Symptoms

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.
Mild traumatic brain injury

The signs and symptoms of mild traumatic brain injury may include:
Physical symptoms

 Loss of consciousness for a few seconds to a few minutes

 No loss of consciousness, but a state of being dazed, confused or disoriented

 Headache

 Nausea or vomiting

 Fatigue or drowsiness

 Problems with speech

 Difficulty sleeping

 Sleeping more than usual

 Dizziness or loss of balance

Sensory symptoms

 Sensory problems, such as blurred vision, ringing in the ears, a bad taste in the mouth or changes in
the ability to smell
 Sensitivity to light or sound
Cognitive or mental symptoms

 Memory or concentration problems

 Mood changes or mood swings

 Feeling depressed or anxious

Moderate to severe traumatic brain injuries

Moderate to severe traumatic brain injuries can include any of the signs and symptoms of mild
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

 Loss of coordination
Cognitive or mental symptoms

 Profound confusion
 Agitation, combativeness or other unusual behavior

 Slurred speech

 Coma and other disorders of consciousness

When to see a doctor

Always see your doctor if you or your child has received a blow to the head or body that
concerns you or causes behavioral changes. Seek emergency medical care if there are any signs
or symptoms of traumatic brain injury following a recent blow or other traumatic injury to the
head.

The terms "mild," "moderate" and "severe" are used to describe the effect of the injury on brain
function. A mild injury to the brain is still a serious injury that requires prompt attention and an
accurate diagnosis.

Causes
Traumatic brain injury is usually caused by a blow or other traumatic injury to the head or body.
The degree of damage can depend on several factors, including the nature of the injury and the
force of impact.

Common events causing traumatic brain injury include the following:

  Falls. Falls from bed or a ladder, down stairs, in the bath and other falls are the most common cause
of traumatic brain injury overall, particularly in older adults and young children.
 Vehicle-related collisions. Collisions involving cars, motorcycles or bicycles — and pedestrians
involved in such accidents — are a common cause of traumatic brain injury.

 Violence. Gunshot wounds, domestic violence, child abuse and other assaults are common causes.
Shaken baby syndrome is a traumatic brain injury in infants caused by violent shaking.

 Sports injuries. Traumatic brain injuries may be caused by injuries from a number of sports,
including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other high-impact
or extreme sports. These are particularly common in youth.

 Explosive blasts and other combat injuries. Explosive blasts are a common cause of
traumatic brain injury in active-duty military personnel. Although how the damage occurs
isn't yet well-understood, many researchers believe that the pressure wave passing through
the brain significantly disrupts brain function.

Traumatic brain injury also results from penetrating wounds, severe blows to the head with
shrapnel or debris, and falls or bodily collisions with objects following a blast.

Risk factors
The people most at risk of traumatic brain injury include:

 Children, especially newborns to 4-year-olds

 Young adults, especially those between ages 15 and 24

 Adults age 60 and older

 Males in any age group

Complications
Several complications can occur immediately or soon after a traumatic brain injury. Severe
injuries increase the risk of a greater number and more-severe complications.
Altered consciousness

Moderate to severe traumatic brain injury can result in prolonged or permanent changes in a
person's state of consciousness, awareness or responsiveness. Different states of consciousness
include:

 Coma. A person in a coma is unconscious, unaware of anything and unable to respond to any
stimulus. This results from widespread damage to all parts of the brain. After a few days to a few
weeks, a person may emerge from a coma or enter a vegetative state.
  Vegetative state. Widespread damage to the brain can result in a vegetative state. Although
the person is unaware of surroundings, he or she may open his or her eyes, make sounds,
respond to reflexes, or move.

It's possible that a vegetative state can become permanent, but often individuals progress to
a minimally conscious state.

 Minimally conscious state. A minimally conscious state is a condition of severely altered

consciousness but with some signs of self-awareness or awareness of one's environment. It is
sometimes a transitional state from a coma or vegetative condition to greater recovery.

 Brain death. When there is no measurable activity in the brain and the brainstem, this is called
brain death. In a person who has been declared brain dead, removal of breathing devices will result
in cessation of breathing and eventual heart failure. Brain death is considered irreversible.

Physical complications

 Seizures. Some people with traumatic brain injury will develop seizures. The seizures may occur
only in the early stages, or years after the injury. Recurrent seizures are called post-traumatic
epilepsy.
 Fluid buildup in the brain (hydrocephalus). Cerebrospinal fluid may build up in the spaces in the
brain (cerebral ventricles) of some people who have had traumatic brain injuries, causing increased
pressure and swelling in the brain.

 Infections. Skull fractures or penetrating wounds can tear the layers of protective tissues
(meninges) that surround the brain. This can enable bacteria to enter the brain and cause infections.
An infection of the meninges (meningitis) could spread to the rest of the nervous system if not
treated.

