Quick Takeaways
- 49ers head coach Kyle Shanahan said his recent car accident changed his understanding of concussions.
- Former 49ers great Roger Craig announced a vascular dementia diagnosis and believes his history of concussions may have contributed.
- A major study found that a single mild TBI was associated with a 17% higher dementia risk, while a severe TBI raised the risk by 35%.
- Brain injuries may cause lasting symptoms even when standard CT scans and MRIs appear normal.
- Persistent symptoms after a head injury should be taken seriously, even when the injury was initially considered “mild.”
Kyle Shanahan’s Concussion Experience Changed His Perspective on “Mild” Brain Injury
Kyle Shanahan stood at the podium on a Saturday in August, bruising still visible near his nose, and he was close to full strength and expected to be on the sideline for the 49ers' preseason opener against the Titans. He'd been in a car accident. He was, by his own account, still working through fatigue and occasional headaches. And he said something that ought to catch the attention of anyone who's ever waved off a "minor" bump on the head, their own or someone else's.
For years, Shanahan had been on the other side of concussion conversations, listening to team doctors explain a player's status and moving on. This time, he was the one being evaluated, and it changed how he heard the words. He said he'd always assumed a "mild" designation meant a short absence, maybe a game, and a "severe" one meant something longer. Going through it himself, he realized those labels were, in his words, "just words." Two people with the same label can be having completely different experiences.
He also described something else worth sitting with: the fear of not knowing whether you'll feel like yourself again. That uncertainty, more than any diagnosis on a chart, is what tends to stay with people.
I've spent close to three decades representing people in the Bay Area who never asked to learn any of this. Most of them didn't get hurt on a football field with a team of specialists standing by. They got hurt in a car on 19th Avenue, in a bike accident on the Embarcadero or on Market Street, on a wet staircase, or in a parking garage, or even at school. And they hear the exact same word Shanahan did: mild. Then they spend months wondering why a "mild" injury still hasn't let them go back to work, read for more than twenty minutes, or get through a Tuesday without a migraine.
A Concussion Can Have Lasting Effects
A concussion is a traumatic brain injury. It’s not a separate or lesser category. The CDC classifies concussions as mild TBI, and by CDC estimates, roughly three out of every four traumatic brain injuries fall into that "mild" bucket. That means the majority of people living with a real, disruptive brain injury are the ones most likely to be told it's "just a concussion" — by a coworker, a family member, an insurance adjuster, or sometimes even a rushed ER discharge summary.
"Mild" in this context is a description of the initial injury mechanism, not a prediction about someone's recovery. Plenty of people classified as mild TBI are back to normal within a couple of weeks. Others are still dealing with headaches, memory gaps, light sensitivity, irritability, and difficulty concentrating months later, a cluster of symptoms sometimes called post-concussion syndrome. The label at intake tells you almost nothing about which group someone will end up in.
Brain Injury Is a Bigger Problem Than Most People Realize
Traumatic brain injury isn't a rare event that happens to football coaches and professional athletes. According to the CDC, the U.S. saw roughly 214,000 TBI-related hospitalizations and nearly 69,000 TBI-related deaths in recent tracked years, which works out to about 190 deaths a day nationwide. Those figures don't even count the many more people treated in an emergency room, urgent care, or a doctor's office and sent home. Falls and motor vehicle crashes are consistently among the leading causes.
Brain injury researchers call this the "silent epidemic." Not because it's rare, but because the people carrying it often look completely fine. There's no cast, no visible wound, sometimes not even a mark. Just a person who used to be able to work a full day and now can't get through one without a headache that sends them home.
Roger Craig’s Vascular Dementia Diagnosis Raises Questions About Long-Term Brain Injury
Roger Craig was one of the most electric running backs of the 49ers' dynasty years, a three-time Super Bowl champion and the first NFL player to rush for 1,000 yards and catch passes for 1,000 yards in the same season. This month, Craig announced that he has been diagnosed with vascular dementia, and he has said publicly that he believes the diagnosis may be connected, at least in part, to concussions he sustained during his playing career.
According to neurologist Dr. Matthew Purbaugh of Bryan Neurology, vascular dementia is the second most common type of dementia in North America. Unlike Alzheimer's disease, which involves a buildup of specific proteins in brain tissue, vascular dementia comes from damage to the blood vessels that supply the brain, sometimes from one major stroke, sometimes from a series of smaller "mini" strokes that go unnoticed as they happen. Purbaugh describes the brain as a network of connected systems; vascular dementia doesn't necessarily destroy individual parts of that network so much as it damages the connections between them, disrupting executive function, decision-making, processing speed, and spatial awareness.
Purbaugh's comments, as reported by KLIN News, raised the concept of "mixed dementia," meaning more than one type of dementia-related brain change happening in the same person at the same time. In the context of a former football player, that most often raises the question of whether vascular dementia is compounding, or being compounded by, chronic traumatic encephalopathy (CTE), the degenerative condition specifically associated with repetitive head trauma. The mechanisms can overlap. Repeated head injuries can damage the brain's small blood vessels directly, potentially accelerating the same kind of vascular changes that cause vascular dementia on their own, separate from any CTE-related changes that may also be present.
