A traumatic brain injury (TBI) occurs when brain tissue is damaged by an external force or trauma. Though “TBI” is something of an umbrella term, the types, symptoms, effects, diagnosis, and recovery of these injuries vary greatly depending on their nature and severity.
The basics of traumatic brain injuries
A traumatic brain injury is a serious risk any time a victim’s head suffers sudden impact from an external force. TBIs can occur in a variety of accidents, including traffic accidents, slip-and-falls, workplace mishaps, and sporting events. Some require only rest under a doctor’s supervision, while others can be fatal or lead to life-changing disabilities such as paralysis or paraplegia.
The Centers for Disease Control and Prevention (CDC) counted about 2.8 million TBI-related emergency department visits, hospitalizations, and deaths in the United States in a single year, and more recent CDC figures put TBI-related deaths at roughly 69,000 a year. Millions more Americans live with a long-term disability tied to a brain injury and need ongoing help with daily functions. The CDC has also reported that tens of thousands of children are hospitalized for brain injuries each year, and while many recover, others face lifelong complications and debilitating physical limitations.
If you’ve suffered an impact to the head in an accident, seek medical treatment even if you do not immediately believe you’ve been injured. Some TBIs do not produce symptoms for days or even weeks and can become severe if left undetected and untreated. Waiting to seek treatment can also hurt your chances of earning compensation: part of a successful personal injury claim is proving you have truly suffered from your injuries, and a gap in your medical record can put a claim’s legitimacy in doubt.
Types of traumatic brain injuries
Doctors typically categorize brain injuries into two broad groups: traumatic brain injuries (TBI), which occur when the head is jolted, knocked, or penetrated and the brain strikes against the skull, and acquired brain injuries (ABI), which occur after birth due to the brain being starved of oxygen, such as in near-drowning, infections, strokes, and tumors. TBIs themselves are further divided into penetrating and non-penetrating injuries.
Penetrating brain injuries (PBIs)
These occur when a foreign object pierces both the skull and the dura mater surrounding the brain. Common penetrations include high-velocity projectiles, such as bullets or shrapnel; low-velocity penetrations, such as from knives or sharp objects; and parts of a bone lodging into brain tissue as a result of a skull fracture. While PBIs often result in death, those who survive may suffer decreases in abilities associated with the damaged area or areas of their brains, though this is on a case-by-case basis. Some PBIs may also lead to additional complications, such as epilepsy, neurogenic pulmonary edema, or respiratory problems.
Non-penetrating (closed) TBIs
The most common form of these injuries is “non-penetrating” (closed), meaning the skull and dura mater were uncompromised. These and other mild TBIs account for about three of every four brain injuries in the United States, and they are typically caused by blunt force to the skull or by the brain being shaken inside it. According to the CDC, TBI-related emergency department visits, hospitalizations, and deaths break down by cause roughly as follows:
- Falls – 47%
- Struck by or against an object – 15%
- Motor vehicle crashes – 14%
- Assault – 8%
- Other or unknown – 16%
Non-penetrating TBIs can occur in a wide range of situations, from slip-and-falls and traffic accidents to workplace mishaps and sports injuries. Some do not produce symptoms for days or even weeks and may be neglected as a result, which has posed particular problems for athletes who return to competition too quickly and suffer further damage to a still-healing injury. Common non-penetrating TBIs include concussions, contusions, and second impact syndrome.
Concussions
A concussion is the most common form of TBI and is usually mild if treated in a timely manner. Concussions are generally caused by sudden impact to the skull, shaking of the brain, or rapid acceleration/deceleration of the brain inside the skull. Common short-term symptoms include headache, confusion, nausea, vomiting, and memory loss (amnesia). Although most concussions are considered “mild” TBIs, they can have devastating long-term consequences if not handled properly or allowed to heal fully. A concussion victim who returns to regular physical activity before making a full recovery is at serious risk of “second impact syndrome” (SIS), which could lead to rapid swelling in the brain and require emergency intervention.
Cerebral contusions
This term refers to various types of bruises of brain tissue, which occur in about 25% of all serious head injuries. A contusion is characterized by bleeding within the brain and is generally caused by direct impact; some cases may require immediate surgery to stop the bleeding. Contusions may occur on the same or opposite side of the brain as the trauma and can lead to headaches, nausea/vomiting, physical/sensory/cognitive difficulties, seizures, or loss of consciousness. Medical evaluation is absolutely necessary to control intracranial pressure and monitor the individual’s condition for further complications.