 Blood vessel damage. Several small or large blood vessels in the brain may be damaged in a
traumatic brain injury. This damage could lead to a stroke, blood clots or other problems.

 Headaches. Frequent headaches are very common after a traumatic brain injury. They may begin
within a week after the injury and could persist as long as several months.

 Vertigo. Many people experience vertigo, a condition characterized by dizziness, after a traumatic
brain injury.

Sometimes, any or several of these symptoms might linger for a few weeks to a few months after
a traumatic brain injury. This is currently referred to as persistent post-concussive symptoms.
When a combination of these symptoms last for an extended period of time, this is generally
referred to as post-concussion syndrome.
Traumatic brain injuries at the base of the skull can cause nerve damage to the nerves that
emerge directly from the brain (cranial nerves). Cranial nerve damage may result in:

 Paralysis of facial muscles or losing sensation in the face

 Loss of or altered sense of smell

 Loss of or altered sense of taste

 Loss of vision or double vision

 Swallowing problems

 Dizziness

 Ringing in the ear

 Hearing loss

Intellectual problems

Many people who have had a significant brain injury will experience changes in their thinking
(cognitive) skills. It may be more difficult to focus and take longer to process your thoughts.
Traumatic brain injury can result in problems with many skills, including:
Cognitive problems

 Memory
 Learning

 Reasoning

 Judgment

 Attention or concentration
Executive functioning problems

 Problem-solving
 Multitasking

 Organization

 Planning

 Decision-making

 Beginning or completing tasks

Communication problems

Language and communications problems are common following traumatic brain injuries. These
problems can cause frustration, conflict and misunderstanding for people with a traumatic brain
injury, as well as family members, friends and care providers.

Communication problems may include:

Cognitive problems

 Difficulty understanding speech or writing

 Difficulty speaking or writing

 Inability to organize thoughts and ideas

 Trouble following and participating in conversations

Social problems

 Trouble with turn taking or topic selection in conversations

 Problems with changes in tone, pitch or emphasis to express emotions, attitudes or subtle
differences in meaning

 Difficulty understanding nonverbal signals

 Trouble reading cues from listeners

 Trouble starting or stopping conversations

 Inability to use the muscles needed to form words (dysarthria)

Behavioral changes

People who've experienced brain injury often experience changes in behaviors. These may
include:

 Difficulty with self-control

 Lack of awareness of abilities

 Risky behavior

 Difficulty in social situations

 Verbal or physical outbursts

Emotional changes

Emotional changes may include:

  Depression
 Anxiety

 Mood swings

 Irritability

 Lack of empathy for others

 Anger

 Insomnia

Sensory problems

Problems involving senses may include:

 Persistent ringing in the ears

 Difficulty recognizing objects

 Impaired hand-eye coordination

 Blind spots or double vision

 A bitter taste, a bad smell or difficulty smelling

 Skin tingling, pain or itching

 Trouble with balance or dizziness

Degenerative brain diseases

Research suggests that repeated or severe traumatic brain injuries might increase the risk of
degenerative brain diseases. But, this risk can't be predicted for an individual — and researchers
are still investigating if, why and how traumatic brain injuries might be related to degenerative
brain diseases.

A degenerative brain disorder can cause gradual loss of brain functions, including:

 Alzheimer's disease, which primarily causes the progressive loss of memory and other thinking
skills
 Parkinson's disease, a progressive condition that causes movement problems, such as tremors,
rigidity and slow movements

 Dementia pugilistica — most often associated with repetitive blows to the head in career boxing —
which causes symptoms of dementia and movement problems
Prevention
Follow these tips to reduce the risk of brain injury:

 Seat belts and airbags. Always wear a seat belt in a motor vehicle. A small child should always sit
in the back seat of a car secured in a child safety seat or booster seat that is appropriate for his or
her size and weight.
 Alcohol and drug use. Don't drive under the influence of alcohol or drugs, including prescription
medications that can impair the ability to drive.

 Helmets. Wear a helmet while riding a bicycle, skateboard, motorcycle, snowmobile or all-terrain
vehicle. Also wear appropriate head protection when playing baseball or contact sports, skiing,
skating, snowboarding or riding a horse.

Preventing falls

The following tips can help older adults avoid falls around the house:

 Install handrails in bathrooms

 Put a nonslip mat in the bathtub or shower

 Remove area rugs

 Install handrails on both sides of staircases

 Improve lighting in the home

 Keep stairs and floors clear of clutter

 Get regular vision checkups

 Get regular exercise

Preventing head injuries in children

The following tips can help children avoid head injuries:

 Install safety gates at the top of a stairway

 Keep stairs clear of clutter

 Install window guards to prevent falls

 Put a nonslip mat in the bathtub or shower

 Use playgrounds that have shock-absorbing materials on the ground

 Make sure area rugs are secure

  Don't let children play on fire escapes or balconies
A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic,"
"MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo
Foundation for Medical Education and Research.

