Physical consequences of TBI depend greatly on what regions of the brain were affected by the injury. Many individuals will experience injury to other body regions (e.g., limbs, spine) in the traumatic event that caused their TBI, which may also result in physical limitations. Individuals may participate in rehabilitation therapies to directly improve their physical functioning and/or identify adaptive technologies to decrease functional limitations. Individuals with TBI may experience a vast majority of physical consequences including weakness on one or both sides of the body and increased clumsiness or decreased coordination.
Specific physical consequences/effects that are often associated with TBIs include:
Headaches are one of the most commonly experienced symptoms after traumatic brain injury (often called “post-traumatic headache”). Over 30% of individuals report having headaches which continue long after injury. Headaches after TBI can be long-lasting and may continue even beyond one year. Headaches can make it difficult for individuals to carry out daily activities or affect an individual’s ability to think and remember things. Individuals with TBI may experience headaches because of the surgery on their skulls or because they have small collections of blood or fluid inside the skull. Headaches can also occur after mild to moderate injury or, in the case of severe TBI, after the initial healing has taken place. These headaches can be caused by a variety of conditions, including a change in the brain caused by the injury, neck and skull injuries that have not yet fully healed, tension and stress, or side effects from medication.
Some of the typical headaches experienced after a TBI are:
Migraine headaches occur when an area of the brain becomes hypersensitive and triggers a pain signal that spreads to other parts of the brain. Migraine headaches are typically associated with certain symptoms including: Dull, throbbing sensation, usually on one side of the head; Nausea or vomiting; Light and sound sensitivity; Pain level rated as moderate to severe; and warning signals that a migraine is coming on such as seeing bright lights or spots.
Tension-type headaches are associated with muscle tension or muscle spasms and stress. Tension-type headaches often occur later in the day and include symptoms such as a tight, squeezing sensation around the entire head or on both sides of the head and a pain level rated as mild to moderate.
Cerviogenic headaches are caused when there is injury to the back of the muscles and soft tissue in the neck and the back of the head. Cerviogenic headaches often arise in the neck, shoulders and back of the head, and sometimes travel over the top of the head. Neck movement or positioning can exacerbate the pain of cerviogenic headaches. These headaches are typically not accompanied by nausea and can range from mild to severe pain.
Medicines used to treat headaches can actually cause headaches, known as rebound headaches. When pain medicines are taken daily on a regular schedule, missing one or two doses can result in a headache. Most headaches are not dangerous. However, in the first few days after a concussion or head injury, an individual should see a health care professional with experience in treating TBIs if the individual headaches worsen or nausea or vomiting accompanies the headache. Medical treatment should also be sought if the individual experiences arm or leg weakness, problems speaking during the headache, or increased sleepiness during the headache.
DIZZINESS AND/OR BALANCE PROBLEMS
People with traumatic brain injury (TBI) commonly report problems with balance. Between 30% and 65% of people with TBI suffer from dizziness and disequilibrium (lack of balance while sitting or standing) at some point in their recovery. Dizziness includes symptoms such as lightheadedness, vertigo (the sensation that you or your surroundings are moving), and imbalance. How bad your balance problem is depends on many factors including: How serious your brain injury is; Where in your brain you were injured; Other injuries you had along with your brain injury such as cervical spine injuries, rib injuries, and or leg injuries; and the medications used to manage the medical issues connected with the traumatic event or accident.
Common Causes of Balance Problems after suffering a TBI
Medications: A number of commonly used medications can lead to dizziness, lightheadedness and decreased balance. Some blood pressure medications, antibiotics, tranquilizers, heart medications, and anti-seizure medications may lead to these complications. An individual should consult with his/her doctor in the event that any of the medications he/she is taking may be causing dizziness or balance problems. A change in medications or dosages may improve the problem.
