A head or brain injury is one of the more serious things that can come out of a car crash, and it is also one of the easiest to miss in the hours right after the wreck.
You can hit your head on the steering wheel, the side window, or the headrest and walk away feeling shaken but fine.
You can also suffer a serious brain injury without ever hitting your head at all, because the brain moves inside the skull when a vehicle stops suddenly.
That is the part most people do not know, and it is the reason so many crash victims skip the emergency room and only realize something is wrong three or four days later.
The stakes are high because head injuries do not always heal the way a broken bone heals. They can change how you think, how you sleep, how you handle stress, and how you relate to the people closest to you.
They are also harder to prove than almost any other injury, which is exactly why insurance companies fight them so aggressively.
How Common Head Injuries Are in Arkansas Crashes
Motor vehicle crashes are one of the leading causes of traumatic brain injury in the United States.
Using 2017 national data, the Agency for Healthcare Research and Quality found that motor vehicle and other transport incidents together accounted for 24.2% of TBI-related inpatient hospital stays and 20.7% of TBI-related emergency department visits that were treated and released.
Those figures combine traffic crashes with other transport-related injuries, so they are not a car crash number on their own, but they show how large a share of brain injuries come from vehicles.
The overall numbers are large. The Centers for Disease Control and Prevention reports approximately 214,110 TBI-related hospitalizations in 2020 and 68,663 TBI-related deaths in 2023.
The CDC also notes that those figures leave out the many brain injuries that are only treated in an emergency room, an urgent care clinic, a primary care office, or that go untreated entirely.
In other words, the true burden of traumatic brain injury is higher than the hospitalization and death counts capture. Arkansas contributes its share of those injuries every year.
The Arkansas Department of Public Safety reported 569 traffic deaths in 2025 and 563 in 2024, and federal highway safety reporting recorded 2,694 serious injuries on Arkansas roadways in 2022.
Serious injury counts capture the worst outcomes, not the concussions that get sent home from a small hospital with instructions to rest.
Picture a rear-end collision, one of the most common causes of car accidents in Arkansas, on I-40 near the Galloway exit east of Little Rock during the afternoon backup.
The driver in the middle car is stopped, gets struck at 35 miles per hour, and never loses consciousness.
She declines the ambulance, drives home, and goes to work the next morning at a distribution center in North Little Rock.
By Friday, she cannot remember conversations from that same morning, and the fluorescent lights on the warehouse floor are giving her a headache that will not stop.
Those symptoms are consistent with a possible mild traumatic brain injury, and it is also a claim that just got much harder to prove because she never went to the hospital.
The Different Types of Head Injuries From Car Accidents
Head injuries from car accidents fall into a handful of categories, and they differ sharply in how visible they are on standard hospital imaging.
| Injury Type | How It Happens in a Crash | Visible on a Standard CT Scan? | Typical Symptom Onset | What Proving It Usually Takes |
| Concussion (mild TBI) | The brain shifts and strikes the inside of the skull during sudden deceleration | Usually not | Immediate to several days later | Symptom documentation, neurological exam, neuropsychological testing |
| Brain contusion | Direct impact bruises brain tissue, often at the point of impact and the opposite side | Often yes, if bleeding is present | Hours to days as swelling develops | CT or MRI imaging, neurologist records, follow-up scans |
| Skull fracture | The head strikes a hard surface such as a window frame, pillar, or pavement | Usually | Immediate | Imaging, surgical records, trauma team documentation |
| Diffuse axonal injury | Rotational forces tear nerve fibers throughout the brain without a single impact point | Frequently not on standard CT | Immediate loss of consciousness, or gradual cognitive decline | Advanced imaging such as DTI MRI, neuropsychological testing, testimony from treating physicians |
The most important column in that table is the third one. A concussion and a diffuse axonal injury can both produce a completely normal CT scan, and in our experience, a normal CT scan is one of the first things an insurance adjuster points to in a head injury file.
Emergency rooms use CT scans mainly to look for bleeding, swelling, and fractures that need urgent treatment, not to detect the microscopic nerve damage behind long-term cognitive problems. A clear scan lowers the concern for that kind of acute, CT-visible emergency.
It does not rule out a concussion, and it does not guarantee that complications cannot develop later, which is why the CDC still tells patients to get emergency care if danger signs such as a worsening headache, repeated vomiting, seizures, slurred speech, or unusual drowsiness appear.