© 1998-2019 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557

Traumatic Brain Injury

(TBI) and Concussion
WHAT IS TBI?

We are all increasingly aware of traumatic brain injury (TBI), whether through the news, media
or personal experience, but what exactly is TBI? TBI is a physical injury to the brain, which has
many causes including vehicle crashes, falls, assault, contact sports and military combat.
Because the brain supervises and controls almost all aspects of normal human function, physical,
psychological, hormonal or otherwise, injury to the brain (TBI) may result in a wide array of
medical, psychological and behavioral problems. While many symptoms, such as headache,
memory problems, difficulty concentrating and visual changes, are common among TBI patients,
rarely will two individuals experience exactly the same problems due to TBI.

TBI may occur when force is applied to the brain, either through a direct impact to the head or its
rapid acceleration and deceleration, as in whiplash. However, every blow to the head will not
necessarily result in TBI in every individual. Similarly, the severity of trauma to the head does
not necessarily determine the severity of a TBI, when it occurs.

TBI ranges in degree from severe to mild. The most severe cases may result in immediate or later
death of the patient. However, more than 75% of TBIs are mild and referred to
as concussion; concussion is also a physical injury to the brain. The good news about concussion
is that most patients recover over a relatively brief period of time. Some concussion patients,
however, will experience persistent problems related to their TBI. Multiple concussions may
increase the risk for long-term problems and have been linked to the development of delayed
brain degeneration.

TBI affects the brain in two major ways. First, actual bruising or tearing of brain tissue and
bleeding within or surrounding the brain may occur, with subsequent brain swelling (edema).
These injuries occur in more severe forms of TBI and are typically absent in mild TBIs. Second
is injury to microscopic nerve fibers (axons), which constitute the “wiring” that connects nerve
cells in the brain (neurons) to each other and to the rest of the body. This microscopic injury
leads to many of the persistent problems which TBI patients may experience.

HOW IS TBI DIAGNOSED?

TBI is a clinical diagnosis; no single test is able to definitively confirm the diagnosis of TBI.
Doctors assess the history of the injury, the patient’s symptoms, the physical examination and
additional tests, including neuroradiology, to confirm a diagnosis of TBI. Many TBI patients
experience a loss of consciousness (blacking out) at the time of their injury. Loss of
consciousness most commonly lasts from seconds to minutes, but in severe TBI may last for
days (coma) and in the most severe cases may persist indefinitely. Patients with mild TBI
(concussion) may not experience any loss of consciousness. Most TBI patients have some degree
of amnesia (loss of memory) for the minutes to hours or longer surrounding their injury.

HOW IS NEURORADIOLOGY USED IN THE DIAGNOSIS OF TBI?

Neuroradiology is an essential tool in the care of TBI patients. It plays two distinct roles
depending on the time at which the patient is assessed. In the period immediately after the
injury, CT scans are most commonly used to diagnose acute problems which may be life
threatening and require emergent treatment such as surgery. The CT scan is fast and widely
available. It is highly effective in detecting bleeding within and surrounding the brain
(hematomas) as well as brain swelling (edema), which may require emergency surgery. When
urgent surgery is not needed, repeat CT scans may be used to follow the resolution of injuries.
CT is much more limited in its ability to detect the widespread microscopic injury to axons
(nerve fibers) which leads to many of the long term problems experienced by TBI patients; it is
not unusual for the CT scan to be entirely normal in a patient with TBI. In fact, the CT scan is
typically normal in patients with milder TBI including concussion. CT scan is also effective for
detecting skull fractures, although these rarely require emergency treatment.

Following the acute period after TBI, neuroradiology is used to detect injury, especially
indications of microscopic injury to axons (nerve fibers), which can explain the persistence or
worsening of symptoms related to TBI. Magnetic resonance imaging (MRI) is a powerful
diagnostic tool that can detect signs of injury such as minute bleeding (microhemorrhage), small
areas of bruising (contusion) or scarring (gliosis), which are invisible to the CT scan. Newer,
specialized types of MRI can assess brain structure at an even finer level or measure brain
function to detect alterations in brain structure and function due to TBI. Because microscopic
injury to the brain may be a cause of problems, however, even MRI may not be able to detect
any abnormality in a patient with TBI. Long after the injury, MRI as well as CT may
demonstrate brain atrophy, which results when dead or injured brain tissue is reabsorbed
following TBI. Because injured brain tissue may not completely recover following TBI, changes
due to TBI may be detectable many years after an injury.

