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Brain Trauma, Concussion, and Coma

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Peter M. Black, Patricio C. Gargollo, and Adam C. Lipson , The Dana Foundation

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Brain Trauma, Concussion and Coma
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Head trauma and the resulting brain injuries are one of the leading causes of death and disability in the industrialized world. In the United States, more than 50,000 people die every year as a result of traumatic brain injury. Furthermore, it is estimated that a head injury occurs every seven seconds, and hospital emergency rooms treat 1 million people for brain injuries every year. Currently about 5.3 million Americans — a little more than 2 percent of the U.S. population — live with disabilities resulting from such injuries.

Traumatic brain injury may occur at any age, but the peak incidence is among people between the ages of 15 and 24. Men are affected three to four times more often than women. Motor vehicle accidents are the leading cause, accounting for approximately 50 percent of all cases. Falls produce the most brain injuries in people older than 60 and younger than 5. Other causes include violent assault and firearms misuse. It has been estimated that after one brain injury, the risk of a second injury is three times greater, and that after a second injury, the risk of a third is eight times greater.

There are many head injury symptoms, ranging in seriousness. Minor injuries will cause mild or no symptoms, while severe injuries will cause major derangement of function. The most common symptom of brain injury after head trauma is a disturbance of consciousness; some people remain awake, but others are confused, disoriented, or unconscious. Headache, nausea, and vomiting are other common symptoms.

Anyone who sustains a head injury should be examined by a physician. Symptoms of brain trauma can be initially subtle, seemingly unrelated to the head, and not immediately apparent. A person who has sustained a serious head injury should not be manipulated or moved by people who are not trained to do so, because this may aggravate an injury.

Diagnosing Brain Trauma

The first thing doctors do when assessing a head injury is determine whether the person is in imminent danger of death. Once the person’s vital functions are stabilized, physicians examine the individual from a neurological perspective, checking:

  • level of consciousness
  • function of the cranial nerves (through pupillary responses to light, eye movements, and facial symmetry)
  • motor function (strength, symmetry, and any abnormality of movements)
  • breathing rate and pattern (linked to brain stem function)
  • deep tendon reflexes, such as the knee jerk
  • sensory function, such as response to a pinprick
  • external signs of trauma, fracture, deformity, and bruising in the head and neck

Each of these parts of the physical exam will give a physician clues about the extent and location of any brain injury.

Doctors also need to know about the person’s behavior before, during, and after the injury. All of these points yield clues about what might have happened and how best to treat the person. Family members or people who witnessed the accident can usually provide helpful information. They can help medical professionals provide the best care possible by taking note of certain symptoms:

  • unusual sleepiness or difficulty awakening
  • mental confusion
  • convulsions
  • vomiting that continues or worsens
  • restlessness or agitation that continues or worsens
  • stiff neck
  • unequal pupil size or peculiar eye movements
  • inability to move arms and legs on either side
  • clear or bloody drainage from the ears or nose
  • bruising around the eyes or behind the ears
  • difficulty breathing

This is a partial list.

Physicians can use a variety of radiological tests to assess a person with head trauma. Most hospital emergency departments can now do computed tomography (CT) scans. CT provides more information, and is excellent for diagnosing skull fractures, bleeding, or other important lesions in the brain. CT also helps doctors follow people with head trauma as they recover. Magnetic resonance imaging (MRI) currently has little involvement in diagnosing and treating an emergency, but once a person’s condition is stable an MRI may provide useful information that a CT cannot, such as evidence of white matter damage.

Different types of injuries require particular treatments. Surgery is needed to remove blood or foreign material, or to reconstruct parts of the skull. Very often brain trauma causes tissue to swell against the inflexible bone. In these cases, a neurosurgeon may relieve the pressure inside the skull by placing a ventriculostomy drain that removes cerebrospinal fluid. If the swelling is massive, a neurosurgeon may remove a piece of the skull so that the brain has room to expand; the surgeon keeps and reimplants the bone after the swelling has gone down significantly. Often during these procedures, the surgeon places a small pressure valve inside the skull to measure pressure on a moment-to-moment basis.

