Brain Trauma, Concussion, and Coma

Thomas I. Cochrane, M.D., MBA and Michael A. Williams, M.D., FAAN, The Dana Foundation
Brain Trauma, Concussion and Coma

Approximately five minutes after a terrible car accident that ejected Matt Trenton from his car, first responders found him face down and not breathing. They placed an endotracheal (breathing) tube in his trachea (windpipe) and transported him to the hospital, where he was admitted to the ICU. He received treatments, such as medications to elevate blood pressure, ventilator support of breathing, and IV fluids for hydration, all of which are necessary to support the brain and the body so that the brain can recover from injury.

Although Matt’s vital organs were not seriously injured, a CT scan showed widespread swelling of the brain. Dr. Roberts, a neurologist, evaluated him. Matt was still in the bed and didn’t move spontaneously.  When blood was drawn from his arm, he did not move it or even wince. When Dr. Roberts shouted Matt’s name and applied painful stimuli to assess his level of consciousness, his eyes did not open. When she held his eyes open, no spontaneous eye movements were evident, nor did he look at her face. A review of Matt’s medications and the lab and toxicology tests showed the presence of no substances that might worsen Matt’s neurologic exam. Therefore, it was clear that Matt had sustained severe brain damage that was causing severely impaired consciousness—i.e., coma. Matt’s parents asked Dr. Roberts if Matt was conscious or unconscious and whether he was likely to recover. (Note:  Matt is not a real patient, but a realistic composite of many patients for whom we have cared.)

In the following article, we present two possible scenarios, discuss how doctors answer these questions, and define the terms: wakefulness, awareness, consciousness, coma, vegetative state, minimally conscious state, and brain death.


A Working Definition of Consciousness: Simultaneous Wakefulness and Awareness

In assessing Matt’s consciousness, Dr. Roberts was not concerned with the notoriously thorny philosophical problems of defining consciousness. She was concerned with assessing the function of the parts of the brain that are responsible for consciousness so that she could determine if Matt was aware of anything and if he was capable of suffering.

Neurologists divide consciousness into two components: wakefulness and awareness. Both must be present for consciousness to be present. The neurons and their circuits (connections) that support wakefulness are in one region of the brain, and the neurons and circuits that provide awareness are in other regions of the brain. Dr. Roberts first had to determine whether Matt’s brain was capable of wakefulness, and then she would look for signs of awareness.

Wakefulness

The part of the brain responsible for wakefulness is the reticular activating system (RAS), a collection of neurons in the upper brainstem that sends widespread stimulatory projections to the areas of the brain responsible for awareness. (See figure1.) When the RAS stimulates the brain, a person’s eyes open. Therefore, spontaneous eye opening or eye opening in response to stimuli is a reliable sign that the RAS is functioning and that wakefulness is present. However, although wakefulness is necessary for consciousness, wakefulness alone is insufficient for consciousness. In other words, eye opening alone is not sufficient to indicate that a person is conscious. Clinically, if the RAS is not functioning normally, then the patient is incapable of becoming conscious and the eyes will not open—even in response to painful stimuli (such as pinching the clavicle or pressing a knuckle into the sternum). As a result, the brain is not “turned on” and cannot support awareness. This is much like a computer—if the power supply does not provide electricity to the computer, the computer will not function.

Figure 1.

To determine if Matt was capable of wakefulness, Dr. Roberts examined him for either spontaneous eye opening or eye opening in response to painful stimuli.

Awareness

The parts of the brain responsible for awareness—the ability to think and perceive—are the neurons (brain cells) in the cortex (grey matter) of the two hemispheres and the axons (communicating projections) in the white matter between those neurons. The brain’s neurons are located in the cerebral cortex—the grey matter at the surface of the brain—and in the deep grey matter in nuclei such as the thalamus. These billions of neurons make trillions of connections via axons in the white matter, constituting functional neural networks that support all conscious effort of the brain, as well as many functions of the brain that do not require consciousness.

