What Happens Immediately After the Injury?

Icahn School of Medicine at Mount Sinai
What Happens Immediately After the Injury?

What happens to the brain at the point of injury?

Traumatic brain injury (TBI) refers to damage or destruction of brain tissue due to a blow to the head, resulting from an assault, a car crash, a gunshot wound, a fall, or the like.

In closed head injury, damage occurs because the person receives a blow to the head that whips the head forward and back or from side to side (as in a car crash), causing the brain to collide at high velocity with the bony skull in which it is housed. This jarring bruises brain tissue and tears blood vessels, particularly where the inside surface of the skull is rough and uneven; damage occurs at (and sometimes opposite) the point of impact. Thus, specific areas of the brain - most often the frontal and temporal lobes - are damaged. This focal damage often can be detected through MRI and CAT scans.

In closed head injury, the rapid movement of the brain can also stretch and injure neuronal axons - the long threadlike arms of nerve cells in the brain that link cells to one another, that link various parts of the brain to each other and that link the brain to the rest of the body. This widespread axonal injury interrupts functional communication within and between various brain regions and sometimes between the brain and other body parts. However, this type of diffuse damage typically cannot be detected through currently available imaging technology (but with new developments, this may change). Its existence is very clear, however, in the widespread effects it has on the individual's functioning.

In sum, after a closed head injury, damage can occur both in specific brain areas (due to bruising and bleeding) and also be found throughout the brain (due to stretched or destroyed axons). The results of a closed head injury tend to affect broad areas of the individual's functioning, primarily due to the diffuse axonal injury. The extent of damage is correlated with the force of the blow to the head; for example, a head forced into a car windshield at high speed will tend to sustain more tissue damage than when the car is traveling at a slower speed.

Open head injury, the second type of TBI, occurs when the skull is penetrated, for example by a bullet. Damage following open head injuries tends to be focal, not diffuse, and the implications for subsequent impairment tend, also, to be focal and limited. However, such injuries can be as severe as closed head injuries, depending on the destructive path of the bullet or other invasive object within the brain.

What happens immediately after TBI?

Immediately following TBI, two types of effects are seen. First, brain tissue reacts to trauma and to tissue damage with a series of biochemical and other physiological responses. Substances that once were safely housed within the cells now flood the brain. These processes further damage and destroy brain cells, in what is called secondary cell death.

The second type of effect is seen in the individual's functioning. For those with more severe injuries, loss of consciousness (LOC) occurs at the time of trauma, lasting from a few minutes or hours to several weeks or even months. Lengthy LOC is referred to as coma. In such serious injuries, the first few days after trauma may also produce negative changes in respiration (breathing) and motor functions.

As an individual regains consciousness (those with the severest injuries may never do so), a variety of neurologically based symptoms may occur: irritability, aggression and other problems. Post-traumatic amnesia (PTA) is also typically experienced when an injured person regains consciousness. PTA refers to the period when the individual feels a sense of confusion and disorientation - Where am I? What happened? - and an inability to remember recent events.

As time passes, these responses typically subside, and the brain and other body systems again approach physiological stability. But, unlike tissues such as bone or muscle, the neurons in the brain do not mend themselves. New nerves do not grow in ways that lead to full recovery. Certain areas of the brain remain damaged, and the functions that were controlled by those areas may emerge as challenges in the individual's life.

Before discussing in greater detail what happens to the person after injury, which depends to great extent on the severity of injury, "severity" needs to be defined (in the next question).

What is meant by "severity of injury?"

Typically, "severity of injury" refers to the degree of brain tissue damage. Although the degree of such damage cannot be directly measured, it is estimated typically by measuring the duration of loss of consciousness (LOC) and the depth of coma (and sometimes by the length of PTA).

The scale most commonly used to measure the depth of coma is the Glasgow Coma Scale (GCS). The GCS is used to rate three aspects of functioning: eye opening, motor response, and verbal response. Individuals in deep coma score very low on all these aspects of functioning, while those less severely injured or recovering from coma score higher.

A GCS score of 3 indicates the deepest level of coma, describing a person who is totally unresponsive. A score of 9 or more indicates that the person is no longer in coma, but is not fully alert. The highest score (15) refers to a person who is fully conscious.

Severity of injury is typically categorized into three levels: mild (or minor), moderate and severe. A commonly used rule of thumb is that mild injury refers to LOC of less than 20 minutes and an initial GCS of 13-15. Typically, an initial GCS of 9-12 defines a moderate injury and 3-8 a severe injury.

Although initial "severity" measures may generally predict long-term impairment, initial severity scores do not correlate well with negative consequences in a person's life. The effects of TBI on individuals and the meaning of those effects depend upon a wide variety of factors, only one of which is initial "severity of injury."

How long does recovery take?

