Traumatic Brain Injury Signs and Symptoms

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Signs and Symptoms (summer)

The signs and symptoms of a traumatic brain injury (TBI) can be subtle. Symptoms of a TBI may not appear until days or weeks following the injury or may even be missed as people may look fine even though they may act or feel differently.

If any of the following symptoms appear suddenly or worsen over time following a TBI, especially within the first 24 hours after the injury, people should see a medical professional on an emergency basis.

Common Signs and Symptoms of a TBI

People should seek immediate medical attention if they experience any of the following symptoms:

  • loss of or change in consciousness anywhere from a few seconds to a few hours
  • decreased level of consciousness, i.e., hard to awaken
  • convulsions or seizures
  • unequal dilation in the pupils of the eyes or double vision
  • clear fluids draining from the nose or ears
  • nausea and vomiting
  • new neurologic deficit, i.e., slurred speech; weakness of arms, legs, or face; loss of balance

Other common symptoms that should be monitored include:

  • Headache
  • Light-headedness, dizziness, vertigo, or loss of balance or coordination
  • Sensory problems:
    • blurred vision, seeing stars, or eyes that tire easily
    • ringing in ears
    • bad taste in mouth
    • loss of sense of smell or taste
  • Sensitivity to lights, sounds, or distractions;
  • Mood changes or swings. agitation (feeling sad or angry for no reason), combativeness, or other unuaual behavior
  • Feelings of depression or anxiety
  • Fatigue or drowsiness; a lack of energy or motivation
  • Changes in sleep patterns (sleeping a lot more or having a difficult time falling or staying awake), inability to wake up from sleep
  • Problems remembering, concentrating, or making decisions
  • Slowness in thinking, speaking, acting, or reading

Headache, dizziness, confusion, and fatigue tend to start immediately after an injury, but resolve over time. Emotional symptoms such as frustration and irritability tend to develop later on during the recovery period. Many of the signs and symptoms can be easily missed as people may appear healthy even though they act or feel different. Many of the symptoms overlap with other conditions, such as depression or sleep disorders.

In some cases, repeated blows to the head can cause chronic traumatic encephalopathy (CTE) – a progressive neurological disorder associated with a variety of symptoms, including cognition and communication problems, motor disorders, problems with impulse control and depression, confusion, and irritability. CTE occurs in those with extraordinary exposure to multiple blows to the head and as a delayed consequence after many years. Studies of retired boxers have shown that repeated blows to the head can cause a number of issues, including memory problems, tremors, and lack of coordination and dementia. Recent studies have demonstrated rare cases of CTE in other sports with repetitive mild head impacts (e.g., soccer, wrestling, football, and rugby). A single, severe TBI also may lead to a disorder called post-traumatic dementia (PTD), which may be progressive and share some features with CTE. Studies assessing patterns among large populations of people with TBI indicate that moderate or severe TBI in early or mid-life may be associated with increased risk of dementia later in life.2

Children: TBI Signs and Symptoms

Children with a brain injury can have the same symptoms as adults, but it is often harder for them to let others know how they feel. Call your child's doctor if they have had a blow to the head and you notice any of these symptoms:

  • Changes in eating or nurseing habits
  • Persistent crying, irritability, or crankiness; inability to be consoled
  • Changes in ability to pay attention; lack of interest in a favorite toy or activity
  • Changes in the way the child plays
  • Changes in sleep patterns
  • Loss of skill, such as toilet training
  • Loss of balance or unsteady walking
  • Vomiting
  • Tiredness or listlessness
  • Changes in performance at school

Effects on Consciousness

A TBI can cause problems with arousal, consciousness, awareness, alertness, and responsiveness. Generally, there are four abnormal states that can result from a severe TBI:

  • Brain death
    The lack of measurable brain function and activity after an extended period of time is called brain death and may be confirmed by studies that show no blood flow to the brain.
  • Coma
    A person in a coma is totally unconscious, unaware, and unable to respond to external stimuli such as pain or light. Coma generally lasts a few days or weeks after which an individual may regain consciousness, die, or move into a vegetative state.
  • Vegetative state
    A result of widespread damage to the brain, people in a vegetative state are unconscious and unaware of their surroundings. However, they can have periods of unresponsive alertness and may groan, move, or show reflex responses. If this state lasts longer than a few weeks it is referred to as a persistent vegetative state.
  • Minimally conscious state
    People with severely altered consciousness who still display some evidence of self-awareness or awareness of one's environment (such as following simple commands, yes/no responses).2
Posted on BrainLine December 1, 2017. Reviewed July 6, 2018.

About the Author

BrainLine offers authoritative information and support to anyone whose life has been affected by brain injury or PTSD: people with brain injuries, their family and friends, and the professionals who work with them.

BrainLine is a national service of WETA-TV, the flagship PBS station in Washington, D.C. Learn more >

Citations

1. Centers for Disease Control and Prevention (CDC), Facts about concussion and brain injury, 2017. www.cdc.gov/
2. National Institute of Neurological Disorders and Stroke, National Institutes of Health, 2015. www.ninds.nih.gov. Updated July 6, 2018.

