What usually happens after a brain injury?

The human brain controls everything we do, including breathing, walking, talking, thinking, behaving and feeling. Unlike a bone that can break and heal, our brains can be injured and not repair themselves. While up to 80% of mild brain injuries, such as concussions, can resolve in 2-3 weeks, some mild and more severe brain injuries usually have lifelong consequences that affect an individual on a day to day basis.

The type of brain injury depends upon the severity of the injury, age at the time of injury, and the symptoms that become present following the injury. The brain injury severity can be mild, moderate, or severe. 

Mild Traumatic Brain Injury 

 

This includes the following types of injuries: A strong, forceful blow or jolt to the head or body. For example, falls, whiplash from a car accident, assaults and fights, being struck as a pedestrian, bicycle crashes, and others. Mild traumatic brain injury may affect your brain cells temporarily and cause changes in thinking, motor skills, sensation, language (speech), or emotions.

Common symptoms of a minor head injury include:

 

If an individual sustains a mild injury such as whiplash in a car accident, a sudden bump to the head by an object (i.e. a cabinet door, a bat or ball, etc.) the individual that has been injured should alert a friend or family member to what has happened and have them inspect the area that was affected. Check for bruising, swelling, and anything that may look different. Assess the level of pain (on a scale of 1 to 10, how severe is the pain). The best thing to do is sit down in a comfortable place, place an icepack on the affected area and contact your general physician (if it is after hours, call to speak to that physician with "an emergency" and have the physician contact you directly. Tell a friend or family member what has happened (call them if they are not with you in person). 

Once you have spoken to your physician and given them a description of what has happened, ask your doctor what should be done next. In some cases, a physician will want to schedule an appointment to see you asap and in other cases, a physician might advise you to go to an emergency room at a hospital. If you have an evaluation done by your physician, they will assess your head injury using the Glasgow Coma Scale (GCS). The GCS is a 15-point test that assesses your mental status. A high GCS score indicates a less severe injury. A low GCS score indicates a more severe injury. They may order CT scans and additional MRI scans of your brain to be completed at an out-patient clinic in order to diagnosis the condition, or if you check into a hospital, they typically have CT scans done after you are evaluated by a doctor on staff (typically a trained neurologist). They may also require you to have MRI imaging done as well. Your general physician may also refer you to see an out-patient neurologist to have an evaluation completed by him or her. The results of the CT scans (and MRI, if needed) will determine 1) the severity of the brain injury, and 2) the type of treatment you will need from that point going forward.  


 

 

A moderate TBI is when a person experiences changes in brain function for longer than a few minutes following trauma. Symptoms may similar to a mild TBI, but the symptoms do not go away or may even get worse. Moderate traumatic brain injuries may be caused by falls, motor vehicle collisions, accidents in the workplace (for example, while operating machinery), assault, contusion which is a bruise (bleeding) on the brain or caused by a bump, blow, or jolt to the head or by a penetrating injury or a penetrating injury (caused by a gunshot for example). This type of injury may lead to long-term or life-long health problems that may affect all aspects of a person’s life. 

Common symptoms of a moderate  head injury include those of a mild injury as well as:
  • A headache that gets worse or does not go away

  • Repeated vomiting or nausea

  • Convulsions or seizures

  • Not being able to wake up from sleep

  • Larger than normal pupil (dark center) of one or both eyes. This is called dilation of the pupil.

  • Slurred speech

  • Weakness or numbness in the arms and legs

  • Loss of coordination

  • Increased confusion, restlessness, or agitation


If an individual sustains a moderate injury such as a sudden fall to the ground, a car accident that has jolted them forward hitting the steering wheel, the best way to handle this is for them to be taken to a hospital immediately. In the hospital, a nurse can assess the level of pain, the severity of the injury, and obtain important information from you to give to the hospital staff about the severity of your injury. The most important thing that an individual's friends & family members can do is try to be as thorough in describing what happened to the individual that sustained the injury and try not to leave out important details, such as how it happened, what caused it to happen, where was the individual at the time of the injury, and what types of symptoms presented in the individual immediately after the injury.
If a head injury causes loss of consciousness, even briefly, immediate evaluation by a doctor is necessary. If doctors observe symptoms or findings that indicate possible brain injury, computed tomography (CT) or sometimes magnetic resonance imaging (MRI) is done. CT is usually done first because it can detect accumulated blood (hematomas), bruises (contusions), skull fractures, and sometimes widespread nerve damage (diffuse axonal injury). MRI may be useful later to check for diffuse axonal injury, injury to the brain stem (which controls levels of consciousness and vital body functions), and less obvious brain injuries. MRI can also help doctors predict prognosis.
 
If you are involved in a brain injury and are taken to the hospital or urgent care, it is very important to describe the symptoms you are experiencing to the attending physician and all other hospital staff. For example, what feels different? Where do you feel any pain? Are your thoughts still cohesive? Can you see things the way you normally do? Are you having problems remembering what happened? While you are in the hospital, if you are alone, ask a nurse to call a member of your family or friend to come visit you in the hospital with you.

Typically, a physician will perform a neurological exam and order CT scans and possibly an MRI to assess the severity of trauma to your brain . The physician or neurologist will make a determination for treatment based upon an individual's presenting symptoms, neurological exam, and what information the  CT scans reveal. The physician may require you to stay overnight in the hospital for an indefinite period of time. 


This includes the following types of injuries: motor vehicle accidents, sports injuries, major impacts to the head, assault, gunshot wounds through the head, military blasts, head on collisions, stroke, aneurysm, and other causes. 
 

People may have some of the same symptoms as occur with minor head injury. Some symptoms, such as headache, may be more severe. Also, symptoms often start with a period of unconsciousness that begins at the time of impact. How long people remain unconscious varies. Some people awaken in seconds, while others do not awaken for hours or even days. On awakening, people often are drowsy, confused, restless, or agitated. They may also vomit, have seizures, or both. Balance and coordination may be impaired. Depending on which area of the brain is damaged, the ability to think, control emotions, move, feel, speak, see, hear, and remember may be impaired—sometimes permanently.

Common symptoms of a severe head injury include

These injuries almost always require immediate hospitalization and neurological exam and evaluation done by a physician and/or neurologist on staff. Physicians and nurses will assess a person's vitals, review the information obtained during the patient's intake, and gather specific information from friends, co-workers, and/or family members, about how the injury occurred and what happened immediately following that. Physicians may order immediate neurosurgery or postpone surgery while keeping the individual stable overnight and checked in for an indefinite period of time. CT scans are done as soon as possible to assess the severity of the injury and the locations in the brain that have been adversely affected. Treatment is determined by the evaluation performed by the attending physicians and the results of the individual's CT scans. Physicians may also contact family members and friends with relevant questions in order to gather more information about the patient (which would include assessing their physical and mental health prior to injury). Typically, hospital staff will contact an individual's closest family members and/or friends for information and support for the patient. 

 

Moderate Traumatic Brain Injury

Severe Traumatic Brain Injury