Recovery after injury is usually quite different for those with moderate-to-severe injuries versus those with mild injuries. And, as must be constantly kept in mind, recovery varies greatly from person to person. Thus, recovery will not be the same for any two people with TBI.

In mild TBI, one person may recover quickly and completely, while another may experience significant challenges even several years after injury. (Recovery after mild TBI is discussed more fully in a later question, What Impact Will Mild TBI Have ona Person's Life?)

In more severe injuries, recovery is a multistage process, which typically continues in a variety of ways for months and years. However, the length of this recovery process is not uniform, and the stages of recovery that are typical when considering the population as a whole, may be very different for any specific individual. Stages may not proceed step-wise but may overlap, one stage with the next, or one or more stages may be skipped altogether. The early recovery process is discussed more fully in the next question.

How is recovery measured right after injury?

The progress seen during the immediate recovery period in individuals with severe to moderate TBI is often tracked using the Rancho Los Amigos Scale, which specifies eight levels - from the depths of coma to return to awareness and purposeful activity. These levels of recovery of functioning reflect processes within the brain, as it heals, stabilizes, and reorganizes itself to some extent.

Although the Rancho scale assumes that recovery will pass through eight stages, a small percentage of people with severe injuries remain stuck at Levels I to III for months or years. They remain in coma or in a relatively unresponsive state and fail to return to purposeful, appropriate functioning.

Rancho Los Amigos Scale

  • Level I (No Response): The individual is in deep coma and does not respond to any stimuli.
  • Level II (Generalized Response): The person sleeps most of the time, with periods of brief wakefulness. Responses and movements are largely reflexes not purposeful.
  • Level III (Localized Response): The person is alert for lengthier periods. He/she reacts inconsistently to commands, but his/her responses are related to the type of stimulus presented. For example, noises will produce a listening response.
  • Level IV (Confused and Agitated): As awareness increases, the individual's behavior reflects his/her sense of confusion and disorganization. Aggressive and/or silly behavior may be seen, with verbal abuse, agitated actions, and incoherent speech. The person's attention span is too short to allow full cooperation in treatment programs; and the person is unable to do basic tasks, such as eating, independently.
  • Level V (Confused, Inappropriate, Not Agitated): Simple commands are now followed consistently; the person's long-term memory is returning; and she/he can now carry out over-learned skills such as eating. Difficulty is evident in following complex commands, short-term memory, learning new skills, and concentrating for more than a few minutes.
  • Level VI (Confused, Appropriate): The individual begins to show goal-directed behavior, but usually still needs direction. The person is more aware of his/her deficits, family members, and so forth. He/she can carry out more tasks independently and retains relearned skills from one occasion to the next.
  • Level VII (Automatic, Appropriate): The individual performs daily routines automatically and is better able to learn new skills, although slower than before injury. The person still has poor short-term memory; judgment and problem solving are still impaired.
  • Level VIII (Purposeful, Appropriate): The person is able to function once more in the community. Impairments in cognitive, social, and emotional functioning, to a greater or lesser extent, may continue.
Posted on BrainLine July 25, 2008.

FromIcahn School of Medicine at Mount Sinai. icahn.mssm.edu

Comments (106)

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.

My Cousin 18-year-old male In perfect health. Got stabbed, two knives to the heart which caused heart damage and also lack of oxygen to the brain. Doctors believe that he liked oxygen to the brain for 45 minutes prior to ambulance arrival. After his heart Mc surgery he is now in a coma. and we don’t know how much brain damage there he is no responding to any test that Dr's are doing. Is there any chance he will ever recover from it. I would like a professional opinion if there’s hope for this young kid who’s fighting for his life.

I was on my knees slowly going toward my dog, and my sister pushed me not too hard but medium. I hit the side/ front of my head on our pool table's edge. Nothing really happened at all but I got a headache and now about 14 hours later have a migraine. It feels like a thumping heartbeat in my head, and it is annoying. I got sleepy after like 6 hours from the hit, and yeah I don't know. My mom and everyone else says I will be fine, but I just can't fall asleep. I am too scared to have permanent damage since I am a very smart person who just wants to live my life happily.

Sorry, my mistake. I was in a coma for a month, icu for another month, and in inpatient rehab for another month. Took me a while to get the ok to just leave the yard. I was always a city person, but now I am a small country person. Village only has about 700 people. I can walk again, talk again, even shop again. God is good and now I am just waiting for the next thing I am going to be given. Just say a prayer for me and make me "up for the challenge".

