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 (67)

I'm so sorry and relate. Agreed, too many neglected cases and misdiagnosis. TBI is life changing and I experience the effects daily, since 1999 and the progressive effects, now increased falling, balance vision and vertigo headaches that are distracting and can't focus. Stiffness and Muscles rigid, fluctuating vision which clears when I can crack my neck and shortly when releasing some fluid build up in ear and nose. Cranial sacral therapy helped, and botox in muscles of face jaw and neck but and a concrete kind of thinking which makes it difficult to learn or comprehend new tasks. I was first injured by a man who backed up into my car while putting my daughter in a car seat in 1998, then suffered multiple head injuries that when the frame displaced jaw, herniated discs and cornea tears with so much more, lost all math skills, wrote backwards, sense of direction and simple things have become like moving mountains and post several head injuries, blurry vision, face jaw pain that never ends: metallic smells, and seasickness. Coordination, ability to express oneself, typing, using a mouse or navigating to get somewhere or complete a simple task has, become exhausting. With the 4 minutes one has to see a neurologist now, or express oneself and stay focused or the chicklet Neurontin which is given out in every initial visit. CTE is only seen postmortem so what and where can one get consistent help because inconsistent treatment, inability to navigate the medical system and wrong diagnosis cause delayed treatment and permanent damage. Lost. Confused and With two degrees that are worthless trying unsuccessfully to learn something new. There are no real supports, no real advocates and few who can relate to the cognitive effects of TBI and say snap out of it, best of luck. (Hoping to find this post again. To see if there will be a reply. I have lost the ability to coordinate pad/mouse and brain or figure out dragon or things that were second nature. Quite frightening and limiting. Thanks Eli

Hi Anonymous, First, congratulations on your recovery, I'm sure it was hard work and determination on your part.
I had a mild concussion from a fall, I hit the back of my head on the pavement and blacked-out for what I think was a minute or two ( not sure ). However, I was extremely good with math. I audited hospital bills as part of my work. After my "mild" concussion, I was unable to do simple math w/o a calculator and then I wasn't sure of what I was doing. It's been almost 25 years and I have never regained my math skills. All other symptoms, except neck pain, have resolved. You are the first person I have encountered with a problem with math skills post concussion. Everyone I mention this to, disregards it, including my neurologist. I would like to know more about your math issue, if you don't mind. Thank you.

I had a similar injury in 1998 - slipped on ice and hit the back of my head on ice covered concrete. I was unable to add simple numbers (like 6+8=14) together in my head until 4 to 5 months afterward. The ability did come back but it was terribly frustrating. Most of the symptoms resolved years ago, but things like side to side movement, like a car swerving if I'm a passenger, still give me the twirly whirlies. I'm okay if that happens when I'm driving - perhaps because I have some semblance of control over what's happening.

I fell 6 months ago and am still struggling with math skills and organization. At first I couldn’t even organize my thoughts to carry on a conversation but that is improving. I get confused with anything requiring math... even the month or day. I’m easily overwhelmed. Hope you have improved!

In high school I got two concussions in 2014, one in January and on in December both from wrestling. I too have had a considerable drop in my math ability. I went from an A B student to a C D student in math. One weird thing though, after the concussions my English grade got higher.

2006/2008 i lost my mom and my grandparents within the span of 2 years 3 years, and was not prepared for my mom's death.

2010 Anybody have traumatic brain injury as a result to hydrocephlaus vp brain shunt put in, 2011  /2012 and then a year later was taken back to hospital and revisions which caused me to be in a coma, not expected to wake up - which i did but after a month - and then later that year i started to go blind having cataract clouds on my eyes that preventing me to function. then i had revisions to my eyes again that caused misaligned eyes blurred vision cob webs on the ways and eyes that are so tired like that im so exhausted - having cataract lenses in my eyes i can not rub my eyes, i can only rub the lenses. the day cataract surgery happened i lost the feel of eyes because of lenses (Both eyes were done at the same time) all the time and then this year i had 4 falls within the span of 6 months because of dizziness - and unbalanced. my speech is starting to be worked on tues, but this was after 5 years fighting for my drs to give me a chance @ one. Now my memory is affected because of all this trauma that my speech pathologist is testing me out for TBI, and my memory and my speech i have been so worried about that i don't know how to relax my brain because i don't want to disappoint anyone that was in my life as friends before surgery or after surgery cause right now because of trauma i don't have friends. Please reply would love to hear advice from anyone. if u all can follow /understand me because talking in sentences is a huge ___ but i can talk flowing on pc. drs said i had bipolar disorder and social anxiety but my shrink said i might NOT have bpd/and social anxiety because of Traumatic Brain injury which they are just finiding out about NOW after 5-6 years.
Anyone help recommend anything i welcome all opinions.

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?

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