Awareness is not a function of solely a single area of the cortex or deep grey matter. Rather, it emerges from the coordinated activity of many parts of the brain. Although consciousness is possible with loss of limited areas of the cortex (as can be seen in some stroke victims), severe and widespread injury to the cortex, thalami, white matter, or any combination of these will result in unconsciousness, even if the RAS is functioning normally.

Awareness is tested by attempting to elicit a response to a command that requires some thinking ability, such as “look at me,” “hold up two fingers,” or “try to mouth words.” Awareness can also be indicated by purposeful movements such as pushing away at a painful stimulus; this purposeful response contrasts to the automatic reflex movements that occur in response to painful stimuli when one is in a coma.


States of Disordered Consciousness

In the first scenario below, we consider Matt’s condition in the days, weeks, and months after his accident and describe his states of consciousness, along with what was known about his prognosis. Patients with severe brain injury and coma who recover may, depending on the severity of the brain injury, progress through several levels of consciousness, from coma, to vegetative state, to minimally conscious state, to consciousness, with varying degrees of motor, cognitive, and affective impairment.  The range of potential outcomes is wide.

Coma—Neither Awake nor Aware

Two days after the accident, Matt did not open his eyes, make any purposeful spontaneous movements, or respond to Dr. Robert’s commands or to any other stimuli, including painful stimuli. Dr. Roberts concluded that the RAS was not working, and she described Matt as being in a coma—he was neither awake nor aware. She had good reason to believe that Matt was not simply in the locked-in state, which is the state of being conscious but unable to move. This happens rarely after certain types of stroke (which would have been seen on his brain scan), or in the late stages of some neuromuscular diseases.

The presence of coma early after an injury does not predict a patient’s outcome. Patients with widespread injury to the brain are more likely to have severe neurologic deficits and are at a higher risk of prolonged unconsciousness. Patients with more focal injuries (for example, only a brainstem injury) may have less severe neurologic impairment and are more likely to have a temporary coma. The nature of the neurologic impairments depends on the areas of the brain that have been injured, and Matt’s injuries were uncertain. Although his brain CT scan did not reveal major structural injuries, he may have suffered (1) widespread injury to the neurons of the cortex and thalamus because he was deprived of oxygen and (2) injury to the white matter because of the physical forces of the traumatic brain injury.

Although the RAS was not functioning normally, Dr. Roberts found that other important brainstem areas were still functioning. Matt’s pupils responded to light, his eyes blinked when his eyelashes were touched, he gagged when a suction catheter was passed through the endotracheal tube to his lungs, and he was initiating breaths on his own, even though he required support from the ventilator. The presence of these brainstem functions was favorable but did not indicate whether he would eventually recover consciousness. Although he had spontaneous breathing, he could not swallow safely or protect his airway from aspiration (sucking liquids into the lung), which would cause pneumonia; therefore, he needed the endotracheal tube. He also required a nasogastric tube into the stomach to receive a feeding solution for adequate nutrition.

Coma usually lasts for no more than two to three weeks. In most instances, coma evolves to the next level of consciousness, known as the vegetative state.

Vegetative State—Awake but Unaware

Unless the RAS is severely injured, its function returns in two to three weeks. Ten days after Matt’s accident, his eyes began to open in response to painful stimuli, which implied the presence of wakefulness and that spontaneous eye opening would eventually occur. However, despite the fact that his eyes were open, when Dr. Roberts called his name or placed her face close to his, Matt did not look at her, which indicated that even though he was awake, he was not aware of her or of his surroundings—i.e., he was still unconscious. Similarly, his motor responses to pain consisted only of reflexes and not purposeful movements. Note that although patients in a vegetative state have reflex responses to pain, because they are not conscious, they cannot experience either pain or suffering. Therefore, Matt’s condition was defined as the vegetative state, a condition that may either be a temporary stage in recovery from a coma or may be more longstanding if the brain injuries are severe and irreversible.

