[WEB PAGE] Traumatic brain injury – Symptoms and causes – Mayo Clinic

Traumatic brain injury

• Symptoms & causes
• Diagnosis & treatment
• Doctors & departments

Overview

Traumatic brain injury usually results from a violent blow or jolt to the head or body. An object that penetrates brain tissue, such as a bullet or shattered piece of skull, also can cause traumatic brain injury.

Mild traumatic brain injury may affect your brain cells temporarily. More-serious traumatic brain injury can result in bruising, torn tissues, bleeding and other physical damage to the brain. These injuries can result in long-term complications or death.

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Symptoms

Traumatic brain injury can have wide-ranging physical and psychological effects. Some signs or symptoms may appear immediately after the traumatic event, while others may appear days or weeks later.

Mild traumatic brain injury

The signs and symptoms of mild traumatic brain injury may include:

Physical symptoms

• Loss of consciousness for a few seconds to a few minutes
• No loss of consciousness, but a state of being dazed, confused or disoriented
• Headache
• Nausea or vomiting
• Fatigue or drowsiness
• Problems with speech
• Difficulty sleeping
• Sleeping more than usual
• Dizziness or loss of balance

Sensory symptoms

• Sensory problems, such as blurred vision, ringing in the ears, a bad taste in the mouth or changes in the ability to smell
• Sensitivity to light or sound

Cognitive or mental symptoms

• Memory or concentration problems
• Mood changes or mood swings
• Feeling depressed or anxious

Moderate to severe traumatic brain injuries

Moderate to severe traumatic brain injuries can include any of the signs and symptoms of mild injury, as well as these symptoms that may appear within the first hours to days after a head injury:

Physical symptoms

• Loss of consciousness from several minutes to hours
• Persistent headache or headache that worsens
• Repeated vomiting or nausea
• Convulsions or seizures
• Dilation of one or both pupils of the eyes
• Clear fluids draining from the nose or ears
• Inability to awaken from sleep
• Weakness or numbness in fingers and toes
• Loss of coordination

Cognitive or mental symptoms

• Profound confusion
• Agitation, combativeness or other unusual behavior
• Slurred speech
• Coma and other disorders of consciousness

Children’s symptoms

Infants and young children with brain injuries might not be able to communicate headaches, sensory problems, confusion and similar symptoms. In a child with traumatic brain injury, you may observe:

• Change in eating or nursing habits
• Unusual or easy irritability
• Persistent crying and inability to be consoled
• Change in ability to pay attention
• Change in sleep habits
• Seizures
• Sad or depressed mood
• Drowsiness
• Loss of interest in favorite toys or activities

When to see a doctor

Always see your doctor if you or your child has received a blow to the head or body that concerns you or causes behavioral changes. Seek emergency medical care if there are any signs or symptoms of traumatic brain injury following a recent blow or other traumatic injury to the head.

The terms “mild,” “moderate” and “severe” are used to describe the effect of the injury on brain function. A mild injury to the brain is still a serious injury that requires prompt attention and an accurate diagnosis.

Causes

Traumatic brain injury is usually caused by a blow or other traumatic injury to the head or body. The degree of damage can depend on several factors, including the nature of the injury and the force of impact.

Common events causing traumatic brain injury include the following:

• Falls. Falls from bed or a ladder, down stairs, in the bath and other falls are the most common cause of traumatic brain injury overall, particularly in older adults and young children.
• Vehicle-related collisions. Collisions involving cars, motorcycles or bicycles — and pedestrians involved in such accidents — are a common cause of traumatic brain injury.
• Violence. Gunshot wounds, domestic violence, child abuse and other assaults are common causes. Shaken baby syndrome is a traumatic brain injury in infants caused by violent shaking.
• Sports injuries. Traumatic brain injuries may be caused by injuries from a number of sports, including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other high-impact or extreme sports. These are particularly common in youth.
• Explosive blasts and other combat injuries. Explosive blasts are a common cause of traumatic brain injury in active-duty military personnel. Although how the damage occurs isn’t yet well-understood, many researchers believe that the pressure wave passing through the brain significantly disrupts brain function.Traumatic brain injury also results from penetrating wounds, severe blows to the head with shrapnel or debris, and falls or bodily collisions with objects following a blast.