Intracranial hemorrhages
This type of bleeding occurs when a blood vessel leaks or ruptures inside the skull following head trauma, which can cause dangerous pressure within the skull and damage to brain tissue. This differs from a “cerebral hemorrhage,” in which bleeding occurs inside the brain tissue itself. Immediate medical treatment is necessary to relieve pressure on the brain and prevent complications that may lead to stroke or other serious conditions.
Blunt force head trauma
While “blunt force head trauma” is often associated with assault or other acts of violence, it can be caused by any force to the skull that does not penetrate it, including in auto accidents. Auto accidents are among the leading causes of blunt force head trauma, alongside falls, athletic competition, and physical assault. Blunt force head trauma most often causes concussions and contusions, though it can also produce bleeding inside the skull. Concussions are caused by shaking of the brain, while contusions involve direct injury to the brain. Some severe cases cause damage to the opposite side of the brain from the impact, known as “contrecoup.” This often occurs when the head is in motion and strikes a stationary object, such as head-to-dashboard impact in a car accident or a head-to-head collision in a contact sport.
Common symptoms of a TBI
Symptoms of TBIs can be difficult to detect and are often neurological or behavioral in nature. Moderate and severe TBIs can produce a wide range of symptoms, and some do not become apparent for days or even weeks after the accident. These may include:
- Confusion and dizziness
- Loss of balance and impaired coordination
- Insomnia or hypersomnia (excessive sleep)
- Memory loss and trouble paying attention
- Persistent headaches, nausea, or vomiting
- Dilated eyes and convulsions/seizures
- Clear fluid draining from the ears or nose
- Numbness or weakness in the fingers or toes
- Impaired hearing, vision, or sense of touch, and increased pain-sensitivity
- Trouble expressing thoughts, processing information, or understanding others
- Impatience, irritability, and sensitivity
Sensitivity to light or noise
Similar to a concussion, one common symptom of a TBI is sensitivity to light or noise. Minor sounds present in normal, everyday environments might be perceived as loud, startling, or irritating, and bright lights can overwhelm the eyes and cause a headache. When part of the brain is hurt to the point that it has to work harder to process this information, it can cause increased sensitivity to these senses. Allowing the brain time to “recharge” so it is not overwhelmed can help, and physicians may be able to prescribe medications to ease the effects of sensory overload.
Nausea and vomiting
Nausea and vomiting are common in any TBI, from mild to severe, and can last hours or even weeks. The Journal of Neurology, Neurosurgery & Psychiatry found that the overall incidence of post-traumatic vomiting in patients with a skull fracture was 28% in adults and 33% in children. This symptom can often be countered with medical solutions, so speaking to a physician can help treat it.
Irritability, sadness, and anxiety
After a TBI, people’s emotions often shift toward more negative feelings that can interfere with their lives, including irritability, sadness, and anxiety. A brain injury can directly affect an area of the brain that deals with emotions and behavior, such as the amygdala. When this part is damaged, it may not process emotions and reactions normally, which can increase feelings of irritability, anxiety, and sadness, and may make it harder to control emotions or lead to mood swings. These symptoms most often last a couple of weeks to a couple of months, though a more severe injury may cause them to last longer.
Effects of a TBI
A traumatic brain injury can have many lifelong impacts on a person’s physical and mental health. Because different parts of the brain handle different functions, the specific effects depend on which area bears the brunt of the injury.
Cognitive functions such as attention and memory
Cognition includes the ability to think and act. Because a TBI damages the brain that governs these duties, and because brain cells can be destroyed, a TBI can cause difficulty paying attention and concentrating, trouble processing information, memory loss, reasoning and decision-making problems, and disorganization. Impulsive or socially inappropriate behavior can also result from a decrease in control and reasoning. These deficiencies often interfere with a person’s work and livelihood, since many occupations require retaining and organizing information in a timely manner. If these effects prove long-lasting, a physician or neuropsychologist can assist with rehabilitative efforts.