Most nonsurgical management of brain trauma involves close monitoring, often in an intensive care unit, to prevent further injury. Physicians will conduct further neurological exams in order to assess whether the person is improving or worsening. Doctors have no “miracle drug” to prevent nerve injury or improve brain function immediately after trauma, but they can use medication to modify a person’s blood pressure, optimize the delivery of oxygen to the brain tissue, and prevent further brain swelling.

From the Dana Foundation. Used with permission. www.dana.org.

Comments [30]

Fish oil is meaningless, but I know you mean no harm by your comments

Jan 4th, 2017 9:43pm

I would suggest looking into nutrition for brain, fish oil, phos choline and seine, coconut oil , b vits and also vielight neuro unit. I had a concussion and did all these things, chiropractic. Fish oil reduces brain swelling, helps heal your brain. Has been 7 months for me and am back to normal. I had light and sound sensitivity,headaches, anxiety,poor memory function, all gone now.

I wish you all well.

Byron

Dec 24th, 2016 12:53pm

My Friend's younger sister had a accident and she suffered head injury after which she has severe edema (Swelling in brain) because of which they had to cut bone from both sides of the brain. she is unconscious for the last one week and her GCS level is 5 and not increasing they have removed her from the Ventilator but they have placed a tracheotomy tube through which they say that she will be able to breath .. she is not responding to anything and her body is stiff no movement what so ever and she has multiple fractures in the body.. I wanna know is there anyone who can help me she is 23 and we wanna know if anyone can help and also tell me when she will be able to wake up and will she be normal like before 

Dec 13th, 2016 7:00am

Sorry to hear you're still being affected from your concussion. Chiropractic really helped me.

Sep 22nd, 2016 4:52am

You could have post concussive syndrome

Sep 21st, 2016 1:45pm

I got a concussion a year ago sept 30th. I'm still having trouble with brightness. I wear sunglasses in stores, on cloudy days,etc. I can't see at night. I lose words and slur when tired or stressed. If someone interrupts me or changes my plans I lose my thoughts. I still walk crooked and slow. I have ringing in my ears, headaches, migraines, a lot of pressure in my head and trouble sleeping. My vision is messed up. I can't remember stuff. However, I can drive short distances now, as long as nothing unexpected happens to throw me off. I can read, watch some tv and do a little computer work. I'm so much better than I was. Doctor told me to sit in my chair for 10 months with no reading, tv, computer, noise, bright lights, writing. It was lonely. I'm able to cook some now if I remember I'm cooking. I still burn things because I forget. My head has a ton of pressure and a very painful spot where I got hit. I wish they'd done a scan on me or addressed the liquid coming out of my ears.

Sep 19th, 2016 1:35am

Excellent article. I've had a concussion comma for 2 weeks, that I almost fully recovered from in a year. And then one year and a half later, I had TBI that keeps getting worse and worse is from (Army) repetitive ammunition blast shock injury that destroys the nerves through ultrasonic and supersonic or subsonic energies. This form most closely matches up to your Diffuse Axonal Injuries. It only took 3 days without earplugs (by Order) on the firing range to have ALL TBI symptoms immediately.

I later find out heavy plastic ear muffs are better for supersonic blasts and foam ear plugs are better for infrasonic (or subsonic) blasts: of which I could have neither. It's a shame all US Army and Marine vets get their brains scrambled for a lifetime of misery. I've had 90 dB tinnitus and no sleep for over 34 years, and it took me 30 years to get 10% tinnitus disability rating ($130/mo - whoopee!): with the VA and (Army and Marines) Services well knowing supply clerks who drive on the firing ranges without earplugs with rifle and mortar explosions have their brains scrambled for life. I now have difficulty remembering why I am walking in rooms (after over 34 years of breathing problems from DAI of brain stem (just got a bi-pap machine last month), anxiety, depression, Maniere's Disorder/vertigo, and all the rest of tbi symptoms. )

Veterans need your brilliance on a shell shock phenomena that has been well known since gun powder wars were invented. I've had both, and appropriately disclosed, concussions will heal for the most part in about a year (with hard work and being young.) Now if you could focus in on the number one reason for suicides in the nation (Army and Marine disabled Vets), it would be blessing for all Army and Marine disabled vets and their families they support.

