Traumatic Brain Injury: Signs and Symptoms

Photo by Staff Sgt. Don Branum

What is Traumatic Brain Injury?

Traumatic brain injury (TBI) is a condition caused by a sudden trauma, such as a blow or jolt to the head or a penetrating head injury, that disrupts the normal function of the brain. Examples of these impacts include the head hitting a solid object, such as a wall or steering wheel, or an object penetrating the skull and brain. TBIs range from mild to moderate, severe or penetrating. While certain signs and symptoms of TBI can be apparent, the injury can also be invisible to service members and to those around them immediately following the impact.¹ [1]

Leading Causes of TBI

TBI can be a result of several different incidents, such as falls or motor vehicle crashes. Among active duty military personnel in combat zones, blasts are a leading cause of TBI. Other causes include bullets, fragments and struck by/against events, which include colliding with a moving or stationary object.

The intensified use of explosive devices and mines in warfare and noise from weapons have resulted in auditory dysfunction, TBI and mental health conditions among members of the military. More than 50 percent of injuries sustained in combat are the result of explosive weapons, including bombs, grenades, land mines, missiles and mortar/artillery shells. These munitions can be directed toward individuals and vehicles or hidden in buildings or other objects.² [2]

Signs and Symptoms of TBI

During his deployments to Iraq, U.S. Army Captain Galen Peterson experienced numerous explosions that caused traumatic brain injuries. In his video profile [3] on DCoE’s website, he describes the challenges of these unseen injuries and how receiving proper treatment has helped him recover.

A person with a mild TBI, or concussion, may remain conscious and complain of not remembering what happened or being “dazed and confused” after an injury takes place.  He or she may experience a loss of consciousness for a few seconds or minutes. In some cases, the signs and symptoms of a concussion can be subtle. Symptoms of a concussion may not be identified as such until days or weeks following the injury, or they may even be missed altogether. The following are some common signs and symptoms of a mild TBI:

• Headaches or neck pain that does not go away.
• Light-headedness, dizziness or loss of balance.
• Urge to vomit (nausea).
• Loss of sense of smell or taste.
• Ringing in the ears.
• Difficulty remembering, concentrating or making decisions.
• Slowness in thinking, speaking, acting or reading.
• Getting lost or easily confused.
• Feeling tired all of the time and having no energy or motivation.
• Mood changes (feeling sad or angry for no reason).
• Changes in sleep patterns (sleeping a lot more or having a hard time sleeping).
• Increased sensitivity to lights, sounds or distractions.
• Blurred vision or eyes that tire easily.

A person with a moderate or severe TBI may show the same symptoms as mild TBI as well the following symptoms, which would require immediate medical attention. These are considered “red flags:”

• Headache that gets worse or does not go away.
• Repeated vomiting or nausea.
• Convulsions or seizures.
• Inability to awaken from sleep.
• Dilation of one or both pupils of the eyes.
• Slurred speech.
• Weakness or numbness in the extremities.
• Loss of coordination.
• Increased confusion, restlessness or agitation.³ [4]

Delays in treatment can reduce the chance for optimal recovery or result in significant cognitive, physical and/or psychological impairment.

TBI can cause a range of functional changes affecting thinking, sensation, language and/or emotions. It can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease and other brain disorders that become more common with aging.

How is TBI Diagnosed?

Individuals exposed to or involved in a blast, fall, vehicle crash or direct impact who become dazed, confused or lose consciousness, even momentarily, should be screened for TBI immediately following the event. Methods of evaluation include:

• MACE (Military Acute Concussion Evaluation) will screen for concussion and ensuing symptoms, as well as provide a brief cognitive assessment.
• A detailed history and examination for more severe brain injuries including brain imaging with a computed tomography (CT) scan. Sometimes, other imaging studies are used to include magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and positron emission tomography (PET).
• Cognitive evaluation will help to evaluate problems with thinking skills including memory and attention.
• Evaluations by physical, occupational and speech therapists will help clarify the specific functional problems of an individual.⁴

Additional Resources

• Traumatic Brain Injury: Treatment and Recovery [6]
• Cognitive Rehabilitation Helps Warriors with Mild TBI [7]
• Defense and Veterans Brain Injury Center [8]
• National Center for Injury Prevention and Control: Traumatic Brain Injury [9]
• Brain Injury Association of America [10]
• Iraq and Afghanistan Veterans of America – Invisible Wounds: Psychological and Neurological Injuries Confront a New Generation of Veterans [11] [PDF 1.21MB]
• CDC – Leading Causes of TBI [12]

Sources

¹ BrainLine [13]  last accessed on 9/12/2011.
² CDC website – Brain Injuries and Mass Casualty Events [14] last accessed on 9/12/2011.
³ National Institute of Neurological Disorders and Stroke [15] last accessed on 9/12/2011.
⁴ Defense and Veterans Brain Injury Center Three Question TBI Screening Tool [5] [PDF 104.74KB] last accessed on 9/12/2011.