Risk factors

The people most at risk of traumatic brain injury include:

• Children, especially newborns to 4-year-olds
• Young adults, especially those between ages 15 and 24
• Adults age 60 and older
• Males in any age group

Complications

Several complications can occur immediately or soon after a traumatic brain injury. Severe injuries increase the risk of a greater number and more-severe complications.

Altered consciousness

Moderate to severe traumatic brain injury can result in prolonged or permanent changes in a person’s state of consciousness, awareness or responsiveness. Different states of consciousness include:

• Coma. A person in a coma is unconscious, unaware of anything and unable to respond to any stimulus. This results from widespread damage to all parts of the brain. After a few days to a few weeks, a person may emerge from a coma or enter a vegetative state.
• Vegetative state. Widespread damage to the brain can result in a vegetative state. Although the person is unaware of surroundings, he or she may open his or her eyes, make sounds, respond to reflexes, or move.It’s possible that a vegetative state can become permanent, but often individuals progress to a minimally conscious state.
• Minimally conscious state. A minimally conscious state is a condition of severely altered consciousness but with some signs of self-awareness or awareness of one’s environment. It is sometimes a transitional state from a coma or vegetative condition to greater recovery.
• Brain death. When there is no measurable activity in the brain and the brainstem, this is called brain death. In a person who has been declared brain dead, removal of breathing devices will result in cessation of breathing and eventual heart failure. Brain death is considered irreversible.

Physical complications

• Seizures. Some people with traumatic brain injury will develop seizures. The seizures may occur only in the early stages, or years after the injury. Recurrent seizures are called post-traumatic epilepsy.
• Fluid buildup in the brain (hydrocephalus). Cerebrospinal fluid may build up in the spaces in the brain (cerebral ventricles) of some people who have had traumatic brain injuries, causing increased pressure and swelling in the brain.
• Infections. Skull fractures or penetrating wounds can tear the layers of protective tissues (meninges) that surround the brain. This can enable bacteria to enter the brain and cause infections. An infection of the meninges (meningitis) could spread to the rest of the nervous system if not treated.
• Blood vessel damage. Several small or large blood vessels in the brain may be damaged in a traumatic brain injury. This damage could lead to a stroke, blood clots or other problems.
• Headaches. Frequent headaches are very common after a traumatic brain injury. They may begin within a week after the injury and could persist as long as several months.
• Vertigo. Many people experience vertigo, a condition characterized by dizziness, after a traumatic brain injury.

Sometimes, any or several of these symptoms might linger for a few weeks to a few months after a traumatic brain injury. This is currently referred to as persistent post-concussive symptoms. When a combination of these symptoms last for an extended period of time, this is generally referred to as post-concussion syndrome.

Traumatic brain injuries at the base of the skull can cause nerve damage to the nerves that emerge directly from the brain (cranial nerves). Cranial nerve damage may result in:

• Paralysis of facial muscles or losing sensation in the face
• Loss of or altered sense of smell
• Loss of or altered sense of taste
• Loss of vision or double vision
• Swallowing problems
• Dizziness
• Ringing in the ear
• Hearing loss

Intellectual problems

Many people who have had a significant brain injury will experience changes in their thinking (cognitive) skills. It may be more difficult to focus and take longer to process your thoughts. Traumatic brain injury can result in problems with many skills, including:

Cognitive problems

• Memory
• Learning
• Reasoning
• Judgment
• Attention or concentration

Executive functioning problems

• Problem-solving
• Multitasking
• Organization
• Planning
• Decision-making
• Beginning or completing tasks

Communication problems

Language and communications problems are common following traumatic brain injuries. These problems can cause frustration, conflict and misunderstanding for people with a traumatic brain injury, as well as family members, friends and care providers.

