Dr. James Kelly Talks About Areas of the Brain Affected by Concussion

BrainLine sat down with Dr. Kelly to talk about how different areas of the brain can be affected by concussion, or mild TBI.

Watch more video clips from Dr. Kelly.

The parts of the brain that are most commonly affected in traumatic brain injury are the frontal and temporal lobes. And part of the reason for that is that they’re up against bone, and it’s fairly rigid and rough bone. The other reason is that when the head rotates, because the neck is positioned posteriorly to the skull--if you really look at where the neck attaches, the front of the head moves greater distances than the rest of the head. And so under those circumstances, the frontal and temporal lobes--as if appendages-- are out there moving greater distances than the core of the sphere, if you will, of the rest of the brain. As a result of that torquing effect there is more damage to the frontal and temporal lobes. The frontal lobes influence personality, planning, initiating, organizing-- the kinds of things that are "high-level" cognitive functions and personality features, largely. The temporal lobes are involved primarily in memory functions and certain language functions. And so if certain parts of the temporal lobes are damaged, then memory functions either for verbal memory in the left hemisphere and nonverbal, visual memory in the right hemisphere can be adversely affected and injured even permanently if the injury is severe enough, while other areas of the brain can be relatively spared. It's interesting. A contrecoup injury--I should explain--is very different than the coup injury. A coup injury means the French word "blow," and so it's as if you were to think of a baseball bat hitting my head. And so the injury would be immediately underneath where that blow occurred. That's the coup injury. In the human experience, it's that scenario. Contrecoup means opposite to blow. And so the common human experience is a fall on the back, and the head is moving but then suddenly stops. So it's not something hitting the head, it's something the head hits of infinite mass--let's say, this floor. And the head suddenly stops, but the brain keeps going. And so at least part of the damage that occurs in the frontal lobes after the back of my head hits the floor is because of a vacuum effect in the closed container of the head. So there is a shift of the brain tissue toward the back of the head that's instantaneous and a decompression injury in the front. And so what we see is a very slow leaking of hemorrhage in the tissue of the frontal lobes when the injury was really at the back of the head. And yet, if people fall on their faces from some distance it turns out that the facial bones themselves fracture, and there is some--what physicians call airbag effect by the face, which gives and tends to protect from contrecoup injury happening in the back of the head. Although it can still certainly happen. And so the common human experience of contrecoup injury happens on either side, if you're lying on one side, or the front, if you land on the back of your head. The face, oddly enough, tends to be protective. Aging and a history of multiple concussions is now a major concern in certain sports, in particular, and some people have started to write about that. There are people who are in one camp thinking that there may be a dementia-like syndrome not unlike boxers get--dementia pugilistica-- that occurs from football with repeated concussions over a long career. And there are others that say, "No, that's not possible. Those people were predisposed to that kind of condition anyway, and that condition does occur in the general population at some level. So the jury is still out on that. There is some evidence that predisposition in a genetic sense-- and we can look for that particular marker of genetic predisposition and any injury to the brain leads to a worse outcome. And perhaps even earlier onset of Alzheimer's-like changes in that genetic subset of us. But even then we don't know why, and we don't know if there is truly a different way of handling that or a protective approach that we should be using. I hear from patients all the time that they are different, that they know they're not the same person they were before. The people that know them best, spouses and family members, will say the same thing. And it's no longer the same John or the same Jane, and the change is really the person's ability to do the high-level interaction, the ability to engage in a fluid sense the core part of that person that allowed for the relationship to develop that they're in-- if that's damaged, then the relationship is damaged; that the family is damaged, under the circumstances. So the brain itself, which is the core part of our person in all ways, if injured changes the person and thus the relationships, family, work, other outside interests. That's all part of who we are. Pre-existing personality really does set the tone for patterns of recovery and likelihood of extent of recovery, and so forth. And so the more we have access to who that person was before an injury occurs, the better we are at looking at a difference from that to--you know-- a later, post-injury person. The other thing that happens commonly is that the pre-existing personality characteristics, after traumatic brain injury, are usually exaggerated. It's as if the post-injury person has become a caricature of his pre-existing personality, so that the salient features are now even more salient. So if this person was a real pain in the neck beforehand, man, are they hard to handle now. And so those sorts of things we know about pre-existing personality and other neurological features that then are part of the formula that that we use to predict and to understand better who that person is afterward.
Posted on BrainLine November 13, 2008. Reviewed July 26, 2018.