WHAT TO DO IF YOU EXPERIENCE A HEAD INJURY

Following a head injury, you should be assessed by a medical professional with expertise in the
assessment of TBI. This might be an emergency medicine physician, neurologist, neurological
surgeon or other physician. In particular, a physician should evaluate all patients who experience
loss of consciousness as soon as possible after the injury, often in an emergency department.
Because all patients with head injuries do not require imaging, the physician will assess the
patient and determine whether CT or MRI is necessary. Patients who have persistent problems or
symptoms following a head injury should consult a medical professional, a neurologist,
psychiatrist or physiatrist, for example, who will determine, based on their medical assessment,
whether MRI is necessary. Patients living with the effects of TBI may obtain helpful information
from the following advocacy organizations:

http://www.biausa.org
http://www.braintrauma.org
https://www.asnr.org/patientinfo/conditions/tbi.shtml
Copyright © 2012 - 2017 American Society of Neuroradiology

All Rights Reserved.

John Walsh, the 69-year-old longtime host of America's Most Wanted and, this year, of The
Hunt on CNN, has also been for decades a serious semipro polo player. And it was when those
two worlds collided that Walsh, who estimates he has broken about 40 bones along with
suffering several concussions while playing polo, began to pay attention to his brain.
"After the show [The Hunt] was launched, I noticed I was having a little bit of trouble
memorizing the big scripts," says Walsh, who is also a national spokesman for Greatcall, a
medical alert service. "I've had two skull fractures, two broken noses, six concussions — I used
to be able to memorize those scripts in an hour. But I'd get confused, and my short-term
memory wasn't so great."

Walsh began consulting with neurosurgeons at the Mayo Clinic. "The doctors told me it's
difficult to diagnose, but they can monitor it," Walsh says. Now he gets regular CT scans of his
brain and does various mental exercises, such as crosswords and word games.
"It takes courage to let your doctor know there may be something wrong," he says. "Most
importantly, it means knowing there's a problem and going for the exams."
Walsh speaks for many older Americans whose head trauma earlier in their lives may begin to
manifest itself after they turn 50. Scientists divide such trauma into transient brain injuries —
where symptoms dissipate after seven to 10 days — and more severe traumatic brain injuries that
have long-term cognitive consequences.
The symptoms of delayed brain trauma have been recognized in professional athletes for years.
Tony Dorsett, 61, is a Hall of Fame running back who played with the Dallas Cowboys. After a
concussion-filled career, he's been diagnosed with serious brain trauma. "I'm doing pretty good,
for the most part, I guess," he says.
He urges people over 50 to "stay active, keep reading, do puzzles, go to movies, talk about books
— the thing to do is engage people." He also advocates exercise — "get that adrenaline flowing,
that rush through your body, that blood to your brain."
Less well documented is the lingering effect of early brain trauma on ordinary Americans.
Not just jocks
"This problem is not unique to athletes," says Robert Cantu, a clinical professor in Boston
University's Department of Neurosurgery and a senior adviser to the National Football League
on head and neck injuries. "Repetitive head injuries can be the result of physical abuse, car
accidents, multiple falls. You may be at risk for CTE [chronic traumatic encephalopathy] later in
life."
CTE and related head injuries can lead to short-term memory problems and difficulty in making
reasoned judgments and decisions. For a person in his 50s, these symptoms could be the result of
head trauma.
"If you had a loss of consciousness earlier in life, there may be greater likelihood of the onset of
cognitive changes later in life," reports Munro Cullum, professor of psychiatry, neurology and
neurotherapeutics at the University of Texas Southwestern Medical Center in Dallas.
Recovery time among older people is dramatically different from younger patients. David Cifu,
director of physical medicine and rehabilitation programs for the national Veterans Health
Administration and chairman of the physical medicine and rehabilitation department at Virginia
Commonwealth University School of Medicine in Richmond, estimates that those over 55 who
suffer a moderate to severe concussion recover to about the same degree as younger patients.
However, he observes, the recovery time may be twice as long as that for younger patients — a
year or more for some seniors.
For example, seniors who have been injured in falls or accidents involving brain trauma "don't
bicycle as well or walk as fast as they did" before the injury, Cifu says. "Clinicians shouldn't give
up too soon — and families shouldn't either."