Comments (113)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

hello,

I have had multiple head injuries. This last one completely changed my life. I never went to the hospital and had no idea that there is help out there for head injuries until three months ago.

I have cried my eyes out and have been so close to taking my own life on numerous occasions because I would get so upset with my mind. It wasn't until just recently I discovered there might be light at the end of the tunnel. To what degree of light and recovery, I'm not clear yet.

I found treatment and need to schedule my doctor's appointment. I have been attempting to make a doctors appointment for the last three months, but I seem to be unable to make the call.... as weird as that sounds. I don't get it. I can call my spouse but when it comes to making appointments, I just keep rewriting the number down. I am still hopeful though I fear it may be another year before I get to actually see a doctor for the first time.

You mention your speech. I too occasionally sound like I'm drunk but I'm completely sober. As time passes it isn't as often.

I'm not too sure of much. I depend on my partner to explain my life to me because I only remember tiny bits and pieces here and there. I would be a complete stranger to my life if it weren't for pictures and a routine I seem to trust and know the things that are repetitive. People who I only meet once or twice its as if I never meet them. I fake it for the majority and I can safely do that only because I trust my partner and believe him over believing myself these days.

I am barely hanging on but I'm hanging on. It sounds like you're finally getting a proper diagnosis so now it's just a matter of your hard work and perserverence and things will start to balance out for you.

I've been to doctor it's not good news. I would like to play easy games I was real good on games

what if you hit your head on a metal door and you start feeling dizzy and 

thank you i am 12 i got layed out in footbll he hit me in the back penelty and i couldnt talk atall for a miniute or two but for some reason i went back inteh game and got 11 more tackles and 3 sack on the qb but in my back there was like nerve damage i think it hurt every time i took a shower it stjung

Thanks for the website and all info Sarah, psychology student, Iran
Auto accident at Wayne and Wilmington 24 June 2010 have all on list plus lower spine/back pain; still suffering at this writing. Some MD's and Neurologists have no experience in TBI. Especially be careful not to go to a MD who first practiced in a socialized medicine country- if you walk and talk your good to go. It happened to me at another place not KMC. Richard in Kettering 937.654.4771 Help with proper care please.
Was a security officer at a local club got bashed and kicked around. Unconcious 10 mins cant even spell my wifes name anymore all the symtoms. 10 days later whats next in my life.
was in fatal car accident, have not had any medical treatment since leaving hospital...three years ago, everything on this list is my daily life
after my hellicopter crash 12-25-72 i was having almost all the signs and symptoms so the doctors at sick call keep telling me its the flu syndrome here is some through losingers return to full duty or they would say general malisia fit for duty
Great article!
Is timing critical? Is there a 24=48 hour period where getting appropriate helps make a difference in the opportunity for full/significant recovery?

1989 I was 9 years old and was in a car wreck. a 16 year old girl hit us head on at the top of a hill when we was on our way to church. I was in the middle back seat wearing the slide able seat belt. so when she hit us I flew straight into the front dash and broke every bone on the left side of my face. the bones on my forehead crushed into my brain and my eye ball was floating around in my head. I was out of conches. the helicopter flew me out. they told my parents if I lived I would be a vegetable. I had 3 surgeries. died three times. in a coma for 9 weeks. they had to cut my head from one ear across my head to the other ear. rebuilt the whole side of my face for a adult size so they would not have to do it again when I grow up. put a metal plate and screws for my forehead. stuck my eye back into socket. when I came out of the coma I was very week. they would hold onto me and walk me a little bit down the hallway. I had lost 3 days of my memory before the wreck. oh ya I was not a vegetable thank the lord. so because of my brain having bones crushed in, it killed the left side of my brain, so my nerves on my right side makes it hard for me to write because my hand cramps really bad and starts to hurt. my toes curls down on my right side and I walk on them. my spine has a curve above my tail bone, so I have arthritis and back pain. the doctor said it will get worse as I get older, so now I am 39 and I just recently trying to write with my left hand, go to a chiropractor since I was 18, I have a lot of pain in my foot to were it is very hard for me to walk. when I get up from sitting I feel like a old lady because I have like three raising ups before I am standing straight. my grandma is 85 and she stands up like a young person with no problems. after hearing about some people not being able to walk later on I think that may happen to my right leg soon. now my left side of my body is fine, nothing wrong at all. because of my left side of my brain being dead it just messed up my right side of my body. I called a lady that works to help peoples nerves, but when I told her my story she said they can not help it because of my brain being dead. but I just thank God for bringing me through all of this when I was 9. I wish there was something to help my nerves. I can tell a big difference about my health the last 10 years. I am very happy I have 2 girls 6 and 8, and I have been married for 20 years. I thank god for letting me have a great family, I have went to church with my husband since I was 16. my health bothers me bad sometimes but I know I just have to go on and thank God for letting me live.

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