Emotion and personality changes
The emotional and behavioral consequences of a TBI are less widely understood than the physical ones. Depending on which part of the brain is most severely affected, some aspect of a person’s mentality or behavior may change. For instance, if the pituitary gland (which regulates the body’s hormones and well-being) is damaged, it may result in depression or symptoms of depression. After a TBI, a person may experience extreme mood swings, verbal or physical outbursts, depression, impulsive behavior, negativity, and poor judgment. Seeing a behavioral therapist or neuropsychologist can help manage these difficulties.
Sensory processing such as sight and hearing
We unconsciously use our five senses (touch, sight, hearing, smell, and taste) throughout the day. When a TBI occurs, these senses can be impaired by damage to the brain regions in charge of sensory processing. For example, near the back of the brain is the occipital lobe, which processes visual information. When it is injured, visual processing may become hypersensitive, a person may have trouble recalling things they have seen, and peripheral vision may be impaired. This extends to each of the five senses, depending on which parts bear the brunt of the accident, and requires immediate medical attention to help prevent a worse outcome.
Motor functions like coordination and balance
Motor functions include coordination, balance, vision, small and large movements, muscle function and strength, and speaking. Fine motor movement and reflexes are largely controlled by the cerebellum, which sits behind the brainstem and regulates the neural signals that control movement and posture. When it is damaged by a TBI, motor functions can be impaired, and everyday tasks such as buttoning a shirt or picking up a fork can become almost impossible, an outcome that is frustrating and debilitating for the injured person.
Second impact syndrome
While TBIs can be devastating on their own, injury victims who also suffer “second impact syndrome” (SIS) may have more serious, even fatal, symptoms. SIS occurs when a victim of a traumatic brain injury, especially a concussion, suffers a second injury before the first has healed. This second impact may cause already-damaged brain tissue to swell rapidly inside the skull (“cerebral edema”), which can lead to permanent brain damage and can be fatal in some cases. This is why a slow, patient recovery is essential.
Second impact syndrome is prevalent among athletes, particularly in full-contact sports such as boxing, football, and hockey. A great deal of progress has been made in the identification, diagnosis, and treatment of sports concussions, particularly in hockey and American football, and the NHL and NFL have grown more cautious about allowing athletes to return to play before the risks of catalyzing an initial concussion are cleared.
Victims of concussions are extremely sensitive to further injury as they recover, and even minor bumps to the head can potentially cause SIS. The most common signs of a concussion include confusion/disorientation, fatigue/insomnia, headaches, memory problems, nausea/vomiting, slurred speech, and short-term personality changes such as irritability. Symptoms of SIS itself are far more severe and may include brain herniation; loss of consciousness, vision, or eye movement; severely dilated pupils; and respiratory failure. Anyone who may be suffering from SIS should seek medical attention as quickly as possible for what may be urgently needed stabilization, ranging from keeping the airways open to neurosurgery in severe cases.
How a TBI is diagnosed
After any impact to the head, you should seek immediate medical attention so professionals can assess and diagnose the injury. The severity of a traumatic brain injury is measured with the Glasgow Coma Scale based on the patient’s reactions to stimuli; the lower the score, the more severe the injury. There is no direct correlation between a patient’s score and the possible length or extent of recovery.
Can a TBI be seen on MRI?
Diagnosis may include a CT scan or magnetic resonance imaging (MRI). An MRI can detect signs of injury such as minute bleeding, small bruised areas, or scarring. However, that is the limit of an MRI’s assistance: it cannot pick up microscopic injury or show how a brain injury may affect one’s emotions or personality. MRIs can be helpful for certain parts of identifying a TBI, but they do not provide a totally comprehensive report.
Brain damage is not always seen by tests
Many people assume that if an MRI or PET scan shows no signs of brain damage, the brain must be intact, but this is not always the case. Studies have shown these diagnostic tests are not sensitive enough to see all brain damage that may be present, and even patients who test negative can still have signs of damage. The author of the treatise Neuropsychiatry of Traumatic Brain Injury notes that despite the brain looking normal on these tests, signs of impairment can remain, while the author of Medical Rehabilitation of Traumatic Brain Injury warns that many physicians cannot treat a TBI correctly because they assume normal scans mean no problem, summing it up as “absence of proof is not proof of absence.”