Peace.

Sep 4th, 2016 6:30pm

My comment regards the concussion I suffered in 1980  when I was 24; inclusive was my 5 days in a coma. All items considered, I can proclaim that I am a very fortunate man to have lived the accomplished & fulfilling life dealt to me since then. What brings me here is to be educated on long term effects of a concussion. Fortunately, the only nagging, recurring, negative effect so far has been the daily headaches since 1989 or 1990. Recently however, I'm experiencing some lightheadedness. I found that a amino acid duplex that increases nitrogen monoxide in my blood helps me neurologically.

Aug 16th, 2016 7:16pm

My boyfriend just fractured his skull it was a depressed fracture. the hospital have now said there may be traces of his skull near and inside his brain and there are possibilities of blood clotting and has to have further sugary. Can anyone help me expect what the surgery involves as i know nothing and am panicking. 

Jul 26th, 2016 12:33pm

My grandpa slipped and fell backwards on concrete, hitting the back of his head causing his brain to hit the front, resulting in a brain bleed. He was in a coma for 3 months. The Dr.'s wanted to pull his life support, but his family said no. When he came out of the coma, he could remember things from when he was a child, but not who his wife of 50 years was, or any of his family born within that time. The doctors said he'd be a vegetable for the rest of his life. Well, 4 years after, he is about 75% better! He still mixes up words occasionally, but he can  now remember his family and his grandkids names. He can walk short distances, and he's got a good sense of humor! Dr.'s said he would have no quality of life. Well, he proved them wrong!

Jul 20th, 2016 1:41am

I fell down or up the stairs at home 5/31. Knocked myself unconscious and a family member found me. I came to and was put in the bed. Woke up that same morning and felt funny and still went to work. Came home that night and laid on the couch and could barely move or talk with a massive headache for 2 days. Throwing up water because I couldn't eat. Finally went to the ER 6/2. They did a CT scan of head and neck. Sent me home with pain meds and said follow up with your doctor. 6/7 saw my doctor and was admitted to the hospital. They ran multiple test. I have a fractured skull, hemmoraging in the brain with bruising swelling and contusions. I was released 6/13 evening. Cannot drive. Cannot work. Follow up with neurologist and primary care physician Monday 6/20.

Jun 17th, 2016 2:12am

It has been 9 months a since my head injury and I am still having headaches dizziness and neurological symptoms. I am having aching and burning sensations in head Ear and face .I pray each day that God will help me cope and I pray for all of you out there that is going thru the same thing. God bless.

Jun 4th, 2016 11:31pm

All, there is hope.  My son was injured in very bad car accident about a year ago.  He suffered a TBI with diffuse axonal injuries.  He was in a coma...the whole nine yards.  Doctors were not optimistic.  I prayed to God and asked him to restore my son.  HE DID IT! As I write this, it is 13 months since the accident and my son is here with me.  He is his "pre-injury" self.  God is good and he is REAL.  Pray!

Jun 1st, 2016 9:09pm

I was in a car accident passenger side I hit my head with the dash board dint think it was a big deal till three months later I got neck pain a headache on top of my head panic attacks. I got an MRI done they said I had nothing. my neck nothing that it was muscle spasms I was like this more months I hated medication I used a lot of ice and cold patches and teas. eventually all if it went away this was 3 years ago .

May 25th, 2016 6:09pm

I suffered a concussion. I had a biking accident. I fell of my mountain bike I hit the ground head first. I regret my injury, i know everything happens for a reason. It has been 3 weeks, I don't feel like myself anymore. I'm living in fear because my body doesn't feel the same. I'm crying but I thank you all for your post. I love y'all and I hope the best for whoever is reading this blog. I know our pain.

May 6th, 2016 8:38pm

My bf has been in a coma for 3 weeks and 2 days now and they say he has ~~Subarachnoid hemorrhage and diffuse axonal injury... i dont know what to do or who knows much about this but the doctors seem to have little hope.

