What Impact Will Mild TBI Have on a Person's Life?

Mount Sinai Medical Center
What Impact Will Mild TBI Have on a Person's Life?

What is mild TBI?

"Mild TBI" is defined by lesser levels of brain damage, as indicated by only brief or no loss of consciousness. Nevertheless, mild injury is important to discuss for four reasons:

  • Although the negative consequences of mild TBI tend to disappear more or less quickly for most people who have mild injuries, some research suggests that about 15 percent continue to suffer symptoms that can be severely debilitating. Thus, "mild" injury may be anything but mild.
  • Those who receive a blow to the head with brief (or no) loss of consciousness are often sent home from the hospital with assurances that they are just fine. However, this may or may not be the case, and when not the case, this misinformation about no long-term problems may have devastating effects, as the person remains unaware of the basis for his or her altered ability to function.
  • Some individuals who have experienced a concussion or whiplash, or a brain injury with brief loss of consciousness, do not enter the health care system at all. In effect, they assure themselves that they are just fine and don't require help. However, long-term problems may emerge and often do not get attributed to the injury, leading to the negative effects referred to above.
  • Mild injuries often occur through the physical abuse of children/spouses or in the jarring of sporting events. The negative effects of such injuries may not emerge immediately in clinically detectable or functionally meaningful form, except as the effects accumulate with repetition of the injury. The beaten wife or the sacked quarterback may be fine, although damage has occurred at the neural level; negative consequences in day-to-day life will appear unless repeated injuries are prevented.

What problems emerge after a mild TBI?

Mild TBI can be a problem for two reasons. First, the cognitive, physical, and emotional effects may not disappear and, in themselves, create problems. These consequences of mild injury are often similar to those described above with respect to moderate and severe injuries. Second, the psychological disruption created by these consequences can add to (or occasionally outlive) the original problems experienced after injury. One might ask, Why is this psychological disruption not also a problem for people with moderate or severe injuries? The difference with mild brain injuries is that neither the injured person nor his/her social network expects any negative effects of the whiplash or concussion. Medical experts have told them, "Go home, watch for problems, but really, you'll be just fine." Or, the injured person has written off the blow to the head as not even worth the effort of seeking medical help. On the other hand, with more severe injuries, expectations of negative consequences are commonly held by health care providers and by members of the injured person's social network. These expectations are reinforced through an intense medical experience, validating that something bad has happened.

What happens to the individual with mild TBI after the injury? As Kay points out, individuals with mild injuries can live out several possible scenarios. Good outcomes occur whenever the dysfunctional consequences of TBI totally and relatively quickly disappear or the individual finds ways to easily accommodate any functional deficits that emerge. This type of recovery assumes that the individual with TBI is an educated consumer. In other words, the person has a clear understanding that problems may occur, the type of problems to expect and that these problems may or may not disappear, but can be accommodated.

Often the individual with a mild TBI returns to his or her daily life after the injury with very little if any awareness that the head injury will have ramifications — short-lived probably, but perhaps long-term. To individuals in this situation, they notice out of the blue that in big and little ways they are no longer able to do what came easily before. "For no reason that I can see, what I know about myself is no longer true." These inexplicable difficulties, which they do not associate with the "blow to my head," can lead the person to feel that he or she is losing it.

As was mentioned above, good outcomes for individuals with minor TBI require their learning in very clear terms what can be expected in the days, weeks, and months following injury. As problems in functioning emerge, they also need to obtain assistance in learning how to compensate for deficits, as is further discussed in other questions.

A variety of resources are available on this Web site, including publications, linkages to other Web sites and information about rehabilitation trials that may help people with cognitive difficulties, mood disorders and fatigue.

This information is from www.tbicentral.org, the website of the Traumatic Brain Injury Research Group at Mount Sinai School of Medicine funded by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education (Grant Nos. H1)

Posted on BrainLine August 23, 2008.

From Mount Sinai School of Medicine. www.mssm.edu.

Comments (15)

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.

I was in a car wreck 8 months ago. Hydroplaned going 80mph on some back roads, hit to guardrails and ended up in a ditch. Upon hitting the first guardrail my head hit my driver side window and the airbag (above that window) came down on my neck, pinning my head. I don’t remember hitting the second guardrail or the rest of the wreck. I just remember smelling something burning and thinking i needed to get out of the car ASAP.
Neck and right shoulder hurt immediately and head hurt where I hit the window. I was brought to the ER where They did an X-ray of my neck and right shoulder. Told I was good to go home, as I only had muscle strain.

Fast forward 1 month and I’m experiencing a lot of neck pain and weakness into both arms (R>L). Had an MRI that showed small disc bulging C2-C7. I was sent to PT for evaluation and dry needling.