Vascular dementia and CTE are not diagnosed in the same way. Vascular dementia can be diagnosed in a living patient. CTE currently cannot; despite years of research into blood- and imaging-based markers, it can only be confirmed after death, through a brain autopsy. So what's been reported about Craig is a vascular dementia diagnosis, paired with his own and his doctor's acknowledgment that a football-related contribution is medically plausible, not a confirmed second diagnosis. That distinction matters medically, and it says something important about brain injury generally. A lot of people living with its long-term consequences will never get a single clean word that explains everything that happened inside their skulls.
Can a Concussion Increase the Risk of Dementia Years Later?
Craig's story isn't an isolated theory about one man's health. One of the largest studies to date, a review of nearly 2.8 million patient records in Denmark published in The Lancet Psychiatry, found that people with any history of TBI had a 24% higher overall risk of developing dementia than people with no such history. The increase wasn't limited to severe injuries. A single TBI classified as severe raised the risk by 35%, but even a single mild TBI, a concussion, raised it by 17%. Separate research published in the journal Neurology found that a TBI history specifically raises the risk of vascular dementia more than it raises the risk of Alzheimer's disease on its own, which lines up with exactly what Craig's neurologist described.
This is where Shanahan's "just words" comment and Craig's diagnosis meet. A "mild" traumatic brain injury isn't only something to get through this season, or even this year. The research increasingly shows it can leave a mark decades later, which is exactly why a serious brain injury claim should account for a client's whole future, not just their next follow-up appointment.
Why Brain Injuries Can Be Serious Even When CT and MRI Scans Are Normal
Whether the timeline is weeks or decades, this is where Shanahan's press conference, Craig's diagnosis, and my daily work overlap almost exactly. I've represented people whose CT scans and MRIs came back "normal" after a serious crash, while they sat across from me struggling to find words, forgetting appointments they'd never have missed before, or describing headaches that hadn't let up in months. Insurance adjusters and defense attorneys have learned to lean on that gap. If the imaging looks clean, they argue, how bad could it really be?
That argument has always been medically backward. CT and MRI scans are built to catch structural damage: bleeding, swelling, fractures. They were never designed to measure whether someone's working memory or processing speed still functions the way it did before the crash. A functional injury can be completely real and invisible to that kind of scan.
That gap is starting to close. Earlier this month, the FDA granted 510(k) clearance to a new software platform that objectively measures brain function using EEG and event-related potentials, essentially the brain's electrical response while a patient performs standardized cognitive tasks, compared against a large database of neurologically healthy adults. We wrote about it in a previous article, A New Tool for Proving the "Invisible Injury": FDA Clears Objective Brain Function Testing for TBI Cases.
For the first time, there's an FDA-cleared, quantifiable way to document the kind of cognitive impairment that clients have been describing to us for years without a scan to back it up. It won't replace neuropsychological testing or a treating physician's judgment, and courts will need time to work through questions of admissibility. But it's a meaningful step toward proving injuries that have too often been waved away for lack of a visible mark.
Brain Injury Symptoms Worth Taking Seriously
Whether it happened in a car accident, a fall, a bike crash, or a blow at work, these are the symptoms we tell clients and their families not to ignore, especially if they show up or worsen in the hours and days after the incident:
- Headaches that are new, worsening, or unusually persistent
- Fatigue that feels disproportionate to the day
- Trouble concentrating, following conversations, or finding words
- Problems with simple math
- Memory problems
- Memory gaps, especially for recent events
- Sensitivity to light or noise
- Irritability, mood changes, or feeling "not like yourself"
- Dizziness, balance problems, or nausea
- Sleep that's suddenly much heavier or much harder to get
None of these require a loss of consciousness to matter, and none of them require a visible head wound. Many of our clients never blacked out at all.
What to Do After a Possible Concussion or Brain Injury
- Get evaluated, even if you feel "fine." Brain injury symptoms can take hours or days to fully surface. Adrenaline is very good at masking a headache.
- Say everything to the doctor, not just the big things. Mention the fatigue, the fogginess, the irritability, not only the headache. These details matter later, and they matter for your care right now.
- Follow up if symptoms linger. If two weeks pass and you're still not right, that's not something to push through quietly. Go back.
- Keep a simple symptom log. A few lines a day about headaches, sleep, concentration, and mood are often more persuasive later than anyone expects, and they're more reliable than trying to reconstruct them from memory months afterward.
- Talk to an attorney before you talk to the other side's insurance company. What you say in that first recorded statement can follow your case for years. A free consultation costs you nothing and commits you to nothing.