Apr 26th, 2016 9:35pm

When traveling by himself, my brother-in-law fell and hit his head on pavement, knocking himself unconscious. He seemed fine initially, but passed away two days later from "a simple slip and fall." He was 47 years old. If you or your loved one has any form of head injury, please go to an emergency room as soon as possible.

Mar 31st, 2016 6:18pm

I had an accident 8 years ago. I'm 24 years old now. Some of the area near the eye and nose have been broken and removed. I feel now my head is not stable and pain. What can i do ??

Mar 21st, 2016 6:37am

Very informative & straight forward. Your article reminded me, circumstances could be much worse. I have an unhealed concussion, 3 months after being hit from behind, by another car going too fast on the highway! I worry it is taking an awful long time to heal.....but eventually it should.

Mar 4th, 2016 4:10am

My partner was in a coma for 2&1/2 weeks last year and has severe nerve damage causing loss of use of his lower left leg, we are struggling to understand how/ why this happened. The coma was a result of a huge overdose during a psychotic episode. Any advice would be gratefully received 

Feb 10th, 2016 3:57am

Has there ever been any studies with the brain after extended amounts of Anesthesia?  At 9 yrs old (in 1980) I had 15 surgeries but one in particular was over 15 hours long.  The doctors warned my parents I may have brain damage.  When I awoke after 2 weeks in a coma I was communicating with the deaf alphabet.  But, how can I possibly have brain damage and then nothing?  I feel like there would be a grey area in  between.

 I have always said my memory is bad and that I have a difficult time learning new things.  I am often told how to do something a few different times before I catch on.  I also feel fine and then Bam!  I hit a wall and need to sleep or at least get rest for awhile.  I feel like there should be more research on extreme amounts of anesthesia.  Any resources would REALLY help!

Jan 6th, 2016 2:03pm

Would you suggest some productive ways to improve/regain cognitive function post-concussion?

Oct 7th, 2015 12:20pm

Is decorticate posturing common with severe brain injury during the early weeks? If a patient begins to bend his/her legs and move them a lot, and lift the arms up and down (sometimes in response to instruction), but the hands remain sort of curled (however not glued to the chest), is this progress?

Aug 28th, 2015 1:16pm

Thanks for the great info.

Aug 18th, 2015 3:39pm

I've suffered two, that is two traumatic brain injuries putting me in a coma both times.  My first traumatic brain injury put into a coma for 4 days.  The second traumatic brain injury I suffered put me into a coma for 3 days.  Repercussions from my first traumatic brain injury include a severe short term memory impairment alongside enforced petit-mal epilepsy forcing me suffer at absolute least one petit-mal seizure every single day. My second brain injury enforced me suffering at least one petit-mal seizure everyday.  Oftentimes, I'd suffer more than one seizure everyday.  Thereafter, a neurologist named me an "epileptic," and prescribed me aplenty medication to ingest everyday named Kepra beside Lamictal.  Unfortunately, aplenty medication was not ending my seizure disorder.  That is why 11-years after my first brain injury doctors implanted a vagus nerve stimulator into my chest.  Unfortunately, my VNS does not stop my seizures being reason I awaited a total of over 14-years before I finally had brain surgery; and a brain surgeon is able to remove the brain bruise I suffered after my first traumatic brain injury. Brain surgery being successful does end my seizure disorder until I suffered another traumatic brain injury that restarted my epileptic seizure disorder existing. "Could be worse," is a sentence I say out loud, and internally, so I'm able to take a step back, and enter "perspective" mind power calming my pessimistic mindset.  

Jun 8th, 2015 7:33pm

Great article

Apr 29th, 2015 12:27pm

your article helped me greatly, many questions were answered , thank you .

Mar 18th, 2015 5:00pm

I had glasgow scale 7 and i was in coma for 17days, i feel stress and pressure very easly i just happy to b alive .

Feb 21st, 2015 6:36pm

The info in this article is just what I needed.  Thank you!

Feb 14th, 2015 8:15am

I suffered a concussion and subarachnoid hemorrhage in Dec. 2014.  I found this article to be comforting as I had read many articles giving me the impression I needed to get my affairs in order!  Thanks

Jan 23rd, 2015 3:17pm


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