Endotracheal and nasogastric tubes that are placed when patients emergently enter the hospital can remain in the body for only a limited period of time because they may cause injury to the larynx or stomach over an extended period of time. However, patients in a vegetative state, like Matt, are incapable of protecting their airways or of taking oral nutrition and hydration. Therefore, a more permanent breathing tube, called a tracheostomy, is surgically inserted through the front of the neck directly into the trachea, and a semi-permanent tube, known as a gastrostomy tube, is inserted directly through the abdominal wall into the stomach so that the patient can receive nutrition and hydration.

Two weeks after his brain injury, Matt’s prognosis was still uncertain. Dr. Roberts told Matt’s parents that in the best case, he would regain consciousness but would likely have severe, permanent physical and cognitive limitations. In the worst case, he would never regain consciousness. Matt’s parents, not wanting to give up prematurely and hoping that he would eventually “wake up,” elected to have the tracheostomy and gastrostomy tubes placed.

Persistent Vegetative State

Six weeks after Matt’s accident, he was breathing through the tracheostomy without the support of a ventilator; however, he still required the gastrostomy tube for nutrition and hydration. He was transferred to a rehabilitation hospital, where Dr. Roberts examined him again and found that he was still vegetative—awake but unaware. By convention, after one month, the vegetative state is described as the persistent vegetative state (PVS). Dr. Roberts explained to Matt’s parents that the term “PVS” does not stand for “permanent vegetative state” and that Matt’s long-term prognosis was still uncertain. Because patients may emerge from PVS, usually within 3–12 months, clarifying the distinction between persistent vegetative state and permanent vegetative state was important.

Matt’s parents asked Dr. Roberts about Matt’s odds of recovering consciousness. The most important factor influencing the likelihood of recovery is the type of brain injury a patient has suffered. Patients in the PVS after a traumatic brain injury can regain awareness as late as 12 months after the injury; however, after that, the likelihood of recovery is very slim. The prognosis with a brain injury caused by hypoxic-ischemic injury (lack of blood flow and oxygen) is worse than that with an injury caused by trauma. Common causes of hypoxic-ischemic injury are cardiac arrest and drowning. Patients with hypoxic-ischemic brain damage are very unlikely to recover any awareness after only three months in the vegetative state; and among those who do, a good neurologic recovery is very rare. Age is also an important factor. Younger patients have a higher probability of recovering consciousness early on; but after 3–12 months (depending on the type of injury), even children are extremely likely to remain in a vegetative state.

Matt’s brain injury was a combination of traumatic and hypoxic-ischemic injury because he was not breathing immediately after the accident. As a result, at six weeks after injury, the odds of Matt recovering some consciousness were small but not impossible. However, if Matt remained in the PVS at three months, his odds of recovering consciousness would be extremely poor, and Dr. Roberts would be able to say with a high degree of certainty that Matt would not have a good cognitive or functional recovery.

The Minimally Conscious State

Nine weeks after the accident, Matt started responding—just a tiny bit—to examiners and his environment. His caregivers noticed that if his eyes were open and someone called to him, his eyes would often, but not consistently, look in the direction of the voice. Sometimes, if his blood was being drawn, he would moan or grimace or weakly pull away from the pain, in a purposeful nonreflexive way. His parents had also seen him attempt to mouth words, but he did not do so on a consistent basis.

Matt was showing possible signs of consciousness, but his degree of neurologic functioning was not sufficient for him to communicate his needs or to care for himself. His condition had progressed to the minimally conscious state (MCS), which is characterized by either minimal or fleeting and inconsistent responses that nonetheless are consciously driven and represent more than the reflex responses seen in a coma and the PVS. Some patients in the MCS progress to have consistent awareness, whereas others continue to fluctuate between the PVS and the MCS. In some sense, the MCS is better than PVS because it suggests that some parts of the cortex, thalami, and white matter are working in a coordinated fashion. However, in the MCS, Matt was able to perceive his pain and his circumstances but was unable to communicate to others about his experience or his own perception of his condition. Because his MCS was the result of such a severe and widespread brain injury, Matt still needed the feeding tube for nutrition and hydration, and meticulous nursing care for all of his physical needs.