Communication problems may include:

Cognitive problems

• Difficulty understanding speech or writing
• Difficulty speaking or writing
• Inability to organize thoughts and ideas
• Trouble following and participating in conversations

Social problems

• Trouble with turn taking or topic selection in conversations
• Problems with changes in tone, pitch or emphasis to express emotions, attitudes or subtle differences in meaning
• Difficulty understanding nonverbal signals
• Trouble reading cues from listeners
• Trouble starting or stopping conversations
• Inability to use the muscles needed to form words (dysarthria)

Behavioral changes

People who’ve experienced brain injury often experience changes in behaviors. These may include:

• Difficulty with self-control
• Lack of awareness of abilities
• Risky behavior
• Difficulty in social situations
• Verbal or physical outbursts

Emotional changes

Emotional changes may include:

• Depression
• Anxiety
• Mood swings
• Irritability
• Lack of empathy for others
• Anger
• Insomnia

Sensory problems

Problems involving senses may include:

• Persistent ringing in the ears
• Difficulty recognizing objects
• Impaired hand-eye coordination
• Blind spots or double vision
• A bitter taste, a bad smell or difficulty smelling
• Skin tingling, pain or itching
• Trouble with balance or dizziness

Degenerative brain diseases

Research suggests that repeated or severe traumatic brain injuries might increase the risk of degenerative brain diseases. But, this risk can’t be predicted for an individual — and researchers are still investigating if, why and how traumatic brain injuries might be related to degenerative brain diseases.

A degenerative brain disorder can cause gradual loss of brain functions, including:

• Alzheimer’s disease, which primarily causes the progressive loss of memory and other thinking skills
• Parkinson’s disease, a progressive condition that causes movement problems, such as tremors, rigidity and slow movements
• Dementia pugilistica — most often associated with repetitive blows to the head in career boxing — which causes symptoms of dementia and movement problems

Prevention

Follow these tips to reduce the risk of brain injury:

• Seat belts and airbags. Always wear a seat belt in a motor vehicle. A small child should always sit in the back seat of a car secured in a child safety seat or booster seat that is appropriate for his or her size and weight.
• Alcohol and drug use. Don’t drive under the influence of alcohol or drugs, including prescription medications that can impair the ability to drive.
• Helmets. Wear a helmet while riding a bicycle, skateboard, motorcycle, snowmobile or all-terrain vehicle. Also wear appropriate head protection when playing baseball or contact sports, skiing, skating, snowboarding or riding a horse.

Preventing falls

The following tips can help older adults avoid falls around the house:

• Install handrails in bathrooms
• Put a nonslip mat in the bathtub or shower
• Remove area rugs
• Install handrails on both sides of staircases
• Improve lighting in the home
• Keep stairs and floors clear of clutter
• Get regular vision checkups
• Get regular exercise

Preventing head injuries in children

The following tips can help children avoid head injuries:

• Install safety gates at the top of a stairway
• Keep stairs clear of clutter
• Install window guards to prevent falls
• Put a nonslip mat in the bathtub or shower
• Use playgrounds that have shock-absorbing materials on the ground
• Make sure area rugs are secure
• Don’t let children play on fire escapes or balconies

By Mayo Clinic Staff

via Traumatic brain injury – Symptoms and causes – Mayo Clinic

[WEB SITE] Neurobehavioral Challenges After Brain Injury

The effects of neurological damage from events like trauma and stroke can be devastating to the individual and those close to them. Brain injury can result in lifelong physical, cognitive, and behavioral changes. The impact of behavior changes can profoundly alter how the injured person functions day to day, even impeding rehabilitative goals and impacting the ability to live independently. Changes in personality and behavior following traumatic brain injury (TBI) often represent the most significant barrier to a successful outcome including reintegration into the community whether for basic daily tasks, work or recreational/social activities.

Common behavior issues following brain injury include behavioral excesses (occurring too much) such as irritability (e.g., poor tolerance, short temper) and aggression (e.g., hitting, grabbing, kicking), property destruction (e.g., striking furniture, throwing items) and inappropriate vocalizations (e.g., cursing, yelling, threats). Also presenting a concern are behavior deficits (do not occur enough) such as compliance with tasks (e.g., cooperation with requests), social skills (e.g., overfamiliar discussions, uncharacteristically rude remarks), initiation (e.g., knowing when to begin tasks) and the academic and return to work skills (e.g., being on time, following directions) to be successful. Some of the most difficult behaviors can be dangerous to the patient and others around them. Treating these dangerous and challenging behaviors, which may include physical aggression toward others, self-injurious behavior, sexual disinhibition, and escape or elopement, requires a treatment commitment across the continuum of care.

