Brain Injury (Acquired Brain Injury)

What to do right after a head injury

1. Call 911 or your local emergency number for any of the emergency signs above.
2. If the person is unconscious and breathing, keep their head and neck still and in line, and monitor breathing. Do not move them unless they are in danger.
3. Do not give them alcohol or sedatives.
4. For a mild injury, someone should stay with the person for the first 24 hours and watch for warning signs.
5. Rest and avoid screens and strenuous activity for the first day or two, then return to activity gradually.

Types of brain injury

Traumatic brain injury (TBI)

Traumatic brain injury is caused by an external force:

• Closed injury: the skull is not broken; the brain moves inside the skull, causing bruising, bleeding or stretching of nerve fibers.
• Penetrating injury: an object breaks the skull and enters the brain.
• Blast injury: pressure waves from explosions.

Specific injuries include concussion, brain contusions (bruises), diffuse axonal injury (widespread stretching of nerve fibers), and bleeding around the brain, including epidural hematoma and subdural hemorrhage. A subdural bleed in an older adult can develop slowly over days to weeks after a minor fall.

Non-traumatic brain injury

• Stroke: a blocked artery or bleeding in the brain.
• Hypoxic or anoxic brain injury: lack of oxygen from cardiac arrest, drowning, choking, severe asthma or carbon monoxide poisoning.
• Infections: encephalitis, meningitis and brain abscess.
• Tumors and their treatment.
• Toxic and metabolic causes: drug overdose, alcohol, very low blood sugar and liver failure.
• Aneurysm rupture.

Severity

The Glasgow Coma Scale (GCS), scored from 3 to 15, measures eye opening, speech and movement. A score of 13 to 15 is mild, 9 to 12 moderate and 8 or lower severe.

Effects of brain injury

Effects depend on which part of the brain is damaged and how severely.

• Physical: weakness, poor balance, headaches, seizures, fatigue, sleep problems, sensitivity to light and noise, problems with vision, hearing, smell or swallowing.
• Cognitive: problems with memory, attention, processing speed, planning and problem solving (executive function), and language.
• Emotional and behavioral: irritability, anger, impulsivity, depression, anxiety, loss of motivation and personality change.
• Hormonal: damage to the pituitary gland can cause hormone deficiencies.

Many effects are invisible, which can make them hard for others to understand.

Diagnosis

• Neurological examination and the GCS.
• CT scan of the head: the first test after significant head injury, to look for bleeding, skull fractures and swelling. Guidelines such as the Canadian CT Head Rule help decide who needs one.
• MRI: shows smaller injuries and is used later.
• Neuropsychological testing: measures thinking skills during recovery.
• Blood tests for brain injury markers are available in some hospitals to help decide whether a CT scan is needed.

Treatment

Emergency care

• maintaining breathing, oxygen and blood pressure
• surgery to remove blood clots or relieve pressure on the brain
• controlling brain swelling and seizures
• intensive care monitoring of pressure inside the skull

Rehabilitation

Rehabilitation starts as soon as it is safe and may continue for months or years:

• physical therapy for movement and balance
• occupational therapy for daily activities and returning to work
• speech and language therapy for communication and swallowing
• neuropsychology for thinking, mood and behavior
• vocational rehabilitation and family support

Mild injuries and concussion

Rest for the first 24 to 48 hours, then a gradual return to normal activity, school and work. Light physical activity is encouraged early. Return to sport follows a stepwise plan and only after symptoms have cleared.

Outlook

Most people with mild brain injury recover within days to weeks, though some develop post-concussion syndrome with symptoms lasting months. Recovery from moderate and severe injury is often fastest in the first 6 months but can continue for years. Some effects may be permanent. Repeated head injuries are linked to long-term problems, including chronic traumatic encephalopathy.

Prevention

• Wear seat belts and use appropriate child car seats.
• Wear helmets for cycling, motorcycling, skiing, skating and contact sports.
• Reduce fall risk in older adults: good lighting, removing trip hazards, grab bars, exercise for balance and medicine reviews.
• Never drive after drinking alcohol or using drugs.
• Learn CPR, which reduces hypoxic brain injury after cardiac arrest.

Frequently asked questions

What are the signs of brain injury after a fall?

Warning signs include loss of consciousness, a worsening headache, repeated vomiting, confusion, drowsiness, slurred speech, weakness, seizures, unequal pupils and clear fluid from the nose or ears. Older adults and people on blood thinners need assessment even after minor falls.

What is the difference between a brain injury and a traumatic brain injury?

Brain injury is the broader term for any damage to the brain after birth. Traumatic brain injury is the type caused by an external force, such as a fall or crash. Non-traumatic brain injuries come from causes such as stroke, lack of oxygen and infection.

Can the brain heal after an injury?

Yes, to a degree. Damaged brain cells do not regrow in large numbers, but the brain can reorganize and form new connections (neuroplasticity). Rehabilitation takes advantage of this. Recovery is often greatest in the first 6 to 12 months but can continue for years.

How long does it take to recover from a brain injury?

Mild injuries such as concussion usually improve within 2 to 4 weeks. Moderate and severe injuries can take months to years, and some effects may be lasting. Recovery depends on the injury's severity, location, age and access to rehabilitation.

Can a brain injury change your personality?

Yes. Damage to the frontal lobes, in particular, can cause irritability, impulsivity, loss of motivation, emotional changes and difficulty with social behavior. These changes can be distressing for families. Neuropsychological support, therapy and education help.