After Matt emerged into the MCS, his parents were hopeful that he would continue to improve. Sadly, after three more months, he had not. He continued to fluctuate between the PVS and the MCS. Dr. Roberts informed Matt’s parents that the likelihood of a good recovery—meaning that Matt could communicate his needs and make useful movements with his hands and arms—was exceedingly low. Although she could not rule out the possibility of minimal improvement over months or years, she could say that he would never be able to care for himself or engage in complex social interactions.

Matt’s parents considered whether Matt would want them to continue tube feedings in his current condition without a reasonable chance of a recovery that he would think was meaningful. After many discussions with their family, friends, social workers, and clinicians, Matt’s parents concluded that he would not have wanted to continue treatment, and they asked that the tube feedings be stopped. This request was honored, and nine days later, Matt passed away without evidence of pain or discomfort. 

Brain Death

In the previous scenario, Matt progressed from coma to the vegetative state to the MCS. However, rather than improve, some patients in coma worsen. In the following alternate scenario, Matt’s brain injuries were much worse than described above, and the clinical course differed significantly.

Two days after his accident, Matt was comatose and had no brainstem reflexes. His pupils did not respond to light, his eyelids did not blink when his eye was touched with sterile cotton, he did not have a gag or cough reflex in response to tracheal suction, and he did not initiate any breaths on his own—all breathing was provided by the ventilator. Dr. Roberts concluded that Matt had suffered a severe and potentially irreversible injury to all of the neurons in his brainstem, cortex, and thalami and that his condition was probably worsening toward brain death, a term that refers to the irreversible loss of all clinical brain functions, including all brainstem reflexes and the drive to breathe.

To confirm brain death, Dr. Roberts performed a series of formal tests known as the brain death examination, which is recommended by the American Academy of Neurology to look for any brain function. This examination confirmed that Matt was comatose and that he lacked all brainstem reflexes, including the respiratory drive. When the ventilator was temporarily disconnected from the endotracheal tube while his vital signs were being carefully monitored,  Matt made no effort to breathe--even when the carbon dioxide level in the bloodstream reached levels that normally elicit gasping and breathing. Following her hospital’s protocol, six hours later, Dr. Roberts performed a second brain death examination, which elicited the same findings.

As is the practice in the U.S. and many other nations, Dr. Roberts pronounced Matt dead on the basis of brain-death criteria. She explained how she made this determination to Matt’s parents and told them that the ventilator and any fluids or medications would soon be stopped, once they had had a chance to say goodbye.

In accordance with hospital protocol and national standards of practice, Matt’s parents were told about the possibility of organ donation. Patients pronounced dead by brain-death criteria have the opportunity to donate all of their major organs (kidneys, liver, pancreas, intestines, heart, and lungs) and tissues (cornea, skin, bone) because the organs and tissues can remain viable for transplantation until the ventilator is stopped. Matt’s parents believed Matt would want to donate his organs, and after discussion with the regional Organ Procurement Organization, they agreed to the donation.

Posted on BrainLine February 4, 2015. Reviewed July 25, 2018.

Cochrane, T.I., & Williams, M.A. (2015) Disorders of Consciousness: Brain Death, Coma, and the Vegetative and Minimally Conscious States. New York: Dana.

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

Comments (61)

Was in major car accident, at time unknowingly suffered tbi , wrongfully accused and arrested of DWI, due to altering effects of consciousness..

Hi, I have a friend who was in a terrible motorcycle accident in January and has been unconscious since then, it is now mid/late April. He has had a couple small instances that he seemed to vocally respond however he has not done so in about 2 weeks. He is no longer on a ventilator and is breathing on his own but that is all he is able to do. They are able to wheel him outside and was in hopes that the fresh air and sun would help since he was a very outdoorsy person before the accident. They did have to remove a small section of his brain due to blood loss but I am unsure of what part. Since he has been unconscious for nearly 3 months, what would the likelihood of him waking up at all be?

Very well explained. I have a relative in ICU currently and this information helps

Thank you for this article. I was looking for research on brain injuries due to car accidents for my new novel. I appreciate that you used a real life scenario. It helped me to understand and follow along. I'm excited because know I can make my story realistic and believable based on how you wrote this in laymen terms. Thanks again.

