Brain Injury

Every 9 seconds, someone in the United States sustains a brain injury—an event that can change everything about a person in a matter of seconds. While brain injuries affect millions worldwide each year, no two injuries are exactly alike, making each person’s journey unique.

Table of contents

• What Is a Brain Injury?
• Types of Brain Injuries
• How Brain Injuries Happen
• Who Is at Risk?
• Signs and Symptoms
• How Brain Injury Is Diagnosed
• Treatment Approaches
• Recovery and Living With Brain Injury

What Is a Brain Injury?

A brain injury affects how a person thinks, acts, and feels^[1]. A traumatic brain injury (TBI) refers to a brain injury caused by an outside force^[3]. This can happen when there is a blow, bump, or jolt to the head, or when an object penetrates the skull^[13]. The injury affects how your brain works and can cause damage to brain cells, blood vessels, and tissues^[2][7].

Brain injuries are a major cause of death and disability worldwide^[6]. In the United States, there were over 69,000 TBI-related deaths in 2021, which means about 190 TBI-related deaths every day^[4]. In 2020, more than 214,000 people needed hospital care for a TBI^[7]. The symptoms and impacts are wide ranging and can change everything about someone in a matter of seconds, affecting both the survivor and their support network^[1].

Types of Brain Injuries

Brain injuries come in different forms and are classified by how they occur and how severe they are. Understanding these differences helps doctors provide the right care.

There are two main types based on how the injury happens^[3][7]:

• Penetrating TBI (also called open TBI) happens when an object pierces the skull and enters the brain tissue. This can occur from bullets, shrapnel, knives, or bone fragments. These injuries typically damage only part of the brain.
• Non-penetrating TBI (also called closed head injury or blunt TBI) is caused by an external force strong enough to move the brain within the skull. The brain may bounce or twist inside the skull, causing damage. This type can happen from falls, vehicle accidents, sports injuries, explosions, or being struck by an object.

Brain injuries are also classified by severity^[7]:

• Mild TBI: More than 75% of all TBIs are mild. Many people call mild TBI a concussion. Even mild TBIs can cause significant and long-term issues. People with mild traumatic brain injury may have trouble returning to their daily routines, including work.
• Moderate TBI: These injuries are more serious and require medical attention.
• Severe TBI: The most serious form affects the entire brain with diffuse injury and swelling^[12]. Most people with moderate or severe traumatic brain injury can develop significant and long-term health issues.

Some TBIs are considered primary, meaning the damage is immediate. Others are secondary, meaning they happen gradually over hours, days, or weeks after the initial injury^[3].

How Brain Injuries Happen

People most commonly get TBIs from falls, firearm-related injuries, motor vehicle crashes, or assaults^[4]. The main causes depend on the type of injury.

Common causes of closed head injuries include^[13]:

• Falls: This is the most common cause in adults aged 65 and older, and the leading cause overall of TBI-related hospitalizations^[4].
• Motor vehicle crashes: This is the most common cause in young adults.
• Sports injuries: Estimates suggest that sports-related brain injury accounts for close to 300,000 injuries each year, with winter sports like skiing and ice-skating accounting for close to 20,000 brain injuries^[6].
• Being struck by an object
• Child abuse: This is the most common cause in children under age 4.
• Blast injuries from explosions

Common causes of penetrating injuries include being hit by a bullet or shrapnel, being struck with a weapon such as a hammer, knife, or baseball bat, or head injuries that cause bone fragments to penetrate the skull^[13].

Firearm-related suicide is the most common cause of TBI-related deaths in the United States^[4]. Motor vehicle crashes account for 50% of all TBIs^[6].

Who Is at Risk?

Anyone can experience a TBI, but certain groups are at greater risk^[4][13]:

• Men are more likely to get a TBI than women and are also more likely to have serious TBI.
• Adults aged 65 and older are at the greatest risk for being hospitalized and dying from a TBI. They are more likely to be hospitalized and die from a TBI compared to all other age groups^[4].
• People aged 15-24 years have the highest rate of injury^[6].
• Children under age 5 are at higher risk^[6].

Additional groups at greater risk include racial and ethnic minorities, service members and veterans, people who experience homelessness, people in correctional facilities, survivors of intimate partner violence, and people living in rural areas^[4].

TBIs may be missed in older adults because symptoms can overlap with other medical conditions that are more common in this age group, such as dementia^[4]. Healthcare providers should check for signs of TBI if an older adult has fallen, had a fall-related injury like a hip fracture, or been in a car crash, especially if they take blood thinners^[4].