Eye tests for brain injury
One common head-injury protocol is confirming that a victim is oriented as to person, place, time, and date, known as “oriented times four,” which is also used in professional sports such as football and hockey. A simple but highly innovative eye test can also help doctors determine whether a patient has suffered a brain injury or concussion. The device, called a “pupillometer,” has been used by the United States Army in medical evaluations to measure pupil size, the distance between pupils, and their responses to visual cues, especially light. Manual pupil measurements taken with a penlight or ophthalmoscope have been shown to be inaccurate and inconsistent, whereas a pupillometer tracks pupillary reactivity in a consistent, objective, and quantifiable way.
How to tell if you have a fractured skull
A skull fracture is any injury in which a strong force causes a break in the cranial bone. Fractures can be very serious, because a break may be severe enough to damage the brain itself once its protection is compromised. Common symptoms that should prompt you to seek medical help include:
- Swelling or tenderness around the area of impact
- Bleeding from the head, nostrils, or ears
- Headache or pain in the area of impact
- Bruising or a bump
- Feeling tired, irritable, moody, or confused
- Impaired vision and/or hearing
- Sensitivity to light and/or noise
- Unconsciousness
- Ringing in the ears
- Loss of balance
Recovery and prognosis
A concussion is usually mild if treated in a timely manner, while more severe TBIs may result in nerve damage or other permanent disabilities. The sooner you receive medical treatment, the better your chances of making a full and healthy recovery. This applies to TBIs of all severities, and especially in cases involving loss of consciousness.
Can TBI symptoms get worse over time?
Whether symptoms worsen depends on the injury’s severity. Mild TBIs can lessen over time and fully recover once enough time and treatment are administered. However, the more severe the injury, the more likely a person is to experience worse physical or mental effects over time, largely because brain chemistry continues to evolve in response to the impact, and brain cells can slowly degrade or become infected from an open wound. This is why it is important to stay in contact with a doctor or specialist who can monitor the injury and work to prevent further damage.
How long does it take to recover from a TBI?
The consequences and remedies of a TBI vary immensely based on the injury. In the first few weeks, a person may experience brain swelling and the initial changes in brain chemistry that begin the discernible symptoms. As that improves, concussion-like symptoms such as nausea and blurry vision may gradually fade, though the timeline depends on which part of the brain was affected. If the occipital lobe was most damaged, for example, blurry vision may remain, and if the amygdala or cerebellum was hit hardest, emotional or motor difficulties may persist longer. After about six months, most people tend to feel and think much better than they did following the accident, and after a couple of years most people should be recovered for the most part, though initial symptoms may still affect daily activities and occupation.
What are the chances of recovering from a TBI?
It is certainly possible to recover from a TBI, and the extent depends largely on the injury’s severity: the less severe the injury, the quicker and better the recovery. According to the American Association of Neurological Surgeons (AANS), among moderate TBI victims, approximately 60 percent will make a positive recovery and about 25 percent will be left with a moderate degree of disability. Among victims of severe TBIs, AANS reports that only 25 to 33 percent of patients have positive outcomes, moderate to severe disability occurs in about a sixth of patients, about 33 percent of these victims do not survive, and the rest remain vegetative.
Because symptoms and difficulties may take longer to present in children than in adults, sometimes not appearing until years later, it can be difficult to determine how much care a child may need in the future, including medical, educational, and occupational therapy. An experienced personal injury lawyer can help account for those current and future needs.
Deadlines that apply to a brain injury claim in Illinois
Because TBI symptoms can surface long after the accident, the filing deadline often becomes the first real obstacle to a claim. In Illinois you generally have two years from the date of the injury to file a personal injury claim (735 ILCS 5/13-202). If the injured person is a child, the clock generally does not start until they turn 18, giving them until age 20 to file (735 ILCS 5/13-211).
One shorter deadline can end a claim on its own. If the claim is against a city, county, school district, park district, transit agency, or another local public entity or its employees, the window is only one year from the date of the injury (745 ILCS 10/8-101). That matters for brain injuries sustained on public property, in a school or municipal sports program, or in a crash involving a government vehicle. Having the facts reviewed early is the safest way to know which deadline applies to you.
Contact 844-SEE-MIKE
If you or a loved one has suffered a traumatic brain injury in an accident, 844-SEE-MIKE can review what happened in a free consultation. We are a Chicago-based injury law firm representing individuals and their families who have been injured in accidents, and we will keep you informed at every step. You pay nothing unless we recover money for you. The information here is general and not legal advice.
