Frequently Asked Questions

Brain Injury

There are three (3) broad classifications of brain injury:

  • ​Mild;
  • Moderate, and
  • Severe.

Each of these have their own medical definitions according to the symptoms associated with each. A patient with a Mild Traumatic Brain Injury is a person who has had a traumatically-induced physiological disruption of brain function, as manifested by at least one of the following:

  1. Any period of loss of consciousness;
  2. Any loss of memory for events immediately before or after the accident;
  3. Any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused); and
  4. Focal neurological deficit(s) which may or may not be transient; but where the severity of the injury does not exceed the following:
    • Loss of consciousness of approximately 30 minutes or less;
    • After 30 minutes, an initial Glasgow Coma Scale score of 13-15; and
    • Post Traumatic Amnesia not greater than 24 hours.

This definition, widely accepted in the medical community, was developed by the American Congress of Rehabilitation Medicine, and is often used (and misused) by clinicians and treating physicians. It should be noted there is nothing “mild” about a mild traumatic brain injury. They can be – and many times are – significantly disabling.

It is important to know that you don’t have to be hit on the head or strike your head on something to have a mild traumatic brain injury. You can sustain a MTBI by undergoing a rapid acceleration/deceleration movement (i.e., whiplash) of the brain. It is the application of such forces to the brain, rather than the head per se, that produces the damage.

Symptoms can include:

  • Headaches;
  • Dizziness;
  • Memory Loss;
  • Inability to retain and retrieve information;
  • Forgetfulness
  • Slowed through process;
  • Difficulty in multitasking;
  • Spatial Disorientation;
  • Blurred Vision;
  • Hearing Loss;
  • Sound Sensitivity;
  • Loss of Sense of Taste or Smell;
  • Personality Changes; and
  • Insomnia.

Yes, basically.  You will see these terms used interchangeably to reference and describe the same thing.  The symptoms are considered the same.  When symptoms of a concussion or MTBI become chronic, that condition is referred to as either a “post-concussion syndrome” or a serious mild traumatic brain injury.

It takes time to know for sure.  Following a blow to the head (or a rapid acceleration/deceleration to the brain, e.g., whiplash) that results in a MTBI (concussion), it generally takes about 3 months for the symptoms to resolve.  If you are still experiencing symptoms after 9 months to 1 year, your injury may be serious.  It is estimated that 15% of people who sustain a concussion will have persistent problems after one year.

Moderate to severe traumatic brain injuries can include any of the signs and symptoms of a mild brain injury, as well as these symptoms that may appear within the first hours to days after a head injury:

  • Physical Symptoms
  • Loss of consciousness from several minutes to hours;
  • Persistent headache or headache that worsens;
  • Repeated vomiting or nausea;
  • Convulsions or seizures;
  • Dilation of one or both pupils of the eyes;
  • Clear fluids draining from the nose or ears;
  • Inability to awaken from sleep;
  • Weakness or numbness in fingers and toes; and
  • Loss of coordination.
  • Cognitive or Mental Symptoms
  • Profound confusion;
  • Agitation, combativeness or other unusual behavior;
  • Slurred speech; and
  • Coma and other disorders of consciousness.

Yes.  Head injuries are classified into two broad categories.  They are either penetrating or closed.  Penetrating head injuries involve some sort of projectile, like a bullet, shrapnel or sharp object, that pierce the skull and have direct contact with the brain.  A closed head injury is when the brain is injured without a projectile being involved through a blunt force trauma like a blow to the head or a violent shaking or twisting of the brain inside the skull.

Yes.  Brain injuries are broadly classified as primary or secondary.  Primary brain injuries occur at the moment of trauma.  Secondary brain injuries, which occur later, involve complex reactive processes set in motion by primary injuries.  For more detailed information on primary and secondary brain injuries, check out our blog articles Primary Brain Injuries, Second Brain Injuries, and Excitotoxicity.

Because the human brain is so complicated, it’s extremely difficult to predict the long-term effects of any traumatic brain injury (TBI). Most cases of mild TBI will resolve over a course of time with minimal problems. In the case of more serious TBIs, a person can experience any number of changes over the course of months and years.

