Mild Traumatic Brain Injury

Traumatic brain injury (TBI) is an injury to the brain caused by a blow or jolt to the head from blunt or penetrating trauma. The injury that occurs at the moment of impact is known as the primary injury. Primary injuries can involve a specific lobe of the brain or the entire brain. Sometimes the skull may be fractured, but not always. Immediately after the accident the person may be confused, not remember what happened, have blurry vision and dizziness, nausea and vomiting, or lose consciousness.

Depending on the type and location of the injury, the person’s symptoms may include:  

• Loss of consciousness. 
• Confusion and disorientation.
• Memory loss/amnesia. 
• Fatigue. 
• Headaches. 
• Visual problems. 
• Poor attention/concentration. 
• Sleep disturbances.
• Dizziness/loss of balance. 
• Irritability/emotional disturbances.
• Feelings of depression.
• Nausea/vomiting.
• Seizures.

Patients with a mild TBI usually do not require surgery. They generally need rest and, at times, medications or therapies to help relieve persistent symptoms.

After a mild brain injury patients can have a wide variety of symptoms. Some patients may not experience any symptoms, while others can have severe symptoms such as headaches, dizziness, memory problems, sleep disorders, fatigue, high levels of emotions or, in some cases, seizures. Descriptions of the common problems people experience after a mild brain injury are listed below:  

• Headaches - Headaches are a very common problem after a TBI. Most patients with a TBI will experience headaches. Over-the-counter acetaminophen (Tylenol) is the best medication to treat your headaches. In most patients, headaches will go away within one month and they should gradually improve with time. If your headache would worsen or become severe and unrelieved by pain medication, call your healthcare provider or return to the emergency department. 
• Dizziness - Dizziness is another very common symptom. The dizziness should improve with time. However if it becomes severe and makes it difficult to complete tasks, please contact your health care provider to discuss options for treating your dizziness. 
• Memory problems - Memory problems are common among patients with a TBI. This can range from problems with organizing tasks to remembering names or even the grocery list. This is called your short-term memory. Generally these memory problems are mild and will resolve over time. However, some patients may need to get help from a speech therapist. A speech therapist can help with ways to organize your thoughts and tasks, and provide tips to practice at home to improve your short-term memory. 
• Sleep disorders/fatigue - Patients with TBI can also have problems with sleep and fatigue. Initially, after a head injury, patients will feel tired, need frequent rest periods, and may want to sleep most of the time for the first several days. Patients may also have difficulty sleeping well at night. It is important to increase your activity level gradually every day. Increasing activity to include light exercise may help your symptoms improve. Keeping the same bedtime every night and reducing mental and physical stimuli for one hour before bedtime may aid in sleep. When going back to work it is important to take your activity tolerance into account. You might need to work part-time initially to build up your endurance before going back full-time. Like all other symptoms, these will diminish with time.
• Emotions - After a TBI some patients have trouble controlling their emotions. This means they might get mad or angry in a situation where they normally would not. Some patients say they cry easily, even at a sad commercial on TV. This can be an adjustment and can cause strain on relationships. Caregivers or spouses may be more likely to notice small changes in personality. To identify specific changes caused by the TBI, contact the patient’s doctor. He or she can conduct a neuropsychological evaluation and create direction for further care. 
• Seizures - Seizures can occur anytime the brain is injured. Patients with a mild TBI are often not given seizure medications because they have a low risk of having a seizure. However, at the discretion of the medical team, some patients may be treated with medication for a short period after the injury to prevent seizures from occurring.

Tips to reduce the risk of a head injury:

• Always wear a helmet when riding a bicycle, motorcycle, skateboard, or all-terrain vehicle.
• Never drive under the influence of alcohol or drugs. 
• Always wear your seat belt and ensure that children are secured in the appropriate child safety seats. 
• Avoid falls in the home by keeping unsecured items off the floor, installing safety features such as non-slip mats in the bathtub, handrails on stairways, and keeping items off of stairs. 
• Avoid falls by participating in an exercise program to increase strength, balance, and coordination.
• Store firearms in a locked cabinet with bullets in a separate location. 
• Wear protective headgear while playing sports.

After a patient is discharged home he/she will need constant supervision for 24-48 hours to watch for these changes listed below:  

• If the patient has an increase in sleepiness. 
• If the patient is unable to be awakened from sleep. 
• If the patient has new onset nausea and vomiting or vomiting that is unable to be controlled with medication.
• If the patient becomes confused or disoriented. 
• If the patient develops weakness on one side of their body. 
• If the patient develops difficulty talking or understanding what is being said. 
• If the patient has a seizure.