Traumatic Brain Injury

While some signs and symptoms of traumatic brain injury are overt and easy to spot, others are more difficult to detect. TBI symptoms also vary depending on the severity and location of the damage.

Common signs and symptoms of a mild traumatic brain injury, such as a concussion, include:

• Dizziness
• Headache
• Confusion
• Lightheadedness
• Blurred vision
• Fatigue or lethargy
• Ringing in the ears

Other symptoms can include changes in personality and behavior, difficulty with memory and concentration, and disruptions to one’s typical sleep patterns.

In addition to the above symptoms, individuals with moderate and severe TBIs may experience:

• Nausea and vomiting
• A persistent headache, or one that continues to worsen
• Seizures or convulsions
• Extreme sleepiness
• Speech changes (including slurring or difficulty recalling words)
• Loss of coordination
• Confusion, restlessness, or agitation
• Weakness or numbness in the arms, legs, hands, or feet
• Pupil dilation in one or both eyes

If you or a loved one has suffered a head injury and is experiencing any of the above symptoms, seek out medical attention as soon as possible. Even mild brain injuries are serious and should be evaluated by a qualified medical professional.

In order to diagnose a traumatic brain injury and assess its severity, medical professionals will gather information about the nature and cause of the injury. In many cases, they may also conduct brain imaging tests and a physical examination.

Prompt medical attention is crucial in assessing and treating potential TBIs. Medical professionals assessing someone for a potential TBI may need to know:

• How the injury occurred
• If the injured person lost consciousness (and for how long)
• Information about the severity of the injury or traumatic event
• Whether the injured individual experienced whiplash or other jarring movements
• If the injured person has experienced changes in alertness, coordination, cognition, or communication

The Glasgow Coma Scale is a test often given to people who have suffered a traumatic brain injury. It scores brain injury severity on a scale of 3 to 15 points, with a higher score indicating less severe injury. Doctors and emergency medical responders administer this test to assess a person’s level of consciousness and awareness following a traumatic event. This may involve evaluating verbal responses, motor responses, and a person’s ability to open their eyes and maintain focus and visual contact.

In addition to this initial assessment, doctors will likely order brain imaging tests like CT scans and MRIs to assess the damage sustained during and after an injury. Additionally, a doctor may want to track swelling by inserting an intracranial pressure monitor probe into the injured person’s skull. Depending on the cause and nature of the brain injury, doctors may also order X-rays of the neck and skull to check for fractures or spinal damage.

Treatments for traumatic brain injury initially focus on stabilizing the individual and preventing risk of further injury. Immediately following the injury, doctors will closely monitor blood pressure, blood flow, and brain oxygen levels until the person’s condition is deemed stable. Some people recovering from TBI will require surgery. Surgery is typically performed to repair ruptured blood vessels in the brain (known as hematomas) or bruised brain tissue (known as contusions).

If brain damage is severe, doctors may also recommend starting rehabilitation treatments soon after the initial injury. While little can be done to reverse brain damage incurred by the initial traumatic event, many people with TBI do make progress with skilled therapy and individualized treatment programs.

A rehabilitation program for traumatic brain injury may include:

• Physical therapy
• Speech and language therapy
• Occupational therapy
• Caregiver training

Rehabilitation for TBI focuses on promoting an individual’s return to their highest level of independent function. Therapists and medical professionals will also consider factors like ongoing safety and quality of life when working with people recovering from traumatic brain injuries. Because all brain injuries are different, recommended TBI treatment plans will depend on the type and severity of a person’s injury, their overall health, and the degree of any resulting impairments.

A traumatic brain injury treatment plan may address:

• Self-care skills
• Cognitive skills (including reasoning, attention, problem solving, and safety awareness)
• Communication
• Mobility
• Pain management
• Family and caregiver support and education

Because recovering from a traumatic brain injury is a long and involved process, an individual may progress through many levels of care with the goal of returning to their prior level of function and place of living if possible. This may start with acute care in a hospital setting and then progress to subacute rehabilitation, followed by rehabilitation in skilled nursing or other inpatient facilities. After that, individuals may return home and continue to receive in-home therapy services or attend day-treatment programs if warranted.

Many active, ongoing research efforts seek to better understand the causes, effects, and potential treatment options for traumatic brain injury. The National Institute of Neurological Disorders and Stroke (NINDS) is currently focused on preventing and mitigating the damage that occurs following a TBI-related event.

Through our Next Generation Research Grants, the American Brain Foundation has funded important research into traumatic brain injury. Holly Hinson, MD, MCR, FAAN, was awarded a Next Generation Research Grant in 2012 for research into a previously undefined syndrome now known as paroxysmal sympathetic hyperactivity or sympathetic storming. Dr. Hinson’s American Brain Foundation-funded research has already helped to classify and identify patients with traumatic brain injuries who are at increased risk for developing this syndrome.