How to... spot mild traumatic brain injury


Dr Steven Allder, consultant neurologist at Re:Cognition Health, on identifying and treating mild traumatic brain injury

How do you define mild traumatic brain injury (TBI)?
The symptoms of a TBI arise as the result of trauma to the head, when the head is struck or violently shaken around. What determines whether we call the injury mild, moderate or severe is the time that the patient blacked out for after the injury. If it was less than 30 minutes, the injury is considered mild. Alongside the pain of the incident itself, the person will have symptoms such as headache, dizziness, nausea, possibly vomiting. If you have that type of injury, combined with those types of symptoms, you have a mild traumatic brain injury.

Is this the same as concussion?
The problem with the word ‘concussion’ is that there is an implicit assumption that the person will fully recover from the injury. So, when you see somebody half an hour after the accident and they have symptoms that suggest a brain injury of some level, you can’t describe

it as concussion, because you do not know the end state. Today there is actually quite a debate about using the word at all because scientifically it doesn’t really hang together as a useful diagnostic term.

Can a mild TBI lead to long-term problems?
Between 70-80% of mild TBI sufferers have recovered within three months of the event. If symptoms persist beyond this point, you must investigate why. This is critical because one possibility is that the initial injury has not fully healed, and if this is the case there is a chance it never will. So firstly, we need to optimise conditions in order to help the brain recover, as well as checking for other causes. Was there something about the initial injury we missed? Has something gone wrong along the recovery pathway? Is there something entirely different at play? After three months my approach to the injury changes significantly.

Is a mild TBI easy to miss?
It can be, especially if a patient comes in with multiple injuries from a car accident, for example. The more dramatic injuries like broken limbs get dealt with immediately and it can be all too easy for mild brain injury symptoms to be overlooked. A mild TBI can be completely missed and not even considered until months later, when the focus on the other injuries has receded.

What are the signs I should be looking for to raise suspicions of TBI?
If you display the symptoms mentioned earlier—headache, dizziness, nausea—then you have probably suffered a TBI. These should be at their worst pretty much straight after the incident, but hour by hour, day by day you should feel that you’re getting better. What you are looking for is progressive improvement, and luckily the vast majority of people follow that path.

If I don’t start feeling better, should I start to get concerned?
There is a small group of TBI patients whose symptoms start to get worse—the headache is terrible, they feel really sick. The longer it goes without them making progressive improvement, the greater the chance that they may not entirely recover. It is essential that you ask your GP about further investigations if you are in this situation. You also have to just be aware that if you do not have your usual level of motor and psychological skills, you should not put yourself in a position where that could cause further problems.

Do friends and family play a role?
Absolutely. These are often the people who are the first to notice that the person who had the accident is ‘just not right’. This can be very hard to quantify, but something has changed since the injury. It could be increased forgetfulness.

They don’t do things you have asked them to do, and swear blind you never asked. They may be more irritable than usual, more liable to fly off the handle. If you are seeing these changes in a friend or family member after an injury, keep a note and ask how they are doing. People can often be really struggling without anyone realising.

How serious can this get?
It can get quite serious, and escalate to the point where people are struggling at work, and their cognitive function has been impacted to a degree where day-to-day life can be significantly harder.

What should you do when recovering from one?
One of the worst things you can do is rush back to work before you are ready. Like any other part of the body, the brain needs time to rest and recover from an injury. If you start pushing it too quickly, your performance will drop, you will start to get stressed. It is all very subtle so it may not be immediately noticeable, but it will be having a definite effect. If you do not give the brain enough rest time, you may slow down the recovery or indeed reduce the chance of a complete recovery.

So despite the name, don’t take them lightly…
No brain injury should be taken lightly. Don’t ignore how you are feeling, and ask your family or social networks to keep an eye on your behaviour. These changes can be subtle but profoundly important and could have major consequences on your life. It is important to recognise them, and if they are long term, make plans to account for them. However, as I have said, the vast majority of people who suffer TBIs go on to make a full recovery without additional help.

For more information, visit ReCognition Health