Contusions and skull fractures are easier cases from an evidence standpoint because the damage is documented on film.
They also tend to be more dangerous in the moment, though severity and long-term effects vary a great deal from person to person.
The frustrating reality of head injury claims is that the injuries with the clearest proof are often not the ones causing the longest disruption to a person’s life.
Why Head Injury Symptoms Show Up Days Later
Delayed symptoms are normal, and the CDC is direct about it. According to the CDC, some mild TBI and concussion symptoms may appear right away, while others may not appear for hours or days after the injury.
Several things contribute to that gap. The stress and adrenaline of a crash can make people feel steadier than they are in the first hours.
Symptoms can evolve as the days pass, and cognitive problems often are not obvious until a person goes back to work and tries to do something demanding.
This is why emergency physicians give head injury discharge instructions that list symptoms to watch for over the following days rather than declaring a patient fully cleared.
There is one more factor that surprises people. You do not have to lose consciousness to have a brain injury, and most people with concussions never black out at all.
Losing consciousness is a symptom of brain injury, not a requirement for one, though many crash victims assume the opposite and use it to talk themselves out of getting checked.
The symptoms worth taking seriously in the days after a crash include:
- Headaches that get worse instead of better
- Trouble remembering the crash or conversations that happened after it
- Dizziness, balance problems, or nausea
- Sensitivity to light or noise
- Blurred or double vision
- Sleeping much more or much less than usual
- Irritability, anxiety, or mood changes your family notices before you do
- Trouble concentrating at work or following a conversation
- Ringing in the ears
If any of these appear, see a healthcare provider rather than waiting to see if it passes.
The CDC advises talking to a provider if symptoms do not go away within two to three weeks or get worse after you return to your regular activities, and your provider may refer you on to a neurologist when that is warranted.
Getting evaluated does two things at once. It gets you the right treatment, and it creates a medical record tied to the crash date, which is the foundation of any head injury claim.
Arkansas Geography Makes Head Injuries Easier to Miss
Where your crash happens in Arkansas has a real effect on whether your head injury gets diagnosed.
UAMS Medical Center in Little Rock is the only adult Level 1 trauma center in the state, with Arkansas Children’s serving as the state’s Level 1 pediatric trauma center.
That means a serious crash in the Delta, in the Ouachitas, or on a two-lane highway outside Fort Smith may go first to a community hospital that can stabilize a patient and run a CT scan but does not have a neurologist on staff.
When a scan shows nothing urgent, a patient can be discharged without any plan for the follow-up care that would catch a mild brain injury weeks later.
Rural road dangers are not a small slice of the problem in this state.
TRIP, a national transportation research nonprofit, found that Arkansas had 312 traffic fatalities on non-Interstate rural roads in 2022, at a fatality rate of 2.25 per 100 million vehicle miles traveled compared to 1.34 on all other roads in the state.
That rural rate ranked 16th highest in the country.
Longer ambulance runs, smaller hospitals, and less immediate access to neurology all point in the same direction.
Consider a poultry plant worker driving home to Danville after a shift when a pickup crosses the center line on Highway 10.
She is taken to the nearest regional hospital, scanned, treated for a laceration, and released the next morning.
Nobody orders a neurology referral because nothing showed on the scan.
Three months later, she has been written up twice at work for mistakes she never used to make, and her attorney is now trying to connect those write-ups to a crash with almost no brain injury documentation in the file.
The lesson for anyone hurt in a crash outside a metro area is simple.
If symptoms linger or get worse, go back to a healthcare provider and say so plainly, and ask whether a referral to a neurologist makes sense in your case.
The Long-Term Consequences People Do Not Expect
The word “mild” in mild traumatic brain injury describes how the injury looked on arrival at the hospital, not how it plays out over the following year.
A study published in JAMA Neurology followed patients treated at 11 Level 1 trauma centers and found that 53% of the mild TBI patients still reported functional limitations 12 months after the injury, compared to 38% of orthopedic trauma patients.
Even among the patients whose CT scans were negative, 49% reported ongoing limitations a full year out.
Those numbers describe people hurt badly enough to be treated at a Level 1 trauma center, not everyone who gets a concussion.
The CDC notes that most people recover from a mild TBI within a few days or weeks.
Still, in that trauma center group, more than half were not back to normal a year out, which is a very different picture than the one an adjuster paints when offering a quick settlement in week three.
