Do I Have a Brain Injury? And What Can I Do About It?

Learn how it may be possible to have a brain injury and not realize it. Four people share stories of the difficulties they experienced with brain injuries, particularly when problems were attributed to something else. Narrated by Dr. Margaret Brown with contribution from Dr. Wayne Gordon, Brain Injury Research Center, Mount Sinai School of Medicine. Produced by Generator Pictures with David Scholem.

[♪ Music ♪] [The Brain Injury Research Center] [Mount Sinai School of Medicine] [New York City] [Do I Have a Brain Injury?] [And, What Can I Do About It?] I probably fell 20 feet or so. My head went forward and hit the steering wheel. He was thrown about 10 feet. I had TB meningitis. I thought maybe I had ADHD or some kind of just memory issue. They all said you need to see a--it's all psychological. I knew there was an enormous change. The pediatrician dismissed my concerns. I know I was totally at sea. I was lost. [Dr. Margaret Brown] At some time in their lives, these people all have had to deal with the serious consequences of a brain injury that went unidentified. In other words, the cause of many of their problems was unclear to them. It was a brain injury, but they didn't know this for months and years after. They've agreed to tell their stories to explain how this can happen and what can be done to help. [Unidentified Brain Injury: How can this happen? What can be done about it?] Hello, I'm Dr. Margaret Brown. I'm a member of the staff of the Brain Injury Research Center at Mount Sinai School of Medicine in New York, and I also have a brain injury. You may be familiar with the very dramatic faces of brain injury that we've seen in the news, like some of the soldiers returning wounded from Iraq and Afghanistan. But brain injury isn't always so visible. It happens all the time in the lives of people like you and me. Research we've done at Mount Sinai suggests that more than 20 million Americans, that's 7 out of every 100, may have brain injuries that affect their well-being over a lifetime. But most of them are not aware that a long ago or a recent injury is the cause of the problems they face daily. In other words, like the people we just saw, they have brain injuries that go unidentified. In trying to explain how this can happen, I'll begin with my story. When I began working at Mount Sinai, I didn't know I had a brain injury. In fact, I didn't know much about brain injury at all, but at weekly staff meetings I heard about the problems that people with brain injury face, and some of these sounded like things I had experienced for most of my life like memory problems and staying focused on tasks. Sitting in just such a meeting, I suddenly recalled something I hadn't remembered since I was a kid. My memory was of lying on the ground in my backyard hurting and feeling very dazed and confused. I had been playing alone, hanging by my knees from the top bar of my swing set in my backyard, and I had fallen on my head. My brain injury remained unidentified because I did not understand that my brain had been injured. In fact, I didn't remember my fall at all, which is very common as an injured brain typically fails to remember the events around the time of an injury. [Someone needs to label what happens as "brain injury"] If an adult had seen what had happened, they might have gotten medical attention for me, but that didn't happen, so no one identified or labeled my brain injury. Brain injuries don't get identified for many other reasons. For example, sometimes labels are given to brain injury that make light of it, as if it isn't important, so the injured person thinks nothing important has happened, or medical terms are used, but the injured person doesn't understand that all of these are simply names for brain injury. I lost consciousness for a little while, not very long. I think I came back to before I actually got to the ER, and they treated my hand, put a cast on my hand, but nobody ever said anything about a brain injury. [Dr. Margaret Brown] What is a brain injury? Anyone who has had a blow to the head and afterwards has either lost consciousness or has been dazed and confused has had a brain injury. Initially any other injuries that I had sustained in the accident were more important to them, and I think at the time people weren't as aware-- including the medical community--weren't as aware of traumatic brain injury. Today if a person goes to an emergency room following a blow to the head in which they sustain a period of loss of consciousness or a period of confusion it is more than likely that the person will be given a clinical neurological exam and a CT scan. If things look okay, the person will be sent home. It is unlikely that the person will be informed of any of the potential long-term consequences of that event. [Dr. Margaret Brown] The brain can also get injured when medical conditions occur such as stroke, high fever, brain tumors, brain inflammation, or near drowning and the person also experiences loss of consciousness or of being dazed and confused. David's case of TB meningitis when he was a child is an example. While the good news is that most people with what are defined medically as mild injuries do recover fully the bad news is that some don't. They are left with problems in functioning that continue to disrupt their lives. Their so-called mild brain injury is anything but. Another reason for brain injury going so often unidentified is that the problems that follow vary so much from one person to the next. In short, there is no one symptom or set of symptoms that says you have a brain injury. The tempers that I used to have I thought were outbursts based on unworthiness, on my own terribleness. You would say something in apples, and he would respond in oranges, and it was very, very confusing. I can tend to maybe laugh inappropriately at things, and I don't always get other people's humor. Names, not just names, but facial recognition and not being able to really put a name to the face. Because there is no set pattern of symptoms and problems after brain injury it is all the more difficult to identify. An additional challenge in tying a mild brain injury to its consequences is that we may not experience some symptoms immediately. For example, you may think you are doing just fine while you stay home from work after an injury, but when you return to your job you find that tasks that were once easy are now hard or impossible. In children, the lag in identifying problems is often related to the more complex demands that are made on the brain as children get older, demands the damaged brain can't handle. [Patricia] John started off fine in school other than socially. He could handle one sheet of paper for homework, but in middle school his executive functions came into play, and he started to really fall apart. [Dr. Margaret Brown] It is important to connect a brain injury to problems that may occur afterwards for 2 reasons. First, seeing and understanding the connection often provides comfort as we finally get an explanation for puzzling changes in ourselves that have disrupted our lives. [David] Something that is nameless and formless and damaging and lurking but doesn't have a name is terrible. [Dr. Margaret Brown] Identifying brain injury also means that you can get appropriate help. One form of such help is treatment, specifically brain injury treatment programs. [Timothy] Once they had done the tests, they had seen that indeed I had something going on there. The doors opened in terms of different opportunities for rehabilitation. [Dr. Margaret Brown] Or help can mean simply learning new ways to address injury-based problems. At the office, if I know something is going to be particularly challenging for me I can allow myself more time for it, and I can take frequent breaks. The most important thing to do if you are concerned about brain injury is to find specialists with experience in diagnosing it and treating it. The best bet for finding such help is to contact your state's brain injury association. Contact information is available on the website of the Brain Injury Association of America. [To find your state's brain injury association:] It is important to know that if a child is diagnosed with a brain injury school staff members can learn to shift their teaching approach to accommodate the specific cognitive and social difficulties the child faces. Additional information on unidentified brain injury can be found on the website Brain Interrupted, which was developed by the John Blair Haldeman Endowed Fund in conjunction with Mount Sinai's Brain Injury Research Center, or contact the research center directly if you have further questions. If people understood about brain injury John would have led a much more normal life and would have had a completely different experience in his life. [in memory of John Haldeman] [Script: Margaret Brown, Ph.D.] [David Scholem] [Filmmakers: Jill Woodward] [Malcolm Linton] [We would also like to thank Patricia Haldeman, Jennipher Dickens] [and Timothy Pruce for sharing their stories of unidentified brain injury.] [♪ Music ♪]
Posted on BrainLine August 20, 2012.

About the author: Wayne Gordon, PhD

Wayne Gordon, PhD, ABPP/Cn, is the Jack Nash Professor of Rehabilitation Medicine and associate director of the Department of Rehabilitation Medicine at the Mount Sinai School of Medicine. He is a neuropsychologist and the director of the Mount Sinai Brain Injury Research Center.

Dr. Wayne Gordon

From the Brain Injury Research Center, Mount Sinai School of Medicine. Used with permission. For more information, go to