My son was in motocross accident he has surgery on the brain . For aneurism he had shunt put in few days ago he has eyes open he does move eyes back forth little looking at nurse I think he’s been icu four weeks this surgery just three days they said we need find long term care place for my son he’s young and a fighter what is the best Ext step for him I don’t want him laying in bed in a place where old people go I want them work which him so he can respond and get better he’s a fighter San diego

Hi. I am 43 years old and 2 1/2 years ago I was hit by a Hummer. He had a red light and I was in the crosswalk. I had 10 rib fractures, one went and burst my lung, my esophagus burst, and I had two broken head wounds. I was sent into critical care surgery. During surgery they took off half of my skull to alleviate pressure and during surgery I had a stroke and died for 2 a half minutes and those are the 2 and a half minutes I do remember. I made it through surgery

my son died on March 29th 2018, from a bullet from a nine millimeter hand gun. The bullet entered in behind his right ear went thru the brain and exited out his front left temple. His wife claims that he was yelling and carrying on with her and flailing his arms around in the air with the gun in his right hand and the gun went off, She also told police that after he fell onto the bed that he was making sounds so she took the gun from his hand in case he might shoot her. I need to know if it happened this way, he was brain dead so how could he still have the gun in his hand ? I just need to know if that is possible.

I was in a car accident in June 2019, I was hit from behind at over 60 miles an hour I was at a red light, my head hit the strearing wheel, I los conciousness now my speach is slur, I drool from my right side, I dont breath normal, I forget wear I'm at, I dont feel my hands I dont feel when I'm hungry.i forget information, I can only sleep1 to 2hrs at a time. This is happening even after 7 month .
IT dont seem like all these symptoms are going to change. Am I going to be scared for life with these symptoms

I'm sorry that you are having issues. Its been 30 years since my coma and I'm still having issues. However, it took me a year and a half before I started to feel almost healed. Still have brain issues, speech, thought, walking, emotional and attachment issues with relationships. Be patient. It takes a long time to heal. I was only in a three day coma after a bad ski race fall. I will be dealing with issues the rest of my life but, I will not give up!! Never! God Bless and hang in there!

I suffered from two gunshot wounds to the inside of her head on the right side how long will it take for my recovery process and I have a bullet still lodged in my brain

My father is 58 years old he was in an Bike accident it has been 18 days and he is still in coma I m so stressed reading all day about the injury he sometimes opens his one eye moves his legs and hands My family is so tensed I wish this won't happen to anybody It's been a hell of trauma to my whole Family I cry every night thinking what could have happened how he could have been saved from the injury
God help us

How about your father now?

My father also had the same case as your but he is only 51 years old and it's 19 days he is in coma ...me and my family are fully depressed ...

Hi several months ago my wife age 76 yrs was killed instantly in a head on car crash i was with her in a min or less she has a lot of body damage to her arms legs an a broken neck but no blood was flowing from any of her wounds why the only blood was from her nose an left ear an it only covered the palm of my hand , need some idea of what caused no other blood loss from any of her sever wounds Thanx

I don't know.. I was a pedestrian, hit by a car going 50mph. I had over 40 broken and fractured bones. Colapsed lung and hematoma in frontal lobe. I implanted in the windsheild, denting the roof of the car about 8" back. Months later, came across the clothes I was hit in. And that was my first thought.. I only had one inch or two round spot of blood. Oh and they didn't cut my clothes off me. But it was weird. Like my body just broke.

Did they tell you that she may have had internal bleeding?

My dad was only 50 years old newly sober from alcohol and I mean very new. He fell at home and hit his head and ended up bleeding out over a period of numerous hours without calling for help. When his mother found him two days later they had to call the polic my dad was only 50 years old newly sober from alcohol and I mean very new. He fell at home and hit his head and ended up bleeding out over a period of numerous hours without calling for help. When his mother found him two days later they had to Call out homicide detectives because of the amount of blood all over his house they thought somebody had murdered him. The detective reassured me six months later after the final autopsy that it was an accident that he just hit his head and was too confused to call for help how is this possible how do you not call for help

Hi Amanda, your story resonated with mine. My 63 year old sister fell at home, I found her and think it may have happened between 10 and 20 hours before being found. There was blood everywhere and her death was with the coroner until it was determined that she went into cardiac arrest. I don't know if that happened before or after the fall. What a distressing thing for your grandmother to see, she will never recover from that.

I'm really sorry to hear about your dad.

Mm, i dont think i had it that bad.. i flew off a snow tube, went up in the air, landed exactly upside down. I couldnt eat for a long time. I had spasms. Couldnt move. I couldnt understand 90% of what people were saying to me for 6 years. Anything that wasnt a direction I could not understand. I could work i just couldnt understand simply what "hello" meant. I didnt say anything. Couldnt remember who people were. I just remember throwing my shoulders backwards as possible and making my shoulders an attempted shield to my fall by jacking them up to get the brunt of it. I slid down the snow tube hill backwards, body up, on my neck and back of my head.. numb. Couldnt feel my tongue. I laughed when I was rescued. I remember all the inabilities I had and everyone bullying me. I got traumatised to no end. I could only do commands.. i barely could survive but I did. I had to act crazy to get people i didnt wanr near me away from me because I was so dumb that I didnt know my ABC's.. it sort of worked. Just overkill. Better than people getting closer to me and being vulnerable right. Everyone bullied me and accused me of doing heroin. That shit is nasty. Its funny because i hate drugs. Then i was accused of being a prostitute. I was stalked, bullied. All during a time i barely understood anything. I got stabbed in the back. It just goes on and on forever. I knew acting sort of. That was cool. I think I recovered after 7 years and was able to fully function again. Ptsd though, was not fun. Being abused for being stupid wasnt fun. It was being snuffed, and I didnt like it what so ever. 99% of people will kick a person with a spinal injury down and that is the truth, at least for this area.