Long-term effects
When she was 10, Melanie Werth fell off a horse, hit her head on pavement and was unconscious
for about 20 minutes. When she was 16 her boyfriend had a car accident, and she was knocked
out again. A year or so later, she was riding her bicycle "really fast" on a country road when she
skidded on a patch of gravel. She was knocked unconscious and broke her shoulder.
In her mid-40s, she began experiencing loss of memory. "I knew my name, I knew my husband,
I knew my daughter," she recalls, "but I couldn't remember how to take my daughter to school. I
forgot how to cook." She went to several doctors, including a psychiatrist, who prescribed
various medications, none of which worked. "I couldn't do things anymore that I had done all my
life," she says. It wasn't until she went to an endocrinologist that she started to get better. "She
helped me a lot," Werth says. She began running, changed her diet and took up meditation.
Today the 58-year-old real estate agent in Fort Worth, Texas, believes these actions "have helped
me find my way back to who I was. I feel good about doing my job. I feel competent again."
Kevin Audley, 50, a counselor in Olathe, Kan., was a 20-year-old University of Kansas student
in 1985 when he fell 2 1/2 stories from his frat house to the concrete sidewalk below during a
party. He didn't know the punch was spiked with grain alcohol. He spent a week in the intensive
care unit. Besides injuries to both knees and his elbow, he also suffered a concussion.
Today he's a successful contributor to books, has launched several websites, counsels dozens of
clients — but has trouble remembering what a friend had for lunch. "I don't hit the save button
for my short-term memory," Audley says.
Deep brain stimulation
Americans over 50 who suffered what doctors call a "single uncomplicated" concussion earlier in
life usually don't have to worry about cognitive impairment later, says Amy Jak, associate
professor in residence in the Department of Psychiatry at the University of California in San
Diego. She adds, however, that those who suffered a "moderate to severe traumatic brain injury
may raise the risk factor." She cautions that other health factors may also elevate the risk: high
blood pressure, diabetes, genetics and mood. "You should manage your health concerns," she
says, "your mood concerns. Depression can also contribute to cognitive problems." She strongly
recommends exercise to promote and preserve mental health.
One intriguing new therapy still very much in the discovery phase is the use of deep brain
stimulation (DBS) as a way to enhance memory. DBS has been used on patients with Parkinson's
disease, depression, epilepsy and other illnesses. It consists of implanting microelectrodes that
send small shocks into specific areas of the brain to restore disrupted functions.
Kendall Lee, a professor of neurosurgery and biomedical engineer at the Mayo Clinic in
Rochester, Minn., has been in the forefront of the application. He has called it "a pacemaker for
the brain." Research has just begun on the use of DBS for improving memory, but Lee believes
that enough has been learned already to support further research. "It's pretty far off," he says,
"but it's very important that it is under investigation."
Meanwhile, John Walsh is sold on his new brain-health regimen. He checks in every six months
with a neurologist and has even cut back on his polo playing — though his first granddaughter
may play a role in that behavioral change.
The man who growls that he has "brought 1,300 dirtbags to justice" over 27 years is now content
to slow down a step or two: "I'm learning to listen."
And Tony Dorsett stays active by chasing Hawke, his year-old grandson. "He wants to get busy,"
says Dorsett. "He was over here yesterday and we went for a walk and I'm telling him, 'Slow
down, slow down!' "
Mike Tharp is a veteran reporter who teaches journalism at Tarrant County College in Texas.
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A concussion is a traumatic brain injury that affects your brain function. Effects are usually
temporary but can include headaches and problems with concentration, memory, balance and
coordination.

Concussions are usually caused by a blow to the head. Violently shaking the head and upper
body also can cause concussions
Some concussions cause you to lose consciousness, but most do not. It's possible to have a
concussion and not realize it.

Concussions are particularly common if you play a contact sport, such as football. Most people
usually recover fully after a concussion.

Symptoms
The signs and symptoms of a concussion can be subtle and may not show up immediately.
Symptoms can last for days, weeks or even longer.

Common symptoms after a concussive traumatic brain injury are headache, loss of memory
(amnesia) and confusion. The amnesia usually involves forgetting the event that caused the
concussion.

Signs and symptoms of a concussion may include:

 Headache or a feeling of pressure in the head

 Temporary loss of consciousness

 Confusion or feeling as if in a fog

 Amnesia surrounding the traumatic event

 Dizziness or "seeing stars"

 Ringing in the ears

 Nausea

 Vomiting

 Slurred speech

 Delayed response to questions

 Appearing dazed

 Fatigue

You may have some symptoms of concussions immediately. Others may be delayed for hours or
days after injury, such as:

 Concentration and memory complaints

 Irritability and other personality changes

 Sensitivity to light and noise

  Sleep disturbances

 Psychological adjustment problems and depression

 Disorders of taste and smell

Seek emergency care for an adult or child who experiences a head injury and symptoms
such as:

 Repeated vomiting
 A loss of consciousness lasting longer than 30 seconds

 A headache that gets worse over time

 Changes in his or her behavior, such as irritability

 Changes in physical coordination, such as stumbling or clumsiness

 Confusion or disorientation, such as difficulty recognizing people or places

 Slurred speech or other changes in speech

Other symptoms include:

 Seizures
 Vision or eye disturbances, such as pupils that are bigger than normal (dilated pupils) or pupils of
unequal sizes

 Lasting or recurrent dizziness

 Obvious difficulty with mental function or physical coordination

 Symptoms that worsen over time

 Large head bumps or bruises on areas other than the forehead in children, especially in infants
under 12 months of age

Complications
Potential complications of concussion include:

 Post-traumatic headaches. Some people experience headaches within a week to a few months
after a brain injury.
 Post-traumatic vertigo. Some people experience a sense of spinning or dizziness for days, week or
months after a brain injury.
  Post-concussion syndrome. Some people have symptoms — such as headaches, dizziness and
thinking difficulties — a few days after a concussion. Symptoms may continue for weeks or
months.

