with contrast. A normal scan rules out a bleed or a fracture. It does not rule out a concussion.

How we check for a concussion in our office

A thorough clinical evaluation is essential to rule out surgical red flags. At every new car accident exam, Dr. Verg screens for concussion, whether or not the patient hit their head:

• Balance with eyes closed (Romberg test). “Not being able to keep balance with eyes closed is a clear sign of a concussion.” It means the brain is not fully tracking where the body is. We repeat it at every re-exam to track recovery.
• Eye movements. Can you hold your gaze at the edges of your vision and cross the midline smoothly?
• Focusing (accommodation) reflex and pupils. “Usually all of those are normal even in people who are quite concussed, except the accommodation. The body kind of forgets certain reflexes, and then somebody might feel nauseous or dizzy when they’re driving because of all the moving objects.”
• Grip strength over repeated trials. Strength that fades from trial to trial can be another sign.
• A symptom-by-symptom review: dizziness, mood, light and sound sensitivity, blackouts or near-fainting, nausea, ringing in the ears, fog and irritability.

When these findings point to a concussion, we refer to a concussion specialist for formal testing, so the injury is documented and tracked. As Dr. Verg tells patients, a specialist can “first document and then track.” And if a month has gone by, it is not too late: “No, absolutely not.”

When to call us right away, or go to the ER

Dr. Verg reminds patients that a concussion is not a brain bleed: “If there were bleeding in the brain, we would have already been in the hospital.” But after a crash, call our office immediately, or go to the emergency department if the doctor is unavailable, if you or a family member has any of these:

• Vomiting
• Severe difficulty being awakened
• Loss of consciousness
• Slurred speech
• Failure to recognize people or places
• Increasing confusion

If you can’t be evaluated fast enough, go to the ER. The ER will most likely perform a CT scan, which shows dangerous bleeding in the brain. Dr. Verg suggests asking the physician whether an MRI could be done instead. One way to ask: “Hey doc, if the imaging can be done in the next 2 hours, could we have an MRI instead? I just heard that it can show subtle changes in the brain.”

Continue to Part 2: How We Treat Concussion After a Car Accident

Supportive, non-surgical care in Vancouver, WA & Clackamas, OR

If you or a loved one are struggling with lingering headaches, dizziness, or brain fog after a motor vehicle accident, you do not have to navigate recovery alone. At Dr. Verg Chiropractic, we provide comprehensive, non-surgical evaluations tailored to your specific injury history and recovery goals.

What we offer auto accident patients:

• Complimentary new-patient consultation: Discuss your crash history and symptoms with our team to explore whether our non-surgical approach is right for you.
• A concussion screen at every car accident exam, whether or not you hit your head.
• Direct insurance claim handling: We work directly with auto insurance Personal Injury Protection (PIP) claims, handling paperwork so you can focus entirely on healing.
• Multilingual care team: To best serve our diverse local communities in Clark and Clackamas counties, our compassionate staff offers fluent care in English, Ukrainian (Українська), and Russian (Русский).

Visit one of our convenient clinic locations:

• Vancouver, WA clinic: 109 SE 101st Ave, Vancouver, WA 98664. Phone: (360) 203-6000
• Portland / Clackamas, OR clinic: 10001 SE Sunnyside Rd #120, Clackamas, OR 97015. Phone: (503) 386-9819

Call today to schedule your complimentary evaluation and take the first confident step toward lasting recovery.

Medical disclaimer

This article is provided for educational and informational purposes only and does not constitute formal medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider regarding any medical condition or post-accident symptoms. Never disregard professional medical advice or delay seeking it because of something you have read in this article. If you suspect you have an acute brain injury or neurological emergency, or wish to adjust prescribed medications or supplements, consult your primary care physician or emergency medical services immediately.

References

• Barrow IM, Hough M, Rastatter MP, Walker M, Holbert D, Rotondo MF. Can within-category naming identify subtle cognitive deficits in the mild traumatic brain-injured patient? Journal of Trauma. 2003;54(5):888-895.
• Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, Kraus J, Coronado VG. Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine. 2004;(43 Suppl):28-60.
• Croft AC, Freeman MD. Correlating crash severity with injury risk, injury severity, and long-term symptoms in low velocity motor vehicle collisions. Medical Science Monitor. 2005;11(10):RA316-RA321.
• Dischinger P, Read K, Kerns T, Ho S, Kufera J, Burch C, Jawed N, McC. Mathias C, Burgess A, Bents F. Causes and outcomes of mild traumatic brain injury: an analysis of CIREN data. 47th Annual Proceedings, Association for the Advancement of Automotive Medicine. 2003;577-592.
• Hofman PA, Stapert SZ, van Kroonenburgh MJ, Jolles J, de Kruijk J, Wilmink JT. MR imaging, single-photon emission CT, and neurocognitive performance after mild traumatic brain injury. AJNR American Journal of Neuroradiology. 2001;22(3):441-449.
• Korn A, Golan H, Melamed I, Pascual-Marqui R, Friedman A. Focal cortical dysfunction and blood-brain barrier disruption in patients with postconcussion syndrome. Journal of Clinical Neurophysiology. 2005;22(1):1-9.