Over the next 5 months my pain increased in severity and new locations, weakness worsened, headache more often, muscle spasms very noticeable in entire right shoulder.. etc. After going back to the ER (extreme pain and weakness in right arm, numbness •I thought I was having a heart attack•) they did an emergent Cervical MRI and after finding out I didn’t have severe stenosis, but only “mild degenerative changes in cervical spine”, they sent me home immediately. Making me think I’m crazy for coming in with complaints to begin with.
I went to urgent care 4 times over those months with similar complaints (even bringing recent MRI and EMG results in to prove I have something going on) But since my report states Carpel Tunnel ulnar & medial in both arms and C6&7 ridiculopathy both arms (L>R), but my complaints were of my neck and a lot of irritation on my right. They sent me home making me think *again I was crazy for feeling this way.
(Must be noted: I had some labs drawn that showed elevated liver enzymes)

So I finally got in with a neurologist 2 days ago and after his exam he ordered a Brain and Thoracic MRI. As my entire body is weak but Right is significantly worse than left, winged scapula bilaterally (R>L), Hyperreflexia in bilateral C7 aspect, but no reflex’s in biceps or wrists Bilaterally. Also, the recent onset of blurred vision, ringing in ears, and falling into the wall while making a simple turn during the walking exam seemed to play a part in his decision making for testing.

He was the first person that I felt like he understood my complaints and knew I wasn’t making up pain or drug seeking. He mumbled at one point while charting “supposed to be an ‘easy neuro workup’”. So I asked what that meant and he said my case is anything but an easy workup.
He actually mentioned a lot of other things that basically I ‘failed’ for lack of a better word, but w my crappy memory, I’m unable to remember everything.

I would just like some input on why a Brain MRI? Or how serious my case seems, as I am also experiencing depression, moderated anxiety, insomnia. None of which were present before my wreck.

I would also like to state that at this point, after months of being treated like I’m crazy for my complaints by several different Doctors & NPs, a neurologist is the one that made me feel most sane. The irony.

I don't know that you will see this, but try to find a Physiatrist that specializes in brain injury. A Physiatrist is a Rehab specialist. That is not a misspelling. The best ones are usually in major cities at Trauma One hospitals, but that it not always the case. Sometimes there are gems practicing in more rural areas. It is worth traveling hours to get to a good physiatrist!

I was in a bad car accident in 1987 following the death of 3 close family members. All happened within a year. I was hit on the passenger side and my car went out of control, crossed a median, two lanes of traffic and slammed head-on into a brick wall. The cops said I broke the windshield with my head.  I had no idea what happened, it was all very fast. I had severe whiplash. I had a knee injury that needed to be stitched and a neck X-ray. I was asked if I lost consciousness to which I answered: "don’t think so."

Very slowly, I began to have feelings of anxiety ( I experienced some brief periods before, like hrs or a day), feelings of claustrophobia, etc. I went through some chiropractic therapy as I could barely move my neck and back and was in pain. Life tried to move on, but things just began to seem different. I felt sad or would cry for no reason. Within a few years, I went through more trauma, surgery, and the death of a young nephew. I began feeling so not myself. I started having vertigo which lasted four months. I was a flight attendant so I could not work. I could barely eat, lost 25 lbs. I returned to work and began having strange feelings of fear for no apparent reason. I didn’t like being alone in a hotel room or venturing out. This was clearly not me. I began having debilitating panic attacks but had no idea what was going on. I just thought I was losing my mind.

Fast forward, I have struggled my whole life since then with panic, anxiety, depression, fear, pain all over, five herniated discs (3neck, 2back) bulging discs and bone spurs and deterioration throughout my spine, memory loss. So many episodes of vertigo, migraines, vestibular migraines. I have been diagnosed with many things and gone to many doctors. I do have an autoimmune thyroid disease which could have resulted from whiplash.

Just 2 yrs ago I found a doctor who is more familiar with brain stuff. She is the first one who made me aware that some of this could be from TBI. It comes on when I am exhausted and used to last for months, even a year. Eventually, my mood will normalize until the next trigger of exhaustion or bad diet or any stress at all. It has gotten better, fewer episodes, not as severe and because I know why it happens it has less of an impact. When I’m in it, it sucks, my brain feels incapable of handling even the simplest things and I get very overwhelmed.

Anyone, let me know your opinion, could this be from a head injury so many years ago?  I’ve also had tons of floaters appear in one eye then both eyes and flashing lights on the sides of my eyes, so many weird things, too numerous to mention.

WOW, this is the same thing I experienced almost a decade after my accident. After conducting more research after getting fed up with my symptoms, I'm realizing that I too likely suffer from a TBI - triggering situations (like lack of sleep, diet etc..) typically cause forgetfulness to the point where I forget where I'm driving at times, slurred speech, sensitivity to alcohol, fogginess, hemiplegic migraines etc.. It's definitely worth exploring more IMO

This sounds exactly like a TBI. I am no specialist but I am at my point of recovery where I read more about how to live with TBi rather than if I can be healed. Good thing about the mental things like anxiety is you can increase your exercise to help. Will be hard with the spine but in the long run it would help that as well.