Drops in blood pressure: A drop in blood pressure when standing or sitting up suddenly, known as postural hypotension, can make individuals feel lightheaded and dizzy. Drops in blood pressure may occur when an individual gets up quickly from sitting on the toilet or a chair, or getting out of bed. Measuring blood pressure while in a lying, sitting, and standing position may help diagnose blood pressure-related balance problems.
Vision impairments: Eyesight is one of the key senses for assisting in an individual keeping his/her balance. Eyesight problems such as double vision, visual instability, partial loss of vision, and problems with depth perception often lead to balance problems.
Inner ear problems (vestibular impairments): The inner ear contains many tiny organs called the vestibular system/labyrinth that help individuals keep their balance. The inner ear has three loop-shaped structures (semicircular canals) that contain fluid and have fine, hair-like sensors that monitor the rotation of your head. It also has other structures (otolith organs) that monitor linear movements of your head. These otolith organs contain crystals that make individuals sensitive to movement and gravity. If the vestibular system is damaged from a head injury, an individual may experience balance problems, dizziness, or a sudden sensation of spinning.
The three types of vestibular impairments are Benign paroxysmal positional vertigo; Labyrinthine concussion or injury; and Traumatic endolymphatic hydrops. Benign paroxysmal positional vertigo is one of the most common causes of vertigo. With trauma, the crystals in the inner ear can be moved out of place, increasing sensitivity to changes in gravity. Benign paroxysmal positional vertigo is associated with brief episodes of vertigo, and symptoms may be triggered by specific changes in head position, such as tipping your head up or down, and by lying down, turning over or sitting up in bed. Symptoms may also be experienced while standing or walking. Labyrinthine concussion, or injury to the nerve to the vestibular system, are also causes of vertigo and imbalance commonly observed after brain injury. Traumatic endolymphatic hydrops occurs when there is a disruption of the fluid balance in the inner ear. When this happens, individuals may have periods of vertigo, imbalance and ringing in the ears that last for hours to days.
Brainstem injury: A traumatic injury to the brainstem and cerebellum (parts of the brain that control movement) can make it hard for an individual to walk and maintain balance.
Leakage of inner ear fluid into the middle ear (called perilymph fistula): This condition sometimes occurs after head injury. The condition can cause dizziness, nausea, and unsteadiness when walking or standing and can worsen when an individual is more active. This condition may get better with rest.
FATIGUE, LACK OF ENERGY, DROWSINESS, SLEEP DISTURBANCES SUCH AS TROUBLE FALLING ASLEEP OR SLEEPING MORE OR LESS THAN USUAL.
Many individuals with TBI suffer from sleep disturbances. The brain directs sleep by putting the body to rest. Injury to the brain often leads to changes in sleep. Lack of sleep can increase or worsen depression, anxiety, fatigue, irritability, and an individual’s sense of well-being. Lack of sleep may also result in poor work performance and traffic or workplace accidents. Sleep disorders are three times more likely to be seen in TBI patients than in the general population and nearly 60% of people with TBI experience long-term difficulties with sleep. Women are more likely to be affected than men, and sleep problems become more likely to develop as the person ages.
Insomnia is one sleep disorder commonly associated with TBI. Individuals with insomnia experience difficulty falling asleep or staying asleep and often times their sleep does not leave them feeling rested. Insomnia can worsen other problems resulting from brain injury, including behavioral and cognitive (thinking) difficulties. Insomnia makes it more difficult to learn new things. Insomnia is typically worse directly after injury and often improves as time passes. Other sleep disorders commonly associated with TBI include Excessive Daytime Sleepiness (Extreme drowsiness); Delayed Sleep Phase Syndrome (Mixed-up sleep patterns); and Narcolepsy which is a condition that causes individuals to fall asleep suddenly and uncontrollably during the day.
Injuries to the base of the skull can damage nerves that emerge directly from the brain (cranial nerves). Cranial nerve damage may result in difficulties with sensory perception such as loss of smell or taste and numbness and/or tingling. Nerve damage to the brain may also cause paralysis of facial muscles; damage to the nerves responsible for eye movements, which can cause double vision; Loss of vision; Loss of facial sensation; and swallowing problems.