Comments (17)

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.

When I was 14 years of age I lost consciousness fell backwards and smashed my head on a granite headstone.When I came to I had extreme headache for at least three days and also unable to sleep for the same period of time.Strangely when I touched metal objects too I got electric shocks in my hands on and off for some time.The pain and other symptoms settled but I've never felt the same in my self ever since the fall,would you know if injury to that part of my head could affect personality I.e. i experienced depression and fatigue and anxiety since that time,thank you.

hello Dr. Thank you for this video. I just found it. My mtbi happened 2007 from car accident. I hit the steering wheel. Thirteen years later I have improved. I have to plan my own health plan. The neuro drs. I saw wouldn't acknowledge I have a brain injury. Also no support from anywhere or anyone. I have a strong spirit hope and now faith.

I have had at least 5 concussions. My first two both happened in less than a week. After the two concussion, I developed hypertension. About a year later, I had a third concussion and my high blood pressure became a lot worse. I would have extremely high blood pressure a few times it was stroke level. I am only 21, and I am the ideal weight for my height. I had a lot of tests done on me, but the doctors couldn’t find anything causing my high blood pressure. They just said it must be hereditary. So far no one in my family other than myself has developed hypertension under the ago of 55. Does anyone else believe that their concussion(s) caused long term high blood pressure?

Thank you for explaining the effects of concussions‼️My 15 year old granddaughter experienced one after a game of water polo. It has lasted over 4 wks.

My husband got fall from cycle. He dont remember how the accident happened. The MRI and CT scan was fine.and from next day of accident he is fine.. It has been 4 days passed the accident happened but he still do not remember how the accident happened. Please suggest

I’m currently 16 bout to turn 17 in a couple months & I recently had a TBI. I fell off the trunk of a friends car and landed on my right side of the head and bounced on the back of my head. I had a subdural hematoma with three brain bleeds and a fractured skull. It was an emergency brain surgery and had a craniotomy performed. I flew in a helicopter with little of consciousness & went to another location to have a surgery. The doctors said there was massive pressure in my brain and half of my butterfly was gone because of it. The brain bleed took more than half of my brain. I’m a month and some weeks in recovery but do not remember the 2 -3 weeks after. Once my 3 week mark hit I was able to be more aware of my surroundings and able to walk. My surgeon was afraid of brain damage but walked out with none. It took a while at first for me to be able to speak, walk, and eat. I get nauseous, dizzy, and have huge headaches internally and externally from my skull. I have neck spasms due to me wearing a neck brace , the trauma, and my fracture. My fracture missed my spine by an inch. It’s a very emotional, mental, and physical obstacle to pass through. Whoever needs to read it , it will surpass. The surgeon called me a miracle and had warned my family previous to surgery of being in a coma, death, or severe brain damage. Thankfully, neither of those occurred. You will get through this!

Thank you for sharing your story because it gives me hope for my daughter’s 16 year old friend. She was badly injured 3 days ago in an alcohol related hit & run car accident. She’s currently unresponsive in the hospital with a small brain bleed and a bruise (contusion) on her frontal lobe. Various other injuries as well. We are all praying for her and the hospital staff. I’m so glad to hear that you are recovering from your injury ❤️. Best of luck and God bless!

God bless you

After an initial traffic collision whilst be dragged under a car , crushing my head , secured around a then crushed helmet . Still with feet secured to the bikes pedals I was flung flying into passing traffic . Supposedly being hit on the Helmet again .

I regained myself losing my bike and retreated , being asked to keep aside from what if any other witnesses where

I found myself with no evidence of Law Enforcement consideration but hospitalised with limited bodily movement .

Without any assessed signs of serious concussion I left hospital . Leaving no MRI or CT .

