Symptoms of Brain Injury

Traumatic brain injury (TBI) victims and their families face devastating emotional and physical challenges.  Overlooked traumatic brain injury symptoms compound these challenges.  Traumatic brain injury symptoms can be subtle and go undiagnosed and untreated.  Over time, untreated brain injury can lead to further brain injury damage, disability, or even death.

Traumatic brain injury can have wide-ranging physical and psychological effects.  Some signs or symptoms may appear immediately after the traumatic event, while others may appear days or weeks later.

There are four major categories of brain injury symptoms:

• Cognitive – difficulty processing information, in expressing thoughts, and understanding others, shortened attention span, inability to understand abstract concepts, impaired decision making ability, and memory loss.
• Perceptual – change in vision, hearing, or sense of touch, spacial disorientation, inability to sense time, disorders of smell and taste, balance issues, and heightened sensitivity to pain.
• Physical – persistent headaches, extreme mental fatigue, extreme physical fatigue, paralysis, tremors, seizures, sensitivity to light, sleep disorders, slurred speech, and loss of consciousness.
• Behavioral/Emotional – irritability and impatience, reduced tolerance for stress, sluggishness, flattened or heightened emotions or reactions, denial of disability, and increased aggressiveness.

Mild Traumatic Brain Injury

Mild TBI symptoms are especially subtle and varied.  Victims may lose consciousness for only a few seconds or minutes, or may not lose consciousness at all.  In fact, a mild brain injury victim may be temporarily dazed or remain completely awake.  Mild traumatic brain injury symptoms may not be immediately apparent.  Since the brain swelling that causes many of these symptoms is often gradual, days or weeks can pass before symptoms appear.

Moderate to Severe Traumatic Brain Injury

Moderate to severe traumatic brain injury symptoms are more pronounced.  Moderate to severe traumatic brain injury victims may experience symptoms such as headache that worsens or does not go away, loss of consciousness more than 20 minutes, vomiting, loss of bowel control, slurred speech, memory loss, convulsions, seizures, paralysis, and or numbness in the limbs.  Bleeding in the head is also common and can be measured by an MRI or CT scan.  Even when treated, intracranial bleeding (ICP) can lead to long term complications or death.  Moderate to severe brain injury victims often lose consciousness, and some do not regain consciousness.  Brain injury victims can remain unconscious for days or even weeks before responding to stimuli.

When the pressure within the skull (intracranial pressure) rises too high, it can be deadly.  Signs of increased ICP include decreasing level of consciousness, paralysis or weakness on one side of the body, and a blown pupil, one that fails to constrict in response to light or is slow to do so.  Cushing’s triad, a slow heart rate with high blood pressure and respiratory depression is a classic manifestation of significantly raised ICP.

Common long-term symptoms of moderate to severe TBI are changes in appropriate social behavior, deficits in social judgment, and cognitive changes, especially problems with sustained attention, processing speed, and executive functioning.  Alexithymia, a deficiency in identifying, understanding, processing, and describing emotions occurs in 60.9% of individuals with TBI.  Cognitive and social deficits have long-term consequences for the daily lives of people with moderate to severe TBI, but can be improved with appropriate rehabilitation.

Small children with moderate to severe TBI may have some of these symptoms but have difficulty communicating them.  Other signs seen in young children include persistent crying, inability to be consoled, listlessness, refusal to nurse or eat, and irritability.

It can be difficult to recognize symptoms of mild, moderate, or severe traumatic brain injury.  Subtle symptoms can conceal serious brain damage, so immediate medical care is crucial to diagnose, treat, and cope with traumatic brain injury.