Signs and Symptoms

The symptoms of TBI depend on the type of injury and how serious the brain damage is^[13]. Some signs or symptoms may appear immediately after the traumatic event, while others may appear days or weeks later^[2]. If you have a traumatic brain injury, it means you were hit in the head hard enough to make your brain bounce around or twist inside your skull, which can damage your brain and injure blood vessels^[7].

Headache, dizziness, confusion, and fatigue tend to start immediately after an injury but usually resolve over time. Emotional symptoms such as frustration and irritability tend to develop during recovery^[3].

Symptoms of Mild TBI

The symptoms of mild TBI can include physical, sensory, and cognitive or behavioral changes^[2][13]:

Physical symptoms:

• Headache
• Nausea or vomiting
• Fatigue or drowsiness
• Problems with speech
• Dizziness or loss of balance
• A brief loss of consciousness (though many people with mild TBI remain conscious)

Sensory symptoms:

• Blurred vision
• Ringing in the ears
• A bad taste in the mouth
• Changes in the ability to smell
• Sensitivity to light or sound

Cognitive and behavioral symptoms:

• State of being dazed, confused, or disoriented
• Memory or concentration problems
• Mood changes or mood swings
• Feeling depressed or anxious
• Difficulty sleeping or sleeping more than usual

Symptoms of Moderate to Severe TBI

Moderate to severe traumatic brain injuries can include any of the signs and symptoms of mild injury, as well as more serious symptoms that may appear within the first hours to days after a head injury^[2][13]:

• Loss of consciousness from several minutes to hours
• Persistent headache or headache that gets worse
• Repeated vomiting or nausea
• Convulsions or seizures
• Larger than normal pupil (dark center) of one or both eyes
• Clear fluids draining from the nose or ears
• Slurred speech
• Weakness or numbness in the arms and legs
• Loss of coordination
• Increased confusion, restlessness, or agitation
• Not being able to wake up from sleep

In babies, TBI symptoms include issues eating or nursing and crying inconsolably, meaning nothing you do to comfort them helps them stop crying^[7].

You should seek immediate medical attention if you or someone else experiences any of these symptoms, especially within the first 24 hours after an injury to the head^[3].

How Brain Injury Is Diagnosed

If you have a head injury or other trauma that may have caused a TBI, you need to get medical care as soon as possible^[13]. Traumatic brain injuries may be emergencies, and in the case of more severe TBIs, consequences can worsen rapidly without treatment^[8].

To make a diagnosis, your healthcare provider will^[13]:

• Ask about your symptoms and the details of your injury
• Do a neurologic exam
• May do imaging tests, such as a CT scan (computed tomography) or MRI (magnetic resonance imaging)
• May use a tool such as the Glasgow Coma Scale to determine how severe the TBI is
• May do neuropsychological tests to check how your brain is functioning

The Glasgow Coma Scale is a 15-point test that helps doctors assess the initial severity of a brain injury by checking a person’s ability to follow directions and move their eyes and limbs, as well as the coherence of speech^[8]. Higher scores mean less severe injuries.

If you saw someone sustain an injury or arrived immediately after an injury, you may be able to provide medical personnel with useful information about how the injury occurred, whether the person lost consciousness, and other details about changes in alertness, speaking, or coordination^[8].

Imaging Tests

A CT scan is usually the first test performed in an emergency room for a suspected traumatic brain injury^[8]. It uses a series of X-rays to create a detailed view of the brain and can quickly show fractures, bleeding in the brain, blood clots, bruised brain tissue, and brain tissue swelling.

MRI uses magnets and radio waves to create detailed images and may be used after the person’s condition stabilizes or to look at brain structure in more detail^[8].

Treatment Approaches

Just as no two people are exactly alike, no two brain injuries are exactly alike, which is important to keep in mind when addressing brain injury treatment^[11]. The treatments for TBI depend on many factors, including the size, severity, and location of the brain injury^[13]. Treatment modalities vary extensively based on the severity of the injury and range from daily cognitive therapy sessions to surgery^[12].

Treatment for Mild TBI

For mild TBI, the main treatment is rest^[13]. If you have a headache, you can try taking over-the-counter pain relievers. It is important to follow your healthcare provider’s instructions for complete rest and a gradual return to your normal activities. If you start doing too much too soon, recovery may be slower.

Resting is good the first few days after a mild TBI or concussion, as this is when symptoms are more severe^[16]. You may need to take a short time off from work or school, although usually no more than 1 to 2 days. After one or two days of rest, it’s important to ease back into your regular activities even if you still have some mild symptoms. If your symptoms get worse, you should cut back on that activity.