It took authorities in a Third Party Insurance Licensing System 6-7weeks for a MRI resulting from a traffic accident . After revisiting Hospitals numerous times with some serious Headaches .

I'm still in the dark but seemingly on my feet left to wait attention that may not have been met and little known evidence apart from my helmet and current brain functions .

A subtile approach has left doubt as to why no attention would be necessary as yet now on 5 months .

I was hit from behind while stopped at a red light. The damage suggests 60+ mph. I am told I was out of it for a minute and wailed. I was hit in the area behind my left ear by a water fountain My husband and I had purchased. At the ER I was told I was fine. I was give 5 days of pain pills. On the 6th day, my head hurt so badly I was vomiting. I returned to the ER and was given a ct scan which was normal. I was treated as a drug seeker by the young doctor who prescribed me Hydroxizine and told me to come back if I needed to talk and then gave me her hours that she worked in the ER. My doctor, my back surgeon, all the local doctors refused to help me. I spent the next two days holding my head hoping that it wouldn't explode from the pain. No one believed me that I was hurt. I have a physiatrist and a physical therapist. The physiatrist finally told me that I needed to seek help from a neurologist. I called several of the local neurologist to all declined to see me and that I was in an automobile accident and they do not want to be involved. When I walked away from dinner being cooked on the stove with no memory of starting dinner, I called my GP and told her I needed to see a neurologist. The neurologist didney EEG in August. I was also sent to a psychiatrist who diagnosed me as having psychosomatic memory loss due to stress. The results of my EEG says it is abnormal secondary to settle intermittent left greater than right frontal slowing the finding is suggestive of an underlying structural lesion. It is almost December and the neurologist has not yet seen me to tell me what the findings mean. I can't listen and retain what people say to me. And as best I can tell, no one cares.

My daughter, now 23, has a moderate TBI on February 17, 2017. She had a frontal lobe injury, a bleed in her thalamus, and a small diffuse axonal injury.
Neurosurgeon said her concussion was equal to a football players entire career of concussions.
Her memory is better, she still is quick to anger, and says things she regrets, but she is working, driving, and doing pretty good considering.
Her main complaints are headaches everyday,nothing helps, and feeling nauseous every morning. She has lost considerable weight , and she was very small to begin with..
Any advice would be appreciated, thank you

Kelly ;
I am so sorry to hear about your daughter's injury. I hope she has made progress since your comment.
I was wondering what doctor you met with to get the details regarding her injury? How did you find those results, Ct scan?
Thank you in advance if you get this message

Accident 39 years ago, in service, received no treatment, migraines and head pain every since. Multiple Neurologists, but I always told them no head trauma because I never knew, don’t remember. I received my military records and found out. Closed head injury and clear TBI. Just dandy. Explains EVERYTHING. pain often in am, upon awakening. I’m livid.

I'm almost 60 yrs old now. I was alway very athletic. Of course i also suffered from numerous injures. Everything from a badly broken nose at 19, broken c5 at 22 car accident at 17 with a bad scar above my.L eye , there is more. But, the last 3 yrs. I began to get hit ( by an x) in a very weird way. I have never experienced this before. What he did was, he would hit me from behind , ( so I didn't know that I was going to be hit) on about the C7 area on the of my neck. I would pass out instantly and then when I came to I found myself shaking violently. I tried to get help but everyone just laughed. I seem like a long time to get back to normal. But not sure how long it really was. My question is have you ever heard of this? Could this be very dangerous. my symptoms are: horrible headaches etc but the biggest problem lately is. Ilve lost parcel use of my upper right arm . My MD has just received approval from ins. Co to start the scans of my brain, arm neck. sincerely, Michele

Thank you for your video

I got hit on my head above my left forehead and after 3 weeks I am having pain like migraine and I found a small bump behind my left ear just above my neck and painful when push and the pain radiates on my shoulder. I have used migraine medications n other pain pills helps a little but not much and I have been suffering for 3 weeks now
I went to the doctor and told me maybe I am stressed but he told me to get Ct scan.

I got a concussion about 4 weeks ago I was doing pretty good but I have wet macular degeneration after I received my injections things started getting worse anxiety bad headaches dizziness what can I do to make it better