I feel for anyone with a head injury, I really do. The uncertainty of a head injury
and its outcome Is the main concern here I think.
The darkest day of my life occurred one normal sunny day when I was riding my
Motorbike and I collided with a car which turned into my path. What happened
Next is extraordinary as I was probably thrown up into the air and when I hit the
Ground my helmet was completely knocked off my head with such force I was
Knocked Out. This was incredibly dangerous. I will never know if the helmet
Failed me or it was just a freak accident.
As I lay Unconscious on the road people from nearby houses and passing cars
Would have stopped and helped, prior to the arrival of the police and paramedics.
I don’t remember anything about the police, paramedics or helpers attending to
me. For around 40 minutes I remained unconscious with absolute minimal memory
of anything.
There was just 2 very, very brief moments when I vaguely remembered anything
At all. It was mostly just darkness and silence, like being shut away alone in a
Dark, Silent and empty room. I never woke up again till I was in Hospital
When I regained consciousness in hospital it felt like I had been asleep but for no
Reason.
The helmet coming off has troubled me and puzzled me since and I believe I
Was Knocked Out by the sheer force transmitted to my brain from a blow to the
Base of my skull/jaw from the helmet being knocked off my head. I broke a tooth
That supports this theory.
I had a friend on the back of my bike who said my helmet just laid in the road as
although he was injured, he was conscious and he told me later what had happened.
He told me I was Unconscious and “Out Cold”.
I was shocked and you never forget the day when your life is turned upside-down
In a few seconds. I was just 18.
Even riding safely with a helmet doesn’t guarantee prevention from a serious
Concussion.

I’ve had 4 concussions that caused me to loose consciousness. Two of the Four (kicked by horse in head and car crash) I lost consciousness for at least an hour. I’ve had numerous minor blows to the head that made me feel dizzy, nauseous and sleepy. I’ve been diagnosed with ADD should I go see a neurologist?

Back lower left quaddrant feels like that part of my head moves
Sometimes when I smile I have brief swver pain. Firemen in December 2014 in Waukon IA slammed my head into the wall getting me out of the den when my half sister set our laundry room on fire. My head was swollen for nearly two years.

My TBI happened on 07/03/2001. I was in a coma for 2 months. Still to this date I still suffer from a good sized list of problems. My frontal lobe was destroyed. I've been told by Dr.'s I'll never fully recover. I've got a lotta hate.

Please work on losing the hate..It’s hard... but it’s draining your good energy to use in being happy. Life is unfair, it can suck, but you’re alive and there’s a world full of new people and experiences if you open yourself up to them. So, forgive for your sake.

I am reading this because I suffered a brain injury and had all the symptoms from getting hit by a Tractor Tailor. I was rushed to the hospital only for them to give me medication that didn't help. They didn't perform any test just asked me my name and what happened.... I don't know what to do because I am progressively getting worse (I'm 16 years old by the way)

I truly fell deeply for all here I am a victim of a road rage attack and rear 80mph impact I am alive and greatful but I will never be the same ,and will never have my quality of life back. I have spent 3 years trying to find be up for this horrendous pain in my head and neck without having to take so many pills. :'(

Hi My partner was in a car accident 3 weeks ago and when the weather got warmer over 75F he starts to overheat. If he doesn't get out of the warmth he gets the concussion symptoms back of , headachy, brain fog, and very tired. Asked two doctors now and both say not normal. Anyone have any suggestions? 

I have a friend who had a cyst growing behind her optic nerve. Surgery was done drilled a hole through her skull by way if nostrils. 5 surgeris later they cannot stop spinal fluids from leaking from her nose. Any recommendations for a better surgeon and where

My husband suffered a terrible accident and caused trauma in the brain and he got surgery and they placed his bone back. My mother in laws says that he hit pretty hard and that he will never be the same person. Is that true? Do injuries like this cause the person to stay the way they are or is there a chance that they can be normal again?