April 25th 2019 my husband was in a horrible car crash. I know it's too early to tell but in all honesty I am scared senseless. This is the first time this has ever happened to me, and although he is doing pretty good (I think) when he did look at me, he gave me a weird look like he didn't know who I was. Is this normal? Will he ever actually remember who I am or what I am to him?

My partner was also in a terrible crash and has a hard time recognizing people, including me. How is your husband now? Did his confusion resolve?

I was in a car accident April 19 2019.
I was diagnosed with multiple neck, back and abdominal injuries. As well as a closed head injury with LOC and a separate head injury. Since then, I’ve been stuttering a lot, and I’ve been having a hard time keeping a conversation. I had so many conversations end awkwardly on Easter. Swallowing has been difficult. I forget things so quickly. I’m worried about this. I don’t have health insurance but the accident was the other drivers negligence. I ran head on into her driver side door. Air bag saved my life. I just don’t feel like myself right now.

July 16, 1996, I‘ve been told I was in a car wreck. I’ve been told I was in a coma. What I call my alive day, July 24, 1996, is the day I came out of the coma. I cracked the left side of my skull on the A post of my Wrangler. I broke both bones in my lower left arm. I was told it’s due to me trying to shield my head from the impact. My left leg was broken in 5 places, 2 of those were in the neck of the femur which could have been possible to cause my bone to die and resulting in my loosing my left leg. Thankfully that didn’t happen. I fractured my left hip. The muscle at the base of the femur degloved (that’s where there’s a severe and direct impact of great force, causing the muscle to be torn away from the skin and pushed aside.) That muscle is still displaced; it resides in the back of my leg rather than on the side. The doctors didn’t replace it because they didn’t believe I would recover. After waking from the coma, I had multiple nurses and doctors tell me I had a severe head trauma but nothing was ever said beyond that. I’ve only in the last 5-6 years learned that some of the issues I’ve had since then are related to the TBI. The insomnia that gets me every night is related to the TBI. The fact that I am an agoraphobic is another result. Crowded places, whether it be people or stuff makes me feel like I’m trapped and can’t move; can’t breathe. Going to new places is a huge issue for me. I have to do things in specific orders. If my routine is out of order, I will forget something. Such as in the morning when getting ready for work, if I put my hair up in a pony tail first, I’ll forget to brush my teeth and put on deodorant. If I put deodorant on first. I’ll forget to brush my teeth. If I don’t hang my keys up as soon as I walk in the door at home. I won’t remember where I’ve put them. I have issues when it comes to remembering numbers now. I have times when I’ll be asked a question, I’ll answer the question and not realize that I didn’t verbalize the answer. I apparently will think the answer in my head and fail to say the answer. That doesn’t happen very often. Often times, I can’t remember what something is called. Such as one night I was trying to describe the nice cool breeze coming through the skylight. I couldn’t remember skylight so I said “that hole in the ceiling with the cover over it”. I’ve forgotten my son’s name only twice in his life. I have a hard time remembering how old I am. I guess it’s the number thing. I’ve noticed that when I am very tired, I tend to stutter more than I usually do. If I’m stressed out, my insomnia worsens and I tend to forget words more often.

As much as I can’t remember things, I used to work at a county jail, passing medications. I had over 300 inmates to pass meds to and I could highlight their names on the rosters without going by the MAR to highlight their names. When they approached my med cart, I knew their names. I even knew what medication they received as well as the dosage. I could also remember their allergies which helped out a few times. I would point out to the doctors their about a script they’ve written to an inmate that they were allergic to.

In fact, all the locations in which I worked as a nurse, I could remember all my patients (and inmates), their medications and their allergies. I could also give you the brand name as well as generic names to all medications and I could list all their uses and adverse reactions, whether it be from the medical side or the mental health side.

I can tell you that none of my “symptoms” have worsen. I can’t say that they’ve improved. I can see a difference when I do those brain game puzzles.

When I worked at the jail, I met an officer that received a TBI a year after I received mine. He’s the one that taught me about my tbi. He’s the one that helped me realize that all those listed above were directly linked to the tbi. He helped me not feel so stupid when it came to those listed above.

There’s only two things that some people in my life have said to me that causes me to immediately get angry with them. That’s when they say it imply that I’m faking my symptoms. Also when they say “I know you don’t understand this....”. Although I do get angry with them for saying those to me, my anger never stays. I’m only angry for a few minutes.