The problems tend to cluster in a few areas.
Cognitive changes come first, and they usually look like trouble with short-term memory, difficulty holding attention through a meeting, slower processing when several things happen at once, and losing words mid-sentence.
Chronic headaches are extremely common and often become the daily symptom that wears a person down the most.
Sleep gets disrupted in both directions, with some people sleeping twelve hours and still feeling exhausted and others unable to fall asleep at all.
Personality and mood changes are the hardest part for families.
A pattern brain injury survivors often describe is a shorter fuse, less patience with children, anxiety in situations that never caused it before, and a flatness or loss of interest in things they used to enjoy.
Spouses frequently notice these changes before the injured person does, which is why testimony from family members carries real weight in these cases.
The financial consequences follow from the cognitive ones.
Someone who managed a crew, drove a commercial route, or handled detailed paperwork may not be able to return to that same job even though they look completely healthy.
Loss of earning capacity in a brain injury case can be worth more than the medical bills, and it is often supported by vocational rehabilitation and economic expert testimony.
How Arkansas Act 28 Changes the Math on Head Injury Cases
Arkansas passed a significant change to how medical expenses are proven in injury cases, and it lands harder on head injury claims than on almost any other type.
Act 28 of 2025, which began as HB 1204, was approved on February 11, 2025 and took effect in August of that year.
The act limits recovery for past necessary medical care, treatment, or services to amounts actually paid by or on behalf of the injured person, plus amounts that remain unpaid and for which the injured person or a third party is still legally responsible.
By its own terms, it addresses past medical expenses, not future medical care.
Before this change, Arkansas followed the collateral source rule, and an injured person could generally present the full billed amount of their medical care to a jury even if health insurance negotiated it down to a fraction of that number.
Here is why this matters more for brain injuries than for a broken femur.
Head injury treatment is often cheap on paper.
An emergency room visit, a CT scan, a few follow-up appointments, and a course of physical therapy might generate bills that look modest next to a surgical case, even when the person’s life has been permanently altered.
In our experience, juries tend to take their sense of how serious a case is from the medical bill number they are shown, whether or not that is a fair way to measure harm.
When Act 28 shrinks that visible number further, it can make a life-changing brain injury look like a minor claim on the verdict form.
There is a practical response to this.
Damages that were never billed to health insurance in the first place are not reduced the same way, and those categories may account for a substantial portion of the value in serious head injury cases.
Future medical care laid out in a life care plan, loss of earning capacity, and non-economic damages for pain, cognitive loss, and the effect on family relationships all sit outside the paid-versus-billed fight.
That makes the medical and vocational proof in a brain injury case more important than it has ever been in this state, because the case can no longer lean on a large billed number to tell the story.
What Insurance Companies Do in Head Injury Claims
In our experience, adjusters handling brain injury files tend to return to the same set of arguments, and knowing them in advance is genuinely protective.
The first is the recorded statement taken early.
An adjuster may call within days of the crash, while a concussion is at its worst, and the questions insurance companies ask after a car accident are often built to lock in early answers about how you are feeling and what you remember.
A person with a fresh brain injury can give vague, inconsistent, and overly optimistic answers, and those answers can go into the file to be read back later as an argument that the injury was not serious or that the story changed.
The second is the normal CT scan argument.
An adjuster may point to a clear scan and treat it as proof that no brain injury occurred, even though CT imaging is not designed to detect the diffuse damage behind most post-concussive symptoms.
That argument is much harder to make when treating physicians are on record explaining the difference.
The third is social media surveillance, which we see used often in head injury cases.
A photograph of you at a Razorbacks game, a birthday dinner, or your kid’s ball field can become an exhibit arguing that your concentration, memory, and light sensitivity cannot be as bad as you claim.
Gaps in treatment draw the same scrutiny, and a brain injury patient who misses appointments because of memory problems or transportation issues may see that gap held up as evidence of recovery.
The fourth is the pre-existing condition file dig.
Any prior concussion, sports injury, migraine history, anxiety diagnosis, or ADHD note in your old records may be offered as the real cause of your current symptoms.
This is also why a broad medical authorization deserves caution, because signing one can hand over years of unrelated records to be reviewed for exactly this purpose.
Comparative fault is the last lever, and Arkansas law gives it teeth.