I had a bad accident in '97. I was going 20 mph on a bicyicle when a woman pulled in front of me. My face distroyed her side mirror which did the same to my face. Every bone in my face was splintered in a thousand pieces. Both jaws were knocked loss, my eye was hanging out, my skull was cracked and I had a bad concution. The doctor said I had little chance of survival and if I did I would be blind. Miraculously I survived but it distroyed my ability to love. I whisk I had died.

I'm sorry to hear about your mom. My brother was attacked and hit in the head several times. It's a nightmare. So I'm praying for you!!! But a nursing home isn't that much different then a hospital and if the hospital says she can't stay a nursing home is the best place to put her. They can give her round the clock care she needs. So I know it's tough to think of but unless you can afford to have round the clock care if you kept her at your home. But if you don't a nursing home is your best option. It' also has less patients then a hospital so she would be in good hands!!! I really hope this helps you out... May the Lord bless and keep you, your mother and family!!! 🙏🏼

Don't take her to a nursing home. Fight. She will not get the care she needs in a nursing home. The insurance companies just want her out. Keep her in the hospital.

My husband was in an accident and got a very bad brain injury and put in a coma for 7 days that he wasn't supposed to wake up from, doctors tell us he is a miracle. He suffers from major mood disorders and major bipolar disorder. He is a sweetheart one minute and a mean person the next. We have tried several medications and currently he is on Latuda, it was working at first and now it seems that he's so immune to it that it doesn't work anymore. I have been recently doing research to see if his brain can be surgically fixed, but haven't really found anything that's stuck out. I want my loving husband back, what do I do, what is the next step to try or path to go down?

I never realized how the seriousness or the depths of brain injury. Almost three tweaks ago my boyfriend had an accident and was in a Coma. His prognosis was not good, with Dr reports stating he had brain damage, so even if he'd survive, he would never walk, talk, or take care of himself. Well he was a miracle and the Lord spared his life. I received the good news and was so ecstatic, he's talking, remembers people and is feeding himself and his walking is progressing everyday. It's amazing!!! The only issue I'm having is, it is just not the man I knew before the accident. His brain functioning isn't working properly. While he knows what's going on, and what happened to him, he's familiar with family, friends and is before life, he always thinks he's in different states and locations, it's like he's emotionless, and lifeless. I go visit and it's devasting me daily. He knows who I am and talks to me, but he was an extremely affectionate, caring person, we were unseparable, now he doesn't show any emotions or affections. It's like I'm a stranger to him and when I call he just wants off the phone. Is this normal or could he of just lost his feelings or awareness of them? Sounds similar to what your experiencing with your husband's moods.

I had a concussion years ago from a rear end accident & I remember feeling absolutely flat like I had no emotions. I actually went out and got a dog for the first time in my life. The love I felt brought me back to feeling emotions again. So my advice would be stay affectionate with your boyfriend, show him how much you care & eventually his brain will heal & his emotions & feeling for you will come to the surface. Be patient & loving.

Hi, After How long ?

I have a friend who was involved in an accident on the 1st of December 2018, He is still in ICU has never woken up since the accident and the doctors don't know what's wrong
with him anymore.

I've had three brain injuries in the last 40 years. The first in a car accident left me unconscious for 24 hours. There was no treatment in the hospital, not even cleaning my head wounds and removing the broken glass. The next two were in 78 and 2000. They were much less serious, but the third left me with diminished short-term memory, inability to focus, diminished spatial sense, impulsivity, sudden mood changes, and having to talk my way through things like stopping at a stop sign. I did some neurofeedback which helped a lot. I wasn't able to continue, and my memory problems persist, although being now in my 70's doesn't help. I would definitely recommend neurofeedback. I had studied it, myself, prior to third injury. After that third concussion my brain wave patterns had changed dramatically. A certain degree of improvement is definitely achievable with neurofeedback. Good luck.