When I first woke up from the coma, I didn’t know about anything past the elevators. I didn’t know outside. I didn’t know I had a home. I had to be reminded who my mother was when she first came to visit me. I basically started my life on the 24th of July in 1996 but whenever I heard a song, whether on the tv or the radio. I knew all the words to that song.

TBI is a terrible thing. I am so sorry you've had to go through what you've gone through, Kim! I sure hope things are improving for you! My ex father-in-law only improved due to being treated in a rehab facility that specialized in tbi. I don't know if you have one around you, but it may be worth looking into?

My brother in law has a brain injury from a car accident. It's been a couple of years now and where his scar is it looks like it's sinking. What could this be?

I whacked my head on a very sturdy glass shower door. Not the average type a really heavy one. Since then I've had issues. No headache or concussion but perhaps sub concussion. I'm very scared about the future.

In 2007 I tripped over a parking curb when I was doing an event at work I hit the right side of my head on a banquet table. However I did not remember that 2 months later I was home and woke up my head was killing me, dizziness, confused, sickness, slurred speech, couldn’t understand what who ever I was talking to was saying. I got in my car drove to a Hospital. Trying to tell them which they couldn’t understand me and me them. Finally they saw me I was told that I told them that I didn’t hit my head. Then left there went to the Doctors and a Dentist. Come to find out that I already have been to 2 other Hospitals and then I drove to work and nobody could understand me. My Boss took me to one of the other rooms and said Don’t you Remember that you tripped over the parking curb and hit your head?? I said no.. Then for some reason I got flashbacks of that moment. Like a puzzle. Now 12 years later I found papers about a case that I can’t remember. There is nothing that I can do about it.. My Lawyers took advantage of me because I was mentally Disabled in my Brain.. Lost everything. I still can’t remember things... Why????

I am 53 years old and was an avid roller skater for much of my life. I decided last might at my granddaughters bday party I wanted to see if I still could. I practiced on the carpet (at the skating rink) and had stopped to talk with the maternal Grandmother when a out of the blue, my feet flew out from under me and the back of my head was the first thing that hit the a table and my body hit the floor. I did not lose conciousness and have not had a headache or any swelling, but the area is so very sore and kept me up for much of the night. I can feel the entire are involved without touching my head (a dull ache like heavy feeling) . I take a low dose aspirin and a Mobic daily and am a bit concerned about a bleed. I feel I would have pronounced symptoms. I know it can take a while to have many of the symptoms so wondering if anyone has experienced anything similar to my ordeal and has advice. Thanks in advance

Any kind of injury to the head that severe should be ideally looked into. A trip to the ER or doctor to get brain scans ASAP to rule out any internal damage.

Hi Donna, This sounds like a question to run by your doctor. Maybe it's worth making an appointment to be seen? Sounds like a nasty fall! Hope you feel better soon.

My story is mild compared to what I read below. Sorry to those who are suffering. I am curious, however, about what happened to me. I am 46 and play ice hockey. While transitioning from forward to backwards I caught and edge and fell backwards, first hitting my butt, then back then back of head, which team mates said my head bounced. I don't recall loosing conciseness but I do recall like what I would describe as a reset felling in my mind. Like being stunned sober, although I was not drinking. Does that make sense? I did not feel confused but did sleep alot the next few days and sensitivity to light was present. I did not go to hospital or doctor and not sure now after 1 month it would even make sense. Does this sound like this was a concussion and I was knocked out?

I am a 34 male, and a TBI survivor,

On June 18th, 2018 I was in a horrible car wreck as an innocent passenger, when the driver turned left over the yellow median lines which is apparently illegal in NJ. Although I probably wouldn't have known that either. The side of the car I was a passenger Incas exposed to oncoming traffic. We were struck at what seems like would have been a tremendous amount of speed, and I was bounced around inside the car, and then when rescue workers finally arrived, I was already in a coma from the impact, I was cut out of the car by the Jaws of life, and given a tracheotomy at the scene,

I as driven in an ambulance to Cooper Memorial Hospital in NJ where I've been told and judging by the fact I'm still alive, they were known to have a fantastic trauma team. At the hospital, while in a cometic state I had monitors placed on/in my head make sure the pressure didn't get too great. As well as filters placed in my thigh to ensure I didn't get any blood clots.

Finally we make it to the very end of August and after many more weeks of being in the coma, and waking up and barely responding to people who meant the world to me, I finally was discharged from Cooper Memorial and sent by an ambulance to Spaulding Rehab Hospital. Im finally now just coming to the realization that a majority of these things I thought I saw and did on the ambulance ride there, and before that were completely fabricated.