Treatment for Moderate to Severe TBI

Brain injury requires access to a full continuum of treatment and community-based supports provided by appropriately educated clinicians serving on an interdisciplinary team^[11]. Treatment can be acute or post-acute:

• Acute treatment involves care that an individual receives in the hospital immediately after their injury
• Post-acute care encompasses long-term treatment for persisting side effects of brain injury

More serious TBI can lead to severe and permanent disability and even death^[3]. Treatment may include medications, surgery to reduce swelling or bleeding, and rehabilitation services^[9].

Brain injury rehabilitation is an important part of recovery and may include physical therapy, occupational therapy, speech and language therapy, and psychological support^[11]. For some, brain injury is the start of a lifelong disease process^[11].

Recovery and Living With Brain Injury

A TBI may lead to short-term or long-term health problems^[4]. Depending on the severity of the injury, those who get a TBI may face health problems that last a few days or the rest of their lives. For example, a person with a mild TBI or concussion may experience short-term symptoms and feel better within a couple of weeks or months. A person with a moderate or severe TBI may have long-term or life-long effects from the injury.

An estimated 5.3 million Americans are living today with disability related to traumatic brain injury^[6]. Brain injury can cause many kinds of physical, cognitive, and behavioral or emotional impairments that may be either temporary or permanent, ranging from subtle to severe^[6].

When Symptoms Are Nearly Gone

Recovery from a mild TBI or concussion means you can do your regular activities without experiencing symptoms^[16]. When your symptoms are mild and nearly gone, you can return to most of your regular activities. Recovery may be slower among older adults, young children, and people who have had a concussion or other TBI in the past.

Most people with a mild TBI or concussion can recover safely with proper care and can return to work, school, and many other activities within a few days or weeks^[16]. However, some people will have symptoms for months or longer. Talk with your healthcare provider if symptoms do not go away within 2 to 3 weeks or get worse after you return to your regular activities.

Post-Concussive Syndrome

If you have one or more symptoms that last months after the injury, your healthcare provider may talk to you about post-concussive syndrome^[16]. This is believed to occur most commonly among people with a history of multiple mild TBIs or concussions, or prior health conditions such as depression and anxiety.

Tips for Living With Brain Injury

Brain injury survivors have shared many helpful tips for managing recovery and daily life^[14][17]:

Stay active: Both physical and mental fitness are important in recovery. Low-impact exercise like walking and biking are good options for those with physical limitations. For mental exercise, activities like Sudoku and crossword puzzles are beneficial. Be sure to recognize your own limits and don’t push yourself too hard or too fast.

Get rest: While exercise is important, physical and mental rest are just as crucial. Get plenty of sleep and pursue activities that are not too strenuous on your body and mind. Limit screen time and loud music before bed, sleep in a dark room, and keep to a fixed bedtime and wake-up schedule^[16].

Stay positive and find your community: Brain injuries can cause numerous challenges, making it difficult to maintain a positive attitude. Many survivors note that staying positive throughout recovery helps with motivation. Connecting with others in the brain injury community can help with processing, support, and celebrating success.

Take it one step at a time: Slow down and let yourself rest. Sometimes trying to do too much results in doing nothing at all. Taking time to think about an issue may help you figure it out.

Reduce stress and anxiety: Stress and anxiety can make recovery harder. Deep breaths can help get oxygen to your brain and relieve stress. Mindfulness-based stress reduction strategies can be beneficial^[17].

Stay organized: Making a to-do list may help you stay organized. A tablet, smartphone, or paper and pencil—whatever works for you, use it. Setting a routine makes it easier to follow through with your intentions and stick to a schedule^[17].

Stay connected: Stay connected to friends and loved ones and talk with them about how you are feeling. Having support from family and friends can help with recovery^[16]. There are many organizations who can help you and your family as you recover.

Additional practical tips:

• Eat healthy foods, hydrate, and exercise regularly
• Surround yourself with positive people who care about you
• Pay attention and become an active listener
• Don’t take life too seriously and don’t let little things get you down
• Set realistic expectations for yourself
• Keep an open mind and maintain hope

A person with a possible TBI should be seen by a healthcare provider^[4]. Your healthcare provider may have treatment to help speed your recovery and may refer you to a specialist if needed. The most important things to remember are that a person with a brain injury is a person first, no two injuries are exactly the same, and the effects of the injury can change over time^[1].