 Cumulative effects of multiple brain injuries. It's possible that some people who have had one or
more traumatic brain injuries over the course of their lives are at greater risk of developing lasting,
possibly progressive, impairment that limits function. This is an area of active research.

 Second impact syndrome. Rarely, experiencing a second concussion before signs and
symptoms of a first concussion have resolved may result in rapid and usually fatal brain
swelling.

Concussion changes the levels of brain chemicals. It usually takes about a week for these
levels to stabilize again, but recovery time varies.

It's important for athletes never to return to sports while they're still experiencing signs and
symptoms of concussion.
https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594

Answers to the following questions may be beneficial in judging the severity of injury:

 How did the injury occur?

 Did the person lose consciousness?

 How long was the person unconscious?

 Did you observe any other changes in alertness, speaking, coordination or other signs of injury?

 Where was the head or other parts of the body struck?

 Can you provide any information about the force of the injury? For example, what hit the person's
head, how far did he or she fall, or was the person thrown from a vehicle?

 Was the person's body whipped around or severely jarred?

Imaging tests

 Computerized tomography (CT) scan. This test is usually the first performed in an emergency
room for a suspected traumatic brain injury. A CT scan uses a series of X-rays to create a detailed
view of the brain. A CT scan can quickly visualize fractures and uncover evidence of bleeding in
the brain (hemorrhage), blood clots (hematomas), bruised brain tissue (contusions), and brain tissue
swelling.
  Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a
detailed view of the brain. This test may be used after the person's condition stabilizes, or if
symptoms don't improve soon after the injury.

Intracranial pressure monitor

Tissue swelling from a traumatic brain injury can increase pressure inside the skull and cause
additional damage to the brain. Doctors may insert a probe through the skull to monitor this
pressure.

Immediate emergency care

Emergency care for moderate to severe traumatic brain injuries focuses on making sure the
person has enough oxygen and an adequate blood supply, maintaining blood pressure, and
preventing any further injury to the head or neck.

People with severe injuries may also have other injuries that need to be addressed. Additional
treatments in the emergency room or intensive care unit of a hospital will focus on minimizing
secondary damage due to inflammation, bleeding or reduced oxygen supply to the brain.
Medications

Medications to limit secondary damage to the brain immediately after an injury may include:

 Diuretics. These drugs reduce the amount of fluid in tissues and increase urine output. Diuretics,
given intravenously to people with traumatic brain injury, help reduce pressure inside the brain.
 Anti-seizure drugs. People who've had a moderate to severe traumatic brain injury are at
risk of having seizures during the first week after their injury.

An anti-seizure drug may be given during the first week to avoid any additional brain
damage that might be caused by a seizure. Continued anti-seizure treatments are used only
if seizures occur.

 Coma-inducing drugs. Doctors sometimes use drugs to put people into temporary comas because
a comatose brain needs less oxygen to function. This is especially helpful if blood vessels,
compressed by increased pressure in the brain, are unable to supply brain cells with normal
amounts of nutrients and oxygen.

Surgery

Emergency surgery may be needed to minimize additional damage to brain tissues. Surgery may
be used to address the following problems:
  Removing clotted blood (hematomas). Bleeding outside or within the brain can result in a
collection of clotted blood (hematoma) that puts pressure on the brain and damages brain tissue.
 Repairing skull fractures. Surgery may be needed to repair severe skull fractures or to remove
pieces of skull in the brain.

 Bleeding in the brain. Head injuries that cause bleeding in the brain may need surgery to stop the
bleeding.

 Opening a window in the skull. Surgery may be used to relieve pressure inside the skull by
draining accumulated cerebral spinal fluid or creating a window in the skull that provides more
room for swollen tissues.

Rehabilitation

Most people who have had a significant brain injury will require rehabilitation. They may need
to relearn basic skills, such as walking or talking. The goal is to improve their abilities to
perform daily activities.

Therapy usually begins in the hospital and continues at an inpatient rehabilitation unit, a
residential treatment facility or through outpatient services. The type and duration of
rehabilitation is different for everyone, depending on the severity of the brain injury and what
part of the brain was injured.