Spaulding Rehab, August 30th - I was a patient making huge strides towards recovery at this rehab from August 30th until September 20th. I would complain about and to and make issues for the nurses/aides/therapists about various unimportant/irrelevant issues I thought existed. I'm finally just now starting to realize how irrelevant/nonexistent they truly were. After 3 weeks of making huge strides toward my recovery I was discharged and allowed to go home.

As much as I couldn't wait to leave that rehab, one of my most difficult challenges so far has been reintegrating into society, and dealing with the realization of how much I wasn't coherent for and accepting how much the world changed while I was away.

I was discharged though to a group of people, as well as my girlfriend who was able to care of for me when I couldn't necessarily take care of myself, and who helped me to fill in all my memory gaps, prior to and after the accident. I will always attribute everything I achieve in my recovery process to her. Kaylee, The love of my life.

Things haven't been easy since leaving the inpatient setting. I still make up nonsensical stories, and wake up believing things, that I shortly thereafter can realize def didn't happen. But I make small steps every single day. Im constantly doing various words searches, words scrambles, and puzzles, as well as every kind of brain teasers I can get my hands on.

Here we are, I've been out of the inpatient rehab setting just a few months. and I'm constantly going to various doctors appointments, and am in the process of setting up all types of new therapies such as vision, hearing, and a therapy to make my voice louder, and to get my vocal chords are harmonious like the were before.

I still have a long ways to go in this recovery process, but I will get where I want to be in spite of/regardless how hard it is. I am now accepting that I will be a lifelong member of recovery, and that not necessarily a bad thing. I used to be incredibly intelligent, at what I've been tested for previously and is considered to be at a genius level. As much as I'll have to study learn and read, I'll do whatever it takes to be intelligent again.

Alright, I need to give myself some credit where credit is due, so I'm still intelligent as is, but just not to the same level or capacity I once had.

I was in a car wreck in 2003 where I was ejected from the vehicle, flew about 50-75ft and hit the road head first. It is almost a guarantee that I lost consciousness but by the time first responders arrived I was awake. I cracked my skull, tore my brain down the middle and bruised the left side of it. My back and neck were broken as well. I spent 21 days in a drug induced coma, when I was brought out of it I was told it would be 6 months before I could expect to be discharged. I checked out of the hospital 13 days later and was back to work a month after that. Because my physical recovery was so swift Everyone including my Drs just assumed I was good to go. I was never given any information on what to expect with a TBI. I was 25 at the time and convinced of my own immortality. Within 6 months I lost everything and everyone I cared about. To this day I still don’t understand it. I just quit caring about anything that wasn’t right in front of me. I still struggle with this. I haven’t been able to maintain a relationship with anyone for more than a year or 2. I still work as an engineer and I am great at my job. My only physical symptom of a TBI is my speech when I get tired. I don’t suffer from depression or anxiety. My personality is the hardest thing to live with. I am 40 now and have learned to avoid people. They will just get hurt. I can love someone with every fiber of my being then go a couple days without seeing them and the feelings are gone. I rarely talk to my family, they always start reminiscing about me before my wreck, like the son they loved died that day and now it’s someone else in his skin. I don’t know why I am even writing this. I stumbled across this article and just felt like commenting. I was never told anything about my TBI or what I could expect. I just wanted to share my experience and maybe save someone else from going into it blindly. Remember that even if your body is whole, your thought process might not be healthy. Awareness doesn’t eliminate the problem but it can help you avoid hurting those that care about you.