Many people with TBI have problems with basic cognitive skills. It’s hard for them to pay attention or concentrate, and they might have trouble learning new material. A TBI can also make you think more slowly, or cause you to get easily confused. People with TBI can have memory problems with both creating new memories (encoding) and recalling things (retrieval). Even insight – the ability to clearly perceive a situation – can be affected. People with TBI may become impulsive, or develop unusual habits. Things that were once easy – like talking and listening – may become difficult or impossible. Their thoughts can wonder and they may have a hard time focusing. For this reason, conversations may be difficult at times.

Because the brain regulates our emotional and psychological lives, TBI can substantially alter your sense of mental wellness. The TBI might cause a personality change, or introduce mental problems. A person with TBI may have mood swings, depression, irritability, aggression, or disinhibition.

Vision problems are a common side effect of TBI, as are changes in your other senses: smell, taste, touch, and hearing. Problems with balance, vertigo, and ringing in the ears are also common. In a small percentage of cases, seizures occur as a result of TBI and may involve a loss of consciousness and muscle contractions. Anticonvulsive drugs or surgical intervention may help to prevent or slow seizure activity.

In severe cases that affect the brain’s most basic functions, fundamental abilities can be altered or inhibited. Paralysis or spasticity (muscle tightening) can affect a person’s ability to move, swallow, or breathe. Digestive problems can arise, and hormonal changes may result. Women with TBI often experience menstrual difficulties.

There are a number of different medical specialists that diagnose and treat brain injuries.  At the onset, we suggest you see a neurologist.  Not every neurologist specializes in brain injuries, however.  You need to find one who does.  We can help put you in touch with a good neurologist in your area.  Your primary care physician may also be able to refer you to a neurologist, but again, you need to make sure the neurologist treats brain injuries.  If you think you have a brain injury, you should see a neurologist as soon as possible.

As soon as the injury occurs, most people should receive care in a medical center that specializes in trauma care. If the examining doctor believes that the injury is a mild TBI, the patient is typically evaluated and tested and possibly discharged with the appropriate recommendations for follow-up care. Patients are told to immediately report any worsening of symptoms.

In the case of moderate and severe TBI, individuals may transition into surgery, intensive care, acute care, or any combination of the three. Specialists at every state of treatment should be available to recommend subsequent stages of treatment. Once the person is medically stable, helpful treatment options may include the following:

  • ​Acute rehabilitation programs;
  • Post-acute rehabilitation centers;
  • Sub-acute care through a skilled nursing facility;
  • Long-term care/supervised living for slow-to-recover patients;
  • Coma stimulation programs;
  • Residential facilities that specialize in TBI;
  • Outpatient rehabilitation;
  • Day treatment programs;
  • Neuropsychological Testing;
  • Neurological medication management;
  • Epilepsy treatment centers;
  • Neurobehavioral management programs; and
  • In-home treatment provided by medical professionals.

Neurologists: Neurologists are doctors who are trained in the diagnosis and treatment of nervous system disorders. These can include diseases of the brain, spinal cord, muscles, and nerves.

Physiatrists: Physiatrists are medical experts in rehabilitation medicine. They typically oversee the rehabilitation process.

Occupational, Physical, Speech and Language Therapists: These therapists work with a person with TBI to regain cognitive and communication skills, physical abilities, and behavioral skills.

Vocational Rehabilitation Experts: These experts are employment coaches who help with regaining job skills.

Behavioral Analysts: These specialists create strategies for dealing with behavioral problems.

Neuropsychologists: These specialized psychologists focus on thinking skills and behavior problems.

Case Managers / Care Coordinators: Case Managers / Care Coordinators assist people in finding and accessing needed programs and services.

Yes, there are many differences.  In general, children are more susceptible to traumatic brain injuries than adults.  This is because their brains, and brain support systems, are not fully formed and are therefore more fragile.  And often, because a child has yet to develop language skills, it is difficult to know if they have suffered a head injury.  There are signs and symptoms a parent can look for.  If you suspect your child has sustained a head injury, seek medical care immediately.  For more detailed information on brain injuries to children you can check out our blog article, Pediatric Traumatic Brain Injuries, where many of the symptoms of brain injury in small children are listed.


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