Rehabilitation specialists may include:

 Physiatrist, a doctor trained in physical medicine and rehabilitation, who oversees the entire
rehabilitation process, manages medical rehabilitation problems and prescribes medication as
needed
 Occupational therapist, who helps the person learn, relearn or improve skills to perform everyday
activities

 Physical therapist, who helps with mobility and relearning movement patterns, balance and
walking

 Speech and language pathologist, who helps the person improve communication skills and use
assistive communication devices if necessary

 Neuropsychologist, who assesses cognitive impairment and performance, helps the person manage
behaviors or learn coping strategies, and provides psychotherapy as needed for emotional and
psychological well-being

 Social worker or case manager, who facilitates access to service agencies, assists with care
decisions and planning, and facilitates communication among various professionals, care providers
and family members
  Rehabilitation nurse, who provides ongoing rehabilitation care and services and who helps with
discharge planning from the hospital or rehabilitation facility

 Traumatic brain injury nurse specialist, who helps coordinate care and educates the family about
the injury and recovery process

 Recreational therapist, who assists with time management and leisure activities

 Vocational counselor, who assesses the ability to return to work and appropriate vocational
opportunities and who provides resources for addressing common challenges in the workplace
https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/diagnosis-treatment/drc-20378561

A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving
brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.

A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain
damage and potential complications.

The good news is that strokes can be treated and prevented, and many fewer Americans die of
stroke now than in the past.

Symptoms
Watch for these signs and symptoms if you think you or someone else may be having a stroke.
Pay attention to when the signs and symptoms begin. The length of time they have been present
can affect your treatment options:

 Trouble with speaking and understanding. You may experience confusion. You may slur your
words or have difficulty understanding speech.
 Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or
paralysis in your face, arm or leg. This often happens just on one side of your body. Try to raise
both your arms over your head at the same time. If one arm begins to fall, you may be having a
stroke. Also, one side of your mouth may droop when you try to smile.

 Trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in
one or both eyes, or you may see double.

 Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or

altered consciousness, may indicate you're having a stroke.

 Trouble with walking. You may stumble or experience sudden dizziness, loss of balance or loss of
coordination
Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain
hemorrhages can result from many conditions that affect your blood vessels. These include:

 Uncontrolled high blood pressure (hypertension)

 Overtreatment with anticoagulants (blood thinners)

 Weak spots in your blood vessel walls (aneurysms)

A less common cause of hemorrhage is the rupture of an abnormal tangle of thin-walled blood
vessels (arteriovenous malformation). Types of hemorrhagic stroke include:

 Intracerebral hemorrhage. In an intracerebral hemorrhage, a blood vessel in the brain

bursts and spills into the surrounding brain tissue, damaging brain cells. Brain cells beyond
the leak are deprived of blood and are also damaged.

High blood pressure, trauma, vascular malformations, use of blood-thinning medications

and other conditions may cause an intracerebral hemorrhage.

 Subarachnoid hemorrhage. In a subarachnoid hemorrhage, an artery on or near the

surface of your brain bursts and spills into the space between the surface of your brain and
your skull. This bleeding is often signaled by a sudden, severe headache.

A subarachnoid hemorrhage is commonly caused by the bursting of a small sack-shaped or

berry-shaped aneurysm. After the hemorrhage, the blood vessels in your brain may widen
and narrow erratically (vasospasm), causing brain cell damage by further limiting blood
flow.

Complications
A stroke can sometimes cause temporary or permanent disabilities, depending on how long the
brain lacks blood flow and which part was affected. Complications may include:

 Paralysis or loss of muscle movement. You may become paralyzed on one side of your body, or
lose control of certain muscles, such as those on one side of your face or one arm. Physical therapy
may help you return to activities affected by paralysis, such as walking, eating and dressing.
 Difficulty talking or swallowing. A stroke might affect control of the muscles in your mouth and
throat, making it difficult for you to talk clearly (dysarthria), swallow (dysphagia) or eat. You also
may have difficulty with language (aphasia), including speaking or understanding speech, reading,
or writing. Therapy with a speech-language pathologist might help.

 Memory loss or thinking difficulties. Many people who have had strokes experience some
memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding
concepts.
  Emotional problems. People who have had strokes may have more difficulty controlling their
emotions, or they may develop depression.

 Pain. Pain, numbness or other strange sensations may occur in the parts of the body
affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you
may develop an uncomfortable tingling sensation in that arm.

People also may be sensitive to temperature changes, especially extreme cold, after a
stroke. This complication is known as central stroke pain or central pain syndrome. This
condition generally develops several weeks after a stroke, and it may improve over time.
But because the pain is caused by a problem in your brain, rather than a physical injury,
there are few treatments.

 Changes in behavior and self-care ability. People who have had strokes may become more
withdrawn and less social or more impulsive. They may need help with grooming and daily chores.

As with any brain injury, the success of treating these complications varies from person to
person.
Preventive medications

If you've had an ischemic stroke or TIA, your doctor may recommend medications to help
reduce your risk of having another stroke. These include:

 Anti-platelet drugs. Platelets are cells in your blood that form clots. Anti-platelet drugs
make these cells less sticky and less likely to clot. The most commonly used anti-platelet
medication is aspirin. Your doctor can help you determine the right dose of aspirin for you.