I don’t have a lot of time to comment this morning but your story resonates. I was rear ended at a stoplight by a kid in big truck in 2006. Totaled my car. We were military, moving cross country that day. ER, nothing broken, massive upper body soft tissue damage, ER discharged me and sent me on my way. We move from Texas to Arkansas the next day w/ rental car. I get to new state, develop outrageous agoraphobia and anxiety disorders. I’m seeing new doctors no continuity of care.  No one puts 2 and 2 together for me. I suddenly can’t find words. My handwriting becomes atrocious. I can’t do math anymore. Insomnia. I can’t stand to look at my Mac computer. I look at a computer and get immediately overwhelmed. Then my mom dies, my husband who’s a pilot and usually deployed - deploys. For years.  My father comes to live with me. I have a teenage son.  The distractions of grief and caregiving make me less focused on the fact that I feel stupid and like my brain is offline.  And that something is wrong. I was thinking mental illness. Early onset dementia. 2014 my dad dies. Husband takes me to a marriage retreat. He’s into the love and eye to eye face to face and I look at him and I’m brutally honest. “I don’t feel anything” the way I’m supposed to. I’m not here anymore. I don’t know what else to say.”   I don’t feel connected to anything the way I was before. It’s like all the ability to relate on a personal level vanished.
While suffering whales and horrible disasters don’t bother me as they once did, I understand my brain is depressed. 10 times a day there’s a voice in my head saying “you should just kill yourself.” And I know it’s not logical because I have a pretty good life except for the fact I’m completely emotionally and physically disengaged from everyone I’m supposed to love. I feel like a complete fraud because now I have to mimic appropriate levels of concern. I became a surface person - if that makes sense. I feel very shallow. Still married. Husband is still a pilot. Son left for college and military. In my unobserved time away from people - I don’t function. I don’t bathe. Move. Brush my teeth. Comb my hair. I just go off rail when no one’s at home with me. Even though I function better when my husbands home,
I’m usually glad when husband leaves because I’m always faking being normal and it’s exhausting.  My TBI is now 12 years old. After my wreck, I never integrated back into my professional life. I think interviewers could sense I wasn’t okay.
I did not get a dime from the wreck as it happened in Texas and I moved to Arkansas, and the other parties insured kept saying “come back to Texas for our doctors to see you” - I couldn’t move my upper body for 6 months, turn my head sideways, and then The panic and agoraphobia. I just shut down. Hid in my house and couldn’t understand why I couldn’t string my thoughts together.  Sad. ER doctors should hand a phamplet to anyone who’s head gets jarred in a car wreck. “No broken bones— here have some pain pills” does not cut it. If I’d been WARNED about TBI, maybe I could have navigated thru it and gotten myself taken care of; I get thru my days, but tons of mental rabbit holes; at most I feel like an imposter in my own life. Most of it just doesn’t seem real and I have to forcibly make myself engage. In everything. Marriage has morphed to the roommate situation sexually. That’s been offline for years~ starting with the car wreck injuries.
The overwhelming feeling I have most days is “I’m here, but not really.”   I went to work a few months ago for a therapeutic group who reintegrates TBI patients (or tries.) I was formerly a hospital administrator and this is my first step back into work life since the accident and having my dad come live with me;
The good news, putting all these pieces together, it’s starting to make sense. Not that I like the sense it’s making.

I repeat: ER physicians owe it to car crash victims, neck injuries or not, to tell them about TBI’s and what to look for. It’s a disease process, that evolves - not an incident.

Thanks so much for writing this. I had a chronic on acute subdural hematoma that required an emergency craniotomy and, while seemingly had a total recovery, I still struggle in many ways, especially when I am tired. I sometimes feel like part of me was lost. It was so helpful to read this and I am sorry for what you have been through. Best to you! ~A

Right on brother I’m going to my second head injury in 20 years I’m 47 and I totally agree with everything you’re saying keep going and not that bad we can get through it

Wow. Thanks for sharing this post. I'm glad you are okay from that experience. It's really amazing that you recovered so quickly. I went through a similar experience and can relate to a lot of what you were saying. I would love to talk more about this with you. It's really comforting to know that I am not the only one dealing with these same types of thoughts or these experiences with others. If you would like to talk, please reach out. Thanks!

I was in a car accident where I was rear ended. I don't recall the next few minutes but I don't know if it was the adrenaline or if I lost consciousness. It was later determined I had a post traumatic concussion. Is there a way to tell if I possibly lost consciousness?

I was knocked unconscious in a bike accident and have had to live the rest of my life never having met the person who carelessly knocked me off my bike. It's just something you have to deal with I'm afraid.

I hit a car at 30mph or so, lost my helmet in the impact and as knocked out for 40 minutes. I never knew a thing at all about the police or paramedics who attended that accident scene and I later woke up in hospital. I just stared at the hospital walls as I came around. A lovely nurse comforted me and just said,"do you remember being knocked out". I couldn't talk and just lay there. The hospital said I had had a nasty bang on my head. I also suffered other injuries to my legs and arms and had a tooth broken by the impact on my head I think.

It's not just the physical damage, the concussion, but the aftermath of getting on with ordinary life and activities again. I lost my confidence but as you get older and mature a little you realize that it could have been worse and you value life more I think. 

I was in a motorcycle accident a month ago, i can't recall the instant of going down nor the slide. I do remember getting up after a couple seconds, being in panic mode, and having police and bystanders ask me a bunch of questions and staring at me.

Anyways, 4 weeks later, I've been recently experiencing moderate to extreme dizziness that I haven't experience before, almost as if i was hung over. Always feeling mentally tired, and whenever my head is flat on a surface like laying down, my vision spins in circles for 8 seconds and lose balance for several minutes.

Sorry to hear that you’ve had a bike accident recently Jeremiah, It sounds like you’ve had a mild concussion with no significant loss of consciousness, but a bang on the head nonetheless, with concussion symptoms. Like any concussion and “Shaking of the Brain” it can bring on your symptoms after the accident. I hope your symptoms subside otherwise it could me more serious and hope your brain functions, return to normal. Don’t push yourself too hard. Take it easy Buddy. Give it time.

My boyfriend just passed away on July 1, 2018 in a motorcycle accident... I was told he was unconscious then was pronounced dead at the hospital... what could the drs Of done to save his life?

