A traumatic brain injury (TBI) is diagnosed with a history of how the injury happened, a neurological exam, a severity score such as the Glasgow Coma Scale, and brain imaging (usually a CT scan first) when bleeding or a fracture is suspected. A mild TBI, or concussion, often looks normal on a scan, so balance, eye-movement and memory testing, plus watching symptoms over time, fill in the picture. If you have a headache that gets worse, repeated vomiting, confusion or trouble waking after a crash in Jacksonville, go to the ER or call 911 first.
Below is each step of a brain injury diagnosis, what each test can and cannot show, and why some diagnoses come days later.
Key facts
- A concussion is a mild traumatic brain injury (mTBI) caused by a blow to the head or a sudden jolt that moves the brain inside the skull.
- Most concussions happen without any loss of consciousness.
- A standard concussion does not show up on a CT or MRI, so a normal scan does not rule one out.
- Florida PIP pays medical benefits only if you receive initial care within 14 days of the crash (F.S. 627.736).
- In 2024, Duval County recorded 23,013 crashes and 15,480 injuries (FLHSMV, Traffic Crash Facts 2024).
ER Red Flags Come First
Before any clinic visit, rule out an emergency. Go to the emergency room or call 911 right away for:
- A headache that gets worse and does not go away
- Repeated vomiting
- A seizure
- One pupil larger than the other
- Slurred speech, weakness, numbness or decreased coordination
- Increasing confusion, restlessness or agitation
- Unusual drowsiness or being hard to wake
- Any loss of consciousness
- Clear fluid from the nose or ears, or new bruising behind the ears or around the eyes
If you take a blood thinner, or you are an older adult, get checked promptly after any head injury. An outpatient injury clinic is not the right first stop for these signs; the ER is.
Step 1: The History
Your provider asks how the crash happened, whether your head struck anything, whether you lost consciousness or have gaps in memory, and how symptoms have changed. A witness can help, because people with a brain injury often do not remember the first minutes clearly.
Step 2: The Glasgow Coma Scale
In the field and in the ER, the Glasgow Coma Scale (GCS) gives a fast severity score. It rates three things: eye opening, verbal response and motor response. Totals run from 3 to 15, and higher scores mean a less severe injury. The GCS spots serious injuries quickly, but it is not sensitive to a mild concussion, so a normal score does not mean there is no brain injury.
Step 3: The Neurological Exam
A neurological exam checks how your brain and nerves are working. It usually covers:
- Orientation, attention and short-term memory
- Pupils and eye movements
- Strength, sensation and reflexes in the arms and legs
- Coordination and balance, including standing and walking tests
- Speech and understanding
At East Coast Injury Clinic, our medical providers and chiropractic neurologists perform detailed neurological exams. We also check the neck, because whiplash often happens alongside a concussion and can cause its own headaches and dizziness. Our guide to headaches after a car crash covers the neck-related and concussion-related types.
Step 4: Brain Imaging (CT and MRI)
Imaging looks for structural damage such as bleeding, bruising, swelling or a skull fracture.
- CT scan. A CT is usually the first imaging test in the ER for a suspected TBI. It is fast and shows fractures and bleeding well.
- MRI. An MRI shows more detail in brain tissue. It is often ordered after the person is stable, or when symptoms do not improve as expected.
Not everyone with a head injury needs a scan; ER teams use the exam and warning signs to decide. We do not have CT or MRI in our office. When imaging is needed, we refer you to an imaging center or hospital and review the results with you. Remember that a standard concussion does not show up on CT or MRI, so a clear scan does not rule one out.
Step 5: Balance, Eye Tracking and VNG Testing
A concussion often affects how the eyes, inner ear and brain work together, which can cause dizziness, blurred vision, trouble reading or feeling off balance in busy places. Testing that may help includes:
- Eye-movement (eye tracking) assessment, which looks at how smoothly and accurately your eyes follow a target and shift focus.
- Videonystagmography (VNG), which uses video goggles to record eye movements and helps show how the inner ear balance system is working.
- Balance testing, standing and moving in different positions.
These tests do not diagnose a concussion by themselves. They add objective information to the history and exam and help our concussion and vestibular rehabilitation specialists plan treatment.
Step 6: Watching Symptoms Over Time
Brain injury symptoms can change over the first days and weeks. Follow-up visits track headaches, dizziness, sleep, mood, concentration and how well you tolerate screens and work. When memory or thinking problems last, formal cognitive or neuropsychological testing may help, and we refer patients for that testing when it is needed.
How a Brain Injury Diagnosis Gets Delayed
Delayed diagnosis is common after car accidents. It usually happens for ordinary reasons:
- Adrenaline masks symptoms at the scene, and people decline an ambulance because they feel fine.