An individual with a traumatic brain injury (TBI) may experience seizures during recovery. Although most people who have a brain injury will never have a seizure, it is good to understand what a seizure is and how to address a seizure should one arise. Most seizures happen in the first several days or weeks after a brain injury. Some seizures may occur months or years after the injury. About 70-80% of people who have seizures are able to treat their condition with medications and can return to most activities. Seizures can make an individual’s condition much worse or even result in death. Generally speaking, the risk of post traumatic seizures is related to the severity of the injury- the greater the injury, the higher the risk of developing seizures. Even mild to moderate injuries can result in seizures.
Seizures happen in 1 of every 10 people who have a TBI that required hospitalization. Seizures usually occur when there is a scar in the brain as a result of the injury. Seizures cause sudden abnormal electrical disturbances in the brain which lead to multiple symptoms such as:
- Strange movements of your head, body, arms, legs, or eyes
- Stiffening or shaking
- Unresponsiveness and staring
- Chewing, lip smacking, or fumbling movements
- Strange smell, sound, feeling, taste, or visual images
- Sudden tiredness or dizziness
- Not being able to speak or understand others.
Symptoms of a seizure happen suddenly and cannot be controlled by the individual. Seizures usually last only a few seconds or minutes, but sometimes continue for 5 to 10 minutes. Bladder or bowel accident or biting down on the tongue or the inside of the mouth may occur during a seizure. After the seizure, individuals may be drowsy, weak, confused. After a severe seizure that lasts longer than 2 minutes, it may be harder for an individual to stand, walk or accomplish basic daily living activities for a few days or longer.
A seizure in the first week after a TBI is called an early post-traumatic seizure. About 25% of individuals who have an early post-traumatic seizure will experience another seizure months or years later. A seizure more than seven days after a brain injury is called a late post-traumatic seizure. About 80% of people who have a late post-traumatic seizure will have another seizure (epilepsy). Having more than one seizure is called epilepsy. More than half of individuals with epilepsy will be forced to deal with this condition for the remainder of their lives.
Medications that are used to control seizures are called antiepileptic drugs (AEDs). Commonly prescribed AEDs include Carbamazepine (also known as Tegretol); Lamotrigine (also known as Lamictal); Levitiracetam (also known as Keppra); Gabapentin (also known as Neurontin); Oxcarbazepine (also known as Trileptal); Phenobarbital; Phenytoin/ fosphenytoin (also known as Dilantin); Pregabalain (also known as Lyrica); Topiramate (also known as Topamax); Valproic acid or valproate (also known as Depakene or Depakote); and Zonisamide (also known as Zonegran). Upon having a seizure it is important to seek care from a healthcare professional to determine the best course of treatment for the individual with the TBI and whether any of these medications
Sustaining an injury to the head or neck increases ischemic stroke risk three-fold among trauma patients younger than 50, according to research presented at the American Stroke Association’s International Stroke Conference 2014.
Researchers studied the health records of 1.3 million patients younger than 50 years who had been treated in emergency trauma rooms. About 11 of every 100,000 patients (145) suffered a stroke within four weeks. Since 2 million patients are seen in U.S. trauma rooms each month, this suggests 214 young people a month have an ischemic stroke after a trauma.
Stroke after trauma may be caused by a tear in the head or neck blood vessels that lead to the brain, which can be a source of blood clots that cause a stroke. Diagnosing these types of tears from the outset of the injury is very important for treatment purposes. If doctors are able to diagnose a tear in these arteries at the time of the trauma, an individual can be prescribed an anti-clotting medicine to help prevent stroke. In the study, 10 percent of the people who had a stroke were diagnosed with this kind of tear, but not all the patients were diagnosed with it prior to stroke.
Other complications that commonly arise after suffering a TBI include sensitivity to noise and/or light; difficulties managing bodily functions such as regulation of blood pressure or body temperature; and chronic pain.