Oh, no!! I am so sorry about your loss, Rebecca! It must be extremely painful for you, and the other people who loved and cared about your boyfriend. Losing a loved one, especially in such a grisly fashion, is extremely tough. Take care, and all the best.

We’re deeply sorry for your loss Rebecca. Recently our family has experienced the care & dedication of the hospital staff, Dr’s & nurses in emergency & in ICU. I can assure you, they would have done absolutely EVERYTHING in their power to save your boyfriend. It’s their job to save lives. Tragedy is nonsensical. Sending you lots of love & strength for the healing of your heart.

Im so sorry for your loss :( i really feel it , i almost lost my brother in a motorcycle accident as well the same he was unconscious and took him to the hospital asap , they did surgery on him asap if they would of waited even with one more minute he wouldnt of made it ... and his still recovering since july 28 , 2018 we didnt have no answers to our questions we just had to wait but thank god has heard us his slowly recovering but surely , im sorry you lost your bf i wish they could done something to save his life ..rip

If a person is found knock out on the ground, doesn't remember the where he is, the day, month or year and is kept at hospital for a couple of days, will that effect him in anyway during his life? Will that be a cause of his brain shrinking 45 years later?

I was in a car accident a year and a half ago. My brother, my dads friend and his two kids were coming into town from a campground we go to. We were cruising along the road until I hear “OH MY GOD”! coming from the drivers seat. Not a millisecond later was my head launched into a back of a seat at 55mph. I woke up in a hospital 10 hours later with most of my close family around me, I was VERY confused and had amnesia as mentioned in the article, I didn’t know who the hell I was. Following the next day I had learned the toll that had been taken on my face. I had two missing teeth, my front and one of my canine and another tooth pushed up through my gum and it was at an odd angle, like it was pointing straight out not downwards like it’s supposed to. I had severed my upper lip in half leaving a bloody mess every time I woke up at the hositpal and at home for a few days because I would drool, oof, I still remember the odor. I had also broken my cheek bone leaving another scar and my bottom teeth went THROUGH the skin just below my bottom lip, leaving a hole( thankfully it healed and is just a scar now). I was also severely concussed, not sure if it was a TBI, maybe a moderate one since I blacked out for so long. It’s affected my everyday life, sometimes it’s the only thing I think about and whenever I do I get sent into this catatonic state and stare at something for unusually long periods of time. I also have had to deal with depression, when I was at my worst I had cut myself and even attempted suicide even though before my accident those thoughts would’ve never crossed my mind. Unless you’ve had a brain injury yourself, there’s no way someone can comprehend the type of state your body is put into when something like this happens, it’s fucking terrifying because I was told I was actually conscious right after my head was smashed, such as having to get out of the car while my two teeth fall to the ground with my brother looking at me in horror. I walk to the side of the road with blood pouring from my mouth knowing my only chance at survival is to lie down, when the pain was too much to bare is when I fainted on the road with blood gushing from my mouth. Ambulance sirens still give me chills. I had also been injured severely twice as a young child, I had my arm almost cut in half, pretty sure it was just hanging from veins, a large glass shard had cut it open due to me punching a glass door and breaking it, I was 4. I had also cut my head open due to me slipping and hitting my head on the sharp edge of a staircase, that was a rough one..., I think I blacked out then too. Another is when I swallowed a nickel before I went to bed, I was 5. I woke up to barely being able to breathe, drooling all over myself and talking like I was gonna die (I think I was). The next thing I remember is being woken up after being taken to the emergency room to have it removed. Another blackout I think because I don’t remember SHIT, it was like one thing then bam the nickel was out and it was like 3-4 hours later. Probably the oxygen depletion to my brain.

Braden, so sorry to hear of your accident. I hope you are seeking therapy. You had a lot of grief, and was severely traumatized. Praying for you.

My nephew died 06.03.2018. He was a firefighter. The firetruck's tire burst. His safety belt tore with impact and he went through the front window. He was 25. Dr explained that he was brain dead. His brainstem broke??? Is there a chance that he could have been saved if he reached the hospital earlier?? The accident happened at 23:00 and help only arrived about an hour later. He still talked with one of his colleagues but lost consciousness just before the ambulance arrived.

I don’t believe so.......most people die immediately. So sorry for your loss. I was rear ended in 1999 and ended up getting Multiple Sclerosis, I was asymtomatic for 18 years, and then I was rear ended again, and I got full blown MS. Way back then, the doctor’s didn’t believe that I also lost my brilliant mind. I used to score in the 90th percentile, and then only 85, so they told me I should be happy because I still scored high. However, it took me much longer to remember things and they attributed it to pain. Not true, I have some brain damage where I have no filter talking, have anger issues and much stress. I have to try to let go of anger by not discussing. Certain issues, and talking slower to make sure I use the proper words. But as I was told, I was lucky about not breaking my brain stem. May he Rest In Peace, an apparently caring person to be a firefighter. God Bless!

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