In response to January 24th question.  There are a list of tests that can and should be done to assist in the diagnosis and decisions for people diagnosed as vegetative.  The issue is hospitals are put on tight time lines anymore.  I read a study that shows that over 40% of TBI patients in nursing care are misdiagnosed as vegetative when they are minimally conscious.  Decisions are forced to be made too soon and with not enough information to do so in many cases.  Go to journeyforjessica.com and I would be happy to send you any information and/or contacts I have that can help you.

I had a car accident two weeks ago. I had pain in my head and felt unwell. I thought it might be because of injury. I had my CT scan done and they found blood in the right side of the brain. I feel very sleepy and get pain in my head. The doctors are going to perform surgery tomorrow to take the blood out. I hope I get normal again

Your comment stood out to me about your mother, please don't lose hope! My mother on January 25, 2016 suffered from extensive brain damage and was in a coma for two weeks then she was in a locked in state couldn't move an inch of her body and was well unaware. She had a trach and feeding tube and was sent straight out to a nursing home becasue we had no choice due to insurance purposes. It's Febuary 2nd and my mom is going home Wednesday February 8th it has been a long slow process, but God has healed her tremendously she is not 100% back but she no longer has a trach she feeds herself and can walk with a walker. There is always hope!

I had a concussion to the back of my head when I fell on the bedroom wood floor at 4am on 5/28/16. When I fell, I passed out and it woke up my husband. Thank goodness that my husband called 911 and didn't just put be back in bed! I spent the next 12 days in the hospital and I can only remember about 10 minutes of it. Come to find out that my brain had bounced to the front of my head and that caused bruising and bleeding inside my brain. (Even now I can't remember the wording for the kind of hemorrhage that I had) Could barely walk without help when I got home. In August 2016 (2 mo later) I started to have really bad headaches 24 hrs a day. Previous to this I was prone to migraines and had the Meds that worked, but not for the headaches I was having. Tylenol didn't faze it either. Had a Dr. visit with a neurologist and he Rx Topamax. There was about a two week graduated increase in the pills and I finally didn't have any headaches. My brain was scrambled... I couldn't even remember plain words like fork or coat, etc. Even now I have a hard time remembering, but if I can't, my husband will give me clues on the words I can't find and then all of a sudden I remember. But by the next day, I have forgotten it again! Found out from another Dr that Topamax doesn't help with gaining your memory back after the concussion...😟 Not a happy camper now. I liked not having a headache/migraine all the time. By the middle of December 2016 I weaned myself off of the Topamax. Yeah, no more headaches! Ok, now it is almost the end of January 2017 and my brain is still on partial empty. Neurologist told me in 8/16 it could take 6 months for my brain to be normal. (I haven't gone back to see him, he was worthless.) Then I heard from another Dr that it could be about a year to recover. Then I read an article on the internet that it could be a year plus before my brain works again correctly. This upsets me, because I used to have a great brain memory. Now I'm looking into healthy vitamins etc for some help. I wish everybody and their families the best with their recovery!

My mother was in a very bad car accident the doctor diagnosed her with Diffuse Axonal Injury. They told us she will never wake up. She is on the trech to help her breath with the shunt and feeding tube. Any suggestions on what I can do to help my mother? I know God is going to wake her up. I have hope but the ICU wants us to take her to nursing home and that's one place I don't want my mom to be in. Any suggestions? Please. God bless you all.

Fish oils...Omega 3's does help lower inflammation in the brain. Also play brain wave music to comatose patients with a pair of lightweight headphones if the hospital will allow. Plenty of free music on the Internet. Essential oils also helps, Frankincense is good. Where it on your clothes whenever you're with the patient, or rub on big toe of each foot.

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

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

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 

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

You could have post concussive syndrome

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.

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.

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.

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. 

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!

Very glad to hear this, a young 17 year old Austin was in a head on car crash minutes from his house they said they should make arrangements he had swelling on his brain and bleeding on brain too that was on the 26 the of may today is the 28th of may he breathed and his eye twitched please pray it is my Megan's boy friend lovely young man.

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.

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.

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!

Thank you so much for your comment

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 .

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.

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.

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.

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 ??

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.

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 

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