Under Arkansas Code Section 16-64-122, if the fault charged to you is equal to or greater than the fault of the party you are suing, you recover nothing.
That 50% threshold gives insurers a strong incentive to press small criticisms of your driving, and a head injury victim whose memory of the crash is fragmented can be a difficult witness on that point.
How Head Injury Cases Are Valued and Proven
Head injury cases are built on medical proof and forward-looking economic proof, not on the size of the emergency room bill.
The economic side includes past medical treatment, the cost of future care projected over a lifetime, lost wages already incurred, and lost earning capacity going forward.
The non-economic side covers pain, cognitive loss, emotional suffering, and the loss of the ordinary daily life a person had before the crash.
In serious cases a spouse may also bring a loss of consortium claim for the damage to the marriage relationship.
Because none of this is visible on an x-ray, these cases live or die on the strength of the medical team behind them.
Ramez Shamieh explains how these cases get built:
“Head injury cases can be difficult to prove because there’s no physical sign of injury. I can’t show a jury that you broke your arm and then show them an x-ray of the break. A head injury is very hard to see. But we are very experienced at handling brain injury cases. The first thing we do is bring in a neurologist, which is a medical doctor who treats brain injuries. One of the things a neurologist orders is an EEG, which tests the brain’s electrical activity to see whether the brain waves are normal or abnormal. If the EEG comes back positive, the neurologist will recommend a DTI MRI. A DTI MRI is the advanced gold standard in MRIs for brain injuries, and it can show issues inside the brain. We hire a number of other experts as well, including neuropsychologists, vocational rehabilitation experts, and economists. These professionals help you and the jury understand how the injury is going to affect you in the short term and the long term. We have handled hundreds of brain injury cases, we work with highly qualified medical doctors, and we feel very comfortable handling any type of brain injury, whether it’s moderate or severe.”
It is worth being clear about what these tools do and do not do.
An EEG measures electrical activity in the brain, and a DTI MRI, or diffusion tensor imaging, maps the white matter tracts that carry signals between regions of the brain.
Neither one is an accepted routine test for diagnosing a mild traumatic brain injury on its own.
The VA and Department of Defense clinical practice guideline suggests against using neuroimaging, serum biomarkers, or EEG to establish a diagnosis of mild TBI, and it notes there is no definitive objective diagnostic test for the condition.
Mild TBI remains primarily a clinical diagnosis based on what happened in the crash, what symptoms followed, and what a physician finds on examination.
What these tests can do in the right case is different and still valuable.
MRI can show traumatic abnormalities that a CT scan missed in selected patients, and neuropsychological testing can measure real function across memory, attention, processing speed, and executive function when symptoms persist.
The same VA and Department of Defense guideline suggests against comprehensive neuropsychological testing in the first 30 days after a mild TBI, because cognitive deficits often resolve on their own in that window, so this testing generally belongs later, with a patient whose problems have not gone away.
Which of these makes sense is a medical decision for your treating physicians, not a checklist every case should run.
What does apply to every case is the record itself.
Consistent documentation of symptoms starting close to the crash date, and follow-up when those symptoms persist, is far more useful than a reconstruction attempted two years afterward.
Arkansas generally gives injury victims three years from the date of the crash to file a personal injury lawsuit under Arkansas Code Section 16-56-105, though different deadlines and procedures can apply in specific situations, including claims involving government entities.
Waiting most of that three years to start documenting a brain injury is one of the most damaging things a person can do to their own case.
What to Do If You Hit Your Head in a Crash
The steps to take after a car accident in Arkansas that protect your health also protect your claim, which makes this straightforward.
Get evaluated the same day, even if you feel fine, and tell the provider specifically that your head struck something or that your head was thrown forward and back.
Ask what symptoms should send you back in, and if problems persist past two or three weeks or get worse, go back and ask whether a referral to a neurologist is warranted.
Have someone you live with write down what they notice over the first two weeks, because family members catch memory lapses and mood changes that the injured person does not perceive.
Keep every appointment, and if you miss one because of symptoms, call and reschedule immediately so the record shows why.
We generally recommend staying off social media while your claim is open.
We also recommend against giving a recorded statement to the other driver’s insurance company, and against signing a blanket medical authorization before a lawyer has reviewed its scope.
These are practical recommendations rather than requirements of Arkansas law.