This struck such a chord. My injury happened when I was 15. I think I lost conciousness (I can't be sure as I don't remember the event) but I DO remember some time after sitting in the back of my parents car with a huge bump on my head, a pounding headache and losing my vision and feeling very "detached". I wasn't taken to hospital or even to the doctor. I was just told by my parents to go to bed, and I'd be fine. My vision returned to 90% over the next few hours and the headache went to a constant low level where it has remained ever since (except when I get occasional pounding headaches). But I immediately knew things weren't right. While my motor skills and speech weren't affected, my cognition and memory were utterly - and permanently - changed. Changed in a way that made me - and still makes me - occasioally suicidal. But I never managed to persuade anyone there was something wrong and I needed help. And eventually I gave up trying. The hardest thing has been having to make this journey entirely on my own.

Matt,

I knew I was not alone, that there were lots of people out there who like YOU and Me, understand what you and I've been through.

I was hit on the driver side of the car in an auto accident. That was January 20, 2004. The auto accident caused the blow and jolt to my head that caused my concussion. I did not know till September 2018 (I lost consciousness too). Until this day I do not remember the auto accident.

I now know thanks to brainline.org it’s called Traumatic Brain Injury (TBI), that caused my Epilepsy Seizures, PTSD, Fracture to My skull, Compression Fracture to my Neck C2, C3, C4, C5, C6, C7 T7, L1, L2 L3, L4, L5 Left, Right Hip, Left, Right Shoulder, Left and Right Hand, Left and Right Legs, Sciatic Nerve, Numbness in My left foot and 28 side effects of Steroid Injections. So now I take 40 kinds of medications because of that auto accident while I was on the Job.

I know there are days you just want to give up, but don’t. There are a lot of us.

I was very lucky a judge stepped in. He got me help with my nervousness, anxiety, emotion’s, mood, headache that will not go away, loss of balance, unsteady walking. This is just the start -- the worst is major depression that kicks in my PTSD.

Have your primary doctor call a Clinical Psychology. Don’t wait till you get to the point where you’re going to hurt some people like I was (that’s why the judge stepped in). Trust me I was in prison for that. That is why I understand. I will pray for both of us now.

Please get help it pays off. I would not be writing you if it did not.

Let me know if this helps, because you’re not alone.

Watch these videos:
https://www.brainline.org/video/what-happens-brain-car-crash https://www.cdc.gov/features/epilepsy-tbis/index.html

In all their medical glory, what have doctors ever cured? They can TREAT common colds, cancer, high blood pressure, but what have they cured? Some doctors are good OTHER NOT! They do NOT understand... difficult to understand. BUT for doctor to discard TBI and call it brush off to psychiatric issues, because not understood or easy to treat sucks... and what can a person do with TBI, if doctor will not help or understand??

I was in a car accident four days ago and declined treatment at the time. I've had a low grade headache ever since. After reading these articles on concussions and TBI, I think I'm going to the hospital to get checked out.

Thank you so much for this article. Too often mTBIs are dismissed by medical professionals and therefore the injured are not getting the care they need from the onset or down the road. Once again, brainline.org proves itself to be one of the most helpful resources out there for all those on the spectrum of TBIs.

I have never looked upon my condition as being a brain injury before, but the more I read here, the more I see that is what it is! I did not think of the long term effects of the abuse I suffered or of any sinster repucussions of it all, I just got on with things and thought, 'thank god that's healed up now'. Until next time! All the while feeling too ashamed and embarrassed to do anything about it and being stupid enough to wait for 'the next time'. The more I think about it, the more I realise I have no one to blame but myself, it's like closing the stable door after the horse has bolted.

This is all very interesting.  I suffered a  contrecoup concussion with no loc 9 years ago, and the doctor told me I would be fine...But afterwards I had headaches, and slept a lot, I broke up with my boyfriend and isolated myself, made poor choices, had a weird feeling in my body that I could taste iron - all the time, found it difficult to focus at work - and things that were easy became more labored....To this day I still have a generalized headache to the front of my head and I have more anxiety mounting on me daily and have difficulty in social situations... 

I learned after the head-on collision my wife and I both experienced, local hospitals are fine for triage. Unless your brains are spilling out however, they will do what they can with stitches, splints and pain pills and send you home as if it was just a visit for a cold. Tell your doctor about how your brain is not working right and stick with it, even though you don't have the self confidence you had before the accident.
Our accident was 14 years ago and I have continued to push my ability to concentrate. I was 66 at the time and we got the impression they, the medical people in general, figured: "Oh well, They are old. It doesn't matter much." As my mental ability has improved, my age has cost me cognitive ability so it is hard to say how far back I have come. Don't quit. No one can fix you as much as you can by keeping an attitude of gratitude for what you do have and enjoying each day. We are still alive.

I suffer alot migraine every day with aura no doctor are helping
A mild concussion, for some, may impact what is known as: Paying Attention vs Inattention. A mild concussion can cause all sorts of very subtle neurological difficulties associated with Inattentive ADHD, complex partial, sustained attention, central auditory processing disorder, dyspraxia, and the new syndrome called cerebellar cognitive affective syndrome (CCAS).