A Brain Injury Attorney’s Perspective on the Long-Term Impact of TBI
I didn't need Kyle Shanahan's press conference, or Roger Craig's diagnosis, to know that "mild" is a word that hides more than it reveals. I've sat with too many clients who were handed that word by a doctor, a claims adjuster, or a well-meaning friend, and then spent the next year, or the next decade, proving it wrong. What strikes me about both of these stories isn't the football context. It's how much of the truth about a brain injury only reveals itself with time — for Shanahan, within weeks; for Craig, only after decades.
Most of our clients don't have a broadcast camera or a team of specialists tracking their recovery. They have a headache, a foggy week, a clean scan, and a claims adjuster telling them that "clean" means "fine." Now, increasingly, research tells us that even that "clean," "mild" injury may carry a cost that doesn't show up for years. Our job is to make sure none of that gets lost. Your injury may be invisible on a scan today, and its full cost may not be knowable for decades, but neither one of those things means it isn't real, and neither one means it can't be accounted for in your case.
When to Talk to a Traumatic Brain Injury Attorney
If you've hit your head in a crash, a fall, or any incident caused by someone else's negligence, and something still doesn't feel right, even weeks later, with a normal scan, we'd like to hear what happened. The same is true if you're watching a parent or a loved one decline cognitively years after a head injury, and you're wondering whether the two are connected.
Claude Wyle and Choulos, Choulos & Wyle have represented Bay Area individuals and families in traumatic brain injury cases for decades. Claude works with medical specialists to help document the immediate and long-term effects of brain injuries that may not be apparent on standard imaging. If you or a loved one is dealing with a possible TBI after an accident caused by someone else, call us at (415) 432-7290 or request a case consultation online. There’s no fee unless we recover on your behalf.
Frequently Asked Questions About Concussions and Traumatic Brain Injury
Is a concussion the same thing as a traumatic brain injury? Yes. A concussion is classified medically as a mild traumatic brain injury. "Mild" describes the initial injury mechanism, not how serious the symptoms or recovery will be.
Can a brain injury be serious even if my CT scan or MRI is normal? Yes. Standard imaging is designed to detect structural damage, such as bleeding or fractures. It often cannot detect the functional changes, such as slowed processing speed or memory difficulty, that follow a concussion or mild-to-moderate TBI. A normal scan doesn’t mean there is no injury.
How long do concussion symptoms usually last? Many people recover within one to two weeks, but others experience symptoms for months, sometimes called post-concussion syndrome. There's no way to predict which group someone falls into from the initial diagnosis alone.
Why do insurance companies dispute mild traumatic brain injury claims so often? Because the injury frequently doesn't appear on standard imaging, insurers and defense attorneys often argue that a normal scan means there's no real injury. This is a documentation gap, not proof that the injury doesn't exist, and it's exactly the gap that treating physicians, neuropsychological testing, and newer tools like FDA-cleared brain function testing are designed to close.
Do I need a lawyer for a concussion from a car accident? Not every minor bump requires legal help. But if your symptoms last more than a week or two, if the accident was someone else's fault, or if an insurance company is downplaying your injury because your scans "look fine," it's worth a free consultation to understand your rights before you say anything else to their insurer.
What should I say to my doctor after a possible head injury? Describe every symptom, not just the most obvious one. Headaches, fatigue, trouble concentrating, irritability, and sleep changes are all relevant, even if they seem minor compared to a headache or a visible injury elsewhere.
What is vascular dementia? Vascular dementia is a form of dementia caused by reduced blood flow to the brain, often from a stroke or a series of smaller, unnoticed "mini" strokes. It's considered the second most common type of dementia in North America and can affect memory, decision-making, processing speed, and spatial awareness.
What is mixed dementia? Mixed dementia means a person has brain changes associated with more than one type of dementia at the same time, most commonly vascular dementia alongside Alzheimer's disease, or, in people with a history of repetitive head trauma, alongside chronic traumatic encephalopathy (CTE). Because CTE can currently only be confirmed after death, mixed dementia involving CTE is usually a possibility a doctor raises rather than a diagnosis they can confirm during a patient's lifetime.
Can a past concussion or brain injury raise my risk of dementia later in life? Research increasingly says yes. A study of nearly 2.8 million patients found that a history of traumatic brain injury raised overall dementia risk by 24%, with even a single mild TBI, a concussion, raising the risk by 17%. This is one reason a brain injury claim should account for long-term, not just immediate, consequences.
This blog post is for general informational purposes only and doesn't constitute legal or medical advice, and it doesn’t create an attorney-client relationship. The description of Kyle Shanahan's accident and recovery is based on his own public statements as reported by Yahoo Sports/Roundtable Sports. The description of Roger Craig's diagnosis is based on reporting by KLIN News, including statements attributed to Dr. Matthew Purbaugh of Bryan Neurology. Choulos, Choulos & Wyle has no relationship with Mr. Shanahan or Mr. Craig and is not suggesting that either individual requires or is seeking legal representation. If you have questions about a specific injury or potential case, please contact our office directly for a free consultation.