- Other injuries, such as neck pain, a broken wrist or airbag injuries to the face and chest, take all the attention in the ER.
- There was no loss of consciousness, so a brain injury was not considered.
- A CT scan was normal, and the person assumed that meant no injury.
- Problems with concentration, sleep or screen tolerance only show up when the person goes back to work or school.
If this sounds familiar, you can still be evaluated. Tell the provider about the crash, even weeks later, and bring any ER paperwork.
Brain Injury After a Jacksonville Crash: Timing and PIP
Jacksonville commuters spend a lot of time on I-95, I-295, J. Turner Butler Blvd (JTB), SR 9A and Beach Blvd. Duval County recorded 23,013 crashes and 15,480 injuries in 2024, according to the Florida Department of Highway Safety and Motor Vehicles.
Under F.S. 627.736, Florida PIP pays medical benefits only if you receive initial care within 14 days of the crash. An ER or urgent care visit counts. The full PIP medical benefit also depends on an Emergency Medical Condition determination by an MD, DO, PA, APRN or dentist; a chiropractor cannot make that determination. Learn more about Florida’s 14-day PIP rule and our car accident injury care, and talk to an attorney about questions on your claim.
For a step-by-step look at the deadline, see our guide to the PIP 14-day rule after a Jacksonville crash.
What We Treat, and What We Refer
We will be honest about our role. Our clinic evaluates and treats concussion and the neck injuries that often come with it, using medical evaluation, neurological exams, vestibular and balance testing, and rehabilitation. We do not treat moderate or severe brain injuries that need hospital care, and we do not perform brain surgery. When a finding needs a neurologist, neurosurgeon or hospital team, we refer you. Recovery timelines vary, and no one can promise when symptoms will fully clear.
Paying for a Brain Injury Evaluation After a Crash
After a car accident in Florida, your own Personal Injury Protection (PIP) coverage is usually the first place your medical bills go, as long as your first care is within 14 days of the crash. If you have a personal injury attorney, we can treat under a Letter of Protection where that is the arrangement; your attorney can call our office to set it up. We also accept a limited number of private health plans. Our front desk verifies coverage before your first visit and explains what is and is not covered for your case.
Frequently Asked Questions
What tests are used to diagnose a traumatic brain injury?
Diagnosis starts with a history and a neurological exam. In the ER, the Glasgow Coma Scale is used to grade severity, and a CT scan is usually the first imaging test when bleeding or a fracture is suspected. An MRI may be ordered later if symptoms do not improve. Balance, eye-movement and memory testing help assess a concussion, which often does not show on a scan.
Do traumatic brain injuries show up on an MRI or CT scan?
Moderate and severe brain injuries often show bleeding, bruising or swelling on a CT or MRI. A typical concussion, the mildest form of TBI, usually does not show up on standard CT or MRI. A normal scan rules out some dangerous problems, but it does not rule out a concussion.
What is the Glasgow Coma Scale?
The Glasgow Coma Scale (GCS) is a quick bedside test used by first responders and ER teams. It scores eye opening, verbal response and movement, with a total from 3 to 15. Higher scores mean a less severe injury. Most people with a concussion score in the normal or near-normal range.
Can a brain injury be diagnosed days after an accident?
Yes. Many people are diagnosed with a concussion days or weeks after a crash, when headaches, dizziness, trouble concentrating or sleep changes do not go away. Tell the provider about the crash even if it seemed minor. Get emergency care at any point for danger signs such as a worsening headache, repeated vomiting or confusion.
What are the signs of brain trauma after a car accident?
Common signs include headache, dizziness or balance problems, nausea, blurred vision, sensitivity to light or noise, feeling foggy, trouble concentrating or remembering, irritability and sleep changes. You do not have to hit your head or lose consciousness to have a brain injury.
Does an eye tracking test or VNG diagnose a concussion?
No single test diagnoses a concussion. Eye-movement testing and videonystagmography (VNG) measure how your eyes, inner ear and brain work together. The results help explain symptoms like dizziness or blurred vision and guide rehabilitation, alongside the history and neurological exam.
Getting Care at Our Jacksonville Clinics
If you were in a crash and something still feels off, our team can evaluate you, coordinate imaging by referral when it is needed, and bring your exam, testing and rehabilitation together under one roof. You can be seen at our Southside clinic at 10550 Deerwood Park Blvd, Suite 609 (32256), near JTB and I-295, or at our North Jacksonville clinic at 13453 N Main St, Suite 302 (32218), north of I-295. Both clinics offer the same services and the same hours, Monday through Friday, 9 AM to 6 PM. Call (904) 513-3954 or request an appointment.