Write down how specific tasks have changed, such as how long it now takes to finish paperwork you used to do quickly, because that kind of concrete detail is far more persuasive than saying you have trouble concentrating.
Talk to Someone Who Handles Brain Injury Cases
If you hit your head in an Arkansas crash, the most valuable thing you can do in the first week is get properly evaluated and get someone working on the evidence while it still exists.
Head injuries are invisible, and that means the case has to be built deliberately from the very beginning rather than assembled after the insurance company has already framed the story.
Shamieh Law has recovered over $300 million for injured people and their families, and our brain injury lawyers in Little Rock start by getting the right medical team involved fast.
That means a neurologist who can order the testing that actually shows the injury, advanced imaging that goes beyond what a standard emergency room scan captures, and the vocational and economic analysis that shows what this injury will cost you over a lifetime.
We treat every client like family, we answer the phone, and we get moving on your case instead of putting it in a stack.
You do not pay medical bills out of pocket to get started, and there is no fee unless we win.
Call Shamieh Law at 501-361-1334 for a free consultation about your head injury claim.
Frequently Asked Questions
Can you have a brain injury if the CT scan was normal?
Yes. CT scans are used mainly to look for bleeding, swelling, and fractures that need urgent treatment, not the microscopic nerve damage behind most post-concussive symptoms, and many people with concussions have completely normal CT results. Mild TBI is primarily a clinical diagnosis based on the mechanism of injury, the symptoms that follow, and a physician’s examination, and the VA and Department of Defense clinical practice guideline suggests against relying on neuroimaging or EEG to establish that diagnosis. MRI can show abnormalities missed by CT in selected patients, and neuropsychological testing can help when symptoms persist, but a clear CT does not rule out a concussion. It also does not guarantee that complications cannot develop, which is why the CDC advises emergency care if danger signs such as a worsening headache, repeated vomiting, seizures, or unusual drowsiness appear.
How long after a car accident can head injury symptoms appear?
The CDC states that some mild TBI and concussion symptoms may appear right away while others may not appear for hours or days after the injury, and some cognitive and mood changes are not obvious for a week or more. Symptoms can evolve over time, and problems with memory or concentration often surface only when a person returns to work and tries something demanding. This is why emergency rooms give discharge instructions listing symptoms to watch for over the following days. If headaches worsen, memory problems appear, or family members notice mood changes, see a healthcare provider, and seek emergency care right away if danger signs such as repeated vomiting, seizures, slurred speech, or unusual drowsiness develop.
Do I have a case if I never lost consciousness?
Yes. Losing consciousness is one possible symptom of a brain injury, not a requirement for one, and most people who suffer concussions never black out. What matters legally is whether the crash caused an injury that a physician can document and connect to the collision. Medical records, imaging, neuropsychological testing, and testimony from people who knew you before and after the crash are typically what establish that connection.
How much is a car accident head injury case worth in Arkansas?
There is no standard figure, because value depends on the severity of the injury, how permanent the deficits are, how much future medical care is needed, and how the injury affects your ability to work. Cases involving permanent cognitive impairment or an inability to return to a prior occupation are generally valued far higher than the medical bills alone would suggest. Arkansas Act 28, which took effect in August 2025, now limits recovery for past necessary medical care to amounts actually paid or still owed, which makes proof of future care costs and lost earning capacity more important than ever. An attorney who handles brain injury cases can evaluate the specific facts of your situation.
Does Arkansas comparative fault affect a head injury claim?
Yes. Under Arkansas Code Section 16-64-122, you cannot recover damages if your share of fault is equal to or greater than the fault of the party you are suing, and your recovery is reduced in proportion to any fault below that threshold. In our experience insurers press comparative fault arguments hard in head injury cases, because a victim with memory gaps can have difficulty describing exactly what happened. Police reports, witness statements, vehicle data, and accident reconstruction are typically used to counter these arguments.
What kind of doctor should I see for a head injury after a car accident?
Start with an emergency room or urgent care evaluation on the day of the crash, and tell the provider exactly how your head was affected. Most people with a concussion are managed by a primary care or emergency provider and recover within days or weeks. The CDC advises talking to your provider if symptoms do not go away within two to three weeks or get worse after you return to your regular activities, and your provider may then refer you on to a neurologist or a neuropsychologist. If you were treated at a smaller hospital and your symptoms are not improving, go back and say so rather than assuming you were fully cleared.