Your doctor might also consider prescribing Aggrenox, a combination of low-dose aspirin
and the anti-platelet drug dipyridamole to reduce the risk of blood clotting. If aspirin
doesn't prevent your TIA or stroke, or if you can't take aspirin, your doctor may instead
prescribe an anti-platelet drug such as clopidogrel (Plavix).

 Anticoagulants. These drugs, which include heparin and warfarin (Coumadin, Jantoven),
reduce blood clotting. Heparin is fast acting and may be used over a short period of time in
the hospital. Slower acting warfarin may be used over a longer term.

Warfarin is a powerful blood-thinning drug, so you'll need to take it exactly as directed and
watch for side effects. Your doctor may prescribe these drugs if you have certain blood-
clotting disorders, certain arterial abnormalities, an abnormal heart rhythm or other heart
problems. Other newer blood thinners may be used if your TIA or stroke was caused by an
abnormal heart rhythm.
https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113
A brain aneurysm (AN-yoo-riz-um) is a bulge or ballooning in a blood vessel in the brain. It
often looks like a berry hanging on a stem.

A brain aneurysm can leak or rupture, causing bleeding into the brain (hemorrhagic stroke). Most
often a ruptured brain aneurysm occurs in the space between the brain and the thin tissues
covering the brain. This type of hemorrhagic stroke is called a subarachnoid hemorrhage.

A ruptured aneurysm quickly becomes life-threatening and requires prompt medical treatment.

Most brain aneurysms, however, don't rupture, create health problems or cause symptoms. Such
aneurysms are often detected during tests for other conditions.

Treatment for an unruptured brain aneurysm may be appropriate in some cases and may prevent
a rupture in the future. Talk with your caregiver to ensure you understand the best options for
your specific needs.

Symptoms
Ruptured aneurysm

A sudden, severe headache is the key symptom of a ruptured aneurysm. This headache is often
described as the "worst headache" ever experienced.

Common signs and symptoms of a ruptured aneurysm include:

 Sudden, extremely severe headache

 Nausea and vomiting

 Stiff neck

 Blurred or double vision

 Sensitivity to light

 Seizure

 A drooping eyelid

 Loss of consciousness

 Confusion

'Leaking' aneurysm

In some cases, an aneurysm may leak a slight amount of blood. This leaking (sentinel bleed) may
cause only a:

 Sudden, extremely severe headache

A more severe rupture often follows leaking.
Unruptured aneurysm

An unruptured brain aneurysm may produce no symptoms, particularly if it's small. However, a
larger unruptured aneurysm may press on brain tissues and nerves, possibly causing:

 Pain above and behind one eye

 A dilated pupil

 Change in vision or double vision

 Numbness of one side of the face

When to see a doctor

Seek immediate medical attention if you develop a:

 Sudden, extremely severe headache

If you're with someone who complains of a sudden, severe headache or who loses consciousness
or has a seizure, call 911 or your local emergency number.

Brain aneurysms develop as a result of thinning artery walls. Aneurysms often form at forks or
branches in arteries because those sections of the vessel are weaker.

Although aneurysms can appear anywhere in the brain, they are most common in arteries at the
base of the brain.

When a brain aneurysm ruptures, the bleeding usually lasts only a few seconds. The blood can
cause direct damage to surrounding cells, and the bleeding can damage or kill other cells. It also
increases pressure inside the skull.

If the pressure becomes too elevated, the blood and oxygen supply to the brain may be disrupted
to the point that loss of consciousness or even death may occur.

Complications that can develop after the rupture of an aneurysm include:

 Re-bleeding. An aneurysm that has ruptured or leaked is at risk of bleeding again. Re-bleeding can
cause further damage to brain cells.
 Vasospasm. After a brain aneurysm ruptures, blood vessels in your brain may narrow erratically
(vasospasm). This condition can limit blood flow to brain cells (ischemic stroke) and cause
additional cell damage and loss.

 Hydrocephalus. When an aneurysm rupture results in bleeding in the space between the brain and
surrounding tissue (subarachnoid hemorrhage) — most often the case — the blood can block
circulation of the fluid surrounding the brain and spinal cord (cerebrospinal fluid). This condition
 can result in an excess of cerebrospinal fluid that increases pressure on the brain and can damage
tissues (hydrocephalus).

 Hyponatremia. Subarachnoid hemorrhage from a ruptured brain aneurysm can disrupt the
balance of sodium in the blood. This may occur from damage to the hypothalamus, an area
near the base of the brain.

A drop in blood-sodium levels (hyponatremia) can lead to swelling of brain cells and
permanent damage.
https://www.mayoclinic.org/diseases-conditions/brain-aneurysm/symptoms-causes/syc-20361483