Acute and Long-Term Symptoms of Brain Injury

According to the Centers for Disease Control, an estimated 5.3 million Americans are living with disability due to a traumatic brain injury.

There is a wide spectrum of the possible severity of traumatic brain injuries.  Mild injuries—sometimes referred to as concussions—may be due a blow to the head during sports or recreational activity and only result in a brief change in mental status.  More severe injuries may be due to rapid acceleration/deceleration movements of the head in a high-speed motor vehicle accident or due to a penetrating injury from a bullet or other weapon.  Severe injuries often result in an extended period of unconsciousness and amnesia. Every person is different, but a traumatic brain injury has the potential to lead to short- or long-term disability and suffering.

Acute Symptoms

If someone you know has sustained a traumatic brain injury, it’s important that you contact a physician, go to the emergency room or call 911. While it is fairly obvious that an individual suffering from a severe brain injury needs to go to the hospital as soon as possible, individuals who have suffered a mild brain injury are often sent home after a visit to the ER or a discussion with a health care practitioner. Many people may have been told it is dangerous to fall asleep after a concussion. While sleep itself is not dangerous, it may mask the onset of signs suggestive of bleeding within the skull that would necessitate immediate medical evaluation in the emergency room after an injury.  Within the next 12 to 24 hours after a concussion, a friend or family member should stay with the individual and monitor him or her for concerning signs, waking the individual at least at regular one- to two-hour intervals, should the individual decide to go to bed. Some concerning signs include:

• Increasing confusion and decreased responsiveness
• Dilated or unequal pupil size
• New onset of weakness or changes in sensation (numbness or tingling)
• New difficulty speaking
• New changes in vision such as double vision, decreased eye movement or decreased vision
• Nausea and vomiting
• Increasing or severe headache
• Seizure/convulsion
• Any other new, concerning symptom

Other symptoms that may be present include:

• Dizziness/balance problems
• Lethargy/tiring easily
• Ringing in the ears, or changes in ability to hear
• Difficulty with thinking skills, memory and attention span
• Inappropriate emotional responses and irritability

It is also recommended that the individual take a break from mental or physical stress until symptoms resolve and that alcohol be avoided.  Though symptoms of concussion usually resolve after several weeks, there is a minority of individuals who continue to experience symptoms. It’s important that you follow up with a health care provider if these signs and symptoms appear:

• Headaches or neck pain that do not go away
• Difficulty remembering, concentrating or making decisions
• Slowness in thinking, speaking, acting or reading
• Getting lost or easily confused
• Feeling tired all of the time, having no energy or motivation
• Mood changes (feeling sad or angry for no reason)
• Irritability (having a low tolerance for frustration)
• Changes in sleep patterns (sleeping a lot more or having a hard time sleeping)
• Light-headedness, dizziness or loss of balance
• Increased sensitivity to lights, sounds or distractions
• Blurred vision or eyes that tire easily
• Loss of sense of smell or taste
• Ringing in the ears

Your health care provider can refer you to specialists who can determine the extent of the brain injury, provide therapy to maximize function and share other resources such as support groups. Getting help soon after the injury by trained specialists may speed recovery.

Long-Term Effects and Treatment Options

How a traumatic brain injury affects someone depends on the type and extent of the injury. Some patients recover completely; others have effects that are life-long.

The goal of the rehabilitation process is to develop a treatment plan unique to a person’s situation, needs and goals, with the ultimate goal being to help a person regain as much independence as possible. Treatment options can include inpatient rehabilitation for those with more severe disabilities or outpatient therapy for those less severely affected.  Physical therapists work on mobility, occupational therapists assist in activities of daily living (ADLs), and speech therapists work on language, thinking and swallowing dysfunction.  Community re-entry programs, day programs, pain and headache management, neuropsychology services and support groups may also be utilized to help the individual achieve maximal independence and relief of symptoms.

The following is a list of the long-term effects of brain injury.

Arousal

• Disorders of consciousness: coma, vegetative state, minimally conscious state
• Lethargy, daytime sleepiness
• Insomnia

Cognitive

• Decreased memory and new learning
• Decreased attention and speed of processing
• Decreased judgment, insight, and planning

Communication

• Decreased language abilities (understanding another’s speech or finding words)
• Decreased speech abilities to articulate words so that others understand

Behavioral

• Depression and anxiety
• Irritability and explosive anger
• Impulsivity

Sensory

• Visual disturbance
• Decreased balance and vertigo
• Decreased hearing

Pain

• Chronic headache
• Muscle and joint pain from trauma at the time of injury
• Burning/electric type pain  from nerve dysfunction

Motor

• Weakness
• Decreased coordination
• Spasticiity: An abnormally increased reflex after aquired brain injury that causes loss of range of motion and contracture over time.

Bowel/Bladder

• Incontinence from decreased awareness of when to toilet or decreased mobility to reach the toilet in time.

A traumatic brain injury can be life-changing. But arming yourself with knowledge and understanding can help you and your family better cope with these life changes.