In the early, acute stages of recovery from brain injury, many of the behavioral complications demonstrated are considered to be a normal phase of recovery. When these behaviors continue beyond those early phases, however, and form on-going negative patterns of interaction with others, very specialized treatment is required.  These behaviors can be disturbing to families and staff, disruptive to therapy, and jeopardize patient safety. The future quality of life for the patient and their family depends on effective interventions, provided with a great deal of consistency and structure. Behavior analysts (professionals in Applied Behavior Analysis) add value to interdisciplinary rehabilitation teams by helping to develop both skill acquisition and behavior reduction programs throughout the patient’s recovery (i.e., acute, post-acute, long term care). Behavior analysts spend a great deal of time directly observing interactions, determining what may be motivating the difficult behaviors, and what responses may need to be strengthened and reinforced. The behavior analyst must then provide training to all those who may interact with the patient, including most importantly, the family. This skilled, specialized intervention establishes more effective and acceptable response patterns that allow the patient to have their needs met and be better understood without displaying problem behavior. The structured behavior plan can also help the patient develop positive, prosocial responses, and more efficient functional skills.

The effects of brain injury are highly individual, which then challenges the behavior analysts, family and others on the treatment team to continually evaluate the responses, goals, and outcomes throughout recovery (e.g., monitoring response to new medications).

Considering the risk to patients and families, the rising healthcare cost and the possibility of reduced services being available, a focus on efficient and effective interventions such as behavior analysis seems essential to a well-integrated, interdisciplinary rehabilitation treatment team. The quality of life for those affected by brain injury depends on having the opportunity to receive not just the standard rehabilitation one might get following knee surgery but rather specialized, experienced and effective treatment specifically designed to address the unique difficulties they face including difficult behavior.

via Neurobehavioral Challenges After Brain Injury | CNS Traumatic Brain Injury Rehabilitation

[WEB SITE] Different but the Same: Emotional Changes After Stroke

When someone survives a stroke, a family feels relief, happiness, and joy. But no one can be prepared for the perplexing wave of emotions that a stroke survivor experiences.Although emotional changes after stroke are typical, the impact on a survivor’s personality may be the most difficult to deal with.  For caregivers and families, it’s important to remember that stroke causes trauma to the brain and that the behaviors and responses displayed are a reflection of that injury.

Recognizing and coping with the behavioral changes that accompany stroke are just as important as addressing physical issues during the rehabilitation process. Emotional reactions are complicated by the array of sensory and motor disabilities that follow brain damage from stroke. Survivors struggle with deficits in language, reading, writing, speech, memory, judgment, planning and so much more. These cognitive problems can weigh heavy on stroke survivors and their families. Conflict may arise when the survivor feels misunderstood or utter despair over the loss of physical capabilities.

While some emotions are “normal” responses to biological and lifestyle changes after stroke, other feelings may signal a more serious problem.

To help you understand what your loved one is going through, here are the most common emotional reactions that accompany stroke:

• Emotional lability – Following a stroke, the person may seem like a stranger: survivors may respond one way immediately after the event, only to respond differently a week or two later. Soon after stroke, the person may struggle to control his or her emotions. Survivors are said to be “emotionally labile”, meaning they are prone to strong feelings and rapid mood swings. The person may embark on fits of laughing or tears that do not fit’s their mood or seem inappropriate for the situation. They may be happy and sad in only a few minutes.

• Impulsivity – Stroke survivors can be impatient and impulsive. Because areas of the brain are disinhibited, stroke survivors may be more impulsive. They fail to think ahead, or move too quickly – possibly causing themselves or those around them harm in the process. Caregivers should be especially watchful for this reaction when makingdecisions about a stroke survivor’s ability to drive a car.

• Anxiety – Anxiety is considered a “normal” reaction to lifestyle adjustment following stroke. As a person begins to cope with their new disabilities, they may feel a sense of loss that triggers anxious feelings.  Anxiety is frequently associated with periods when a person is left along for a period of time. Fears can arise of another medical emergency, their growing dependence on caretakers, and helpless for their condition.

• Self-centered behavior – Insensitivity to others is commonly seen in post-stroke patients. Many survivors become largely concerned with their own interests and exhibit inflexible, rigid thinking. This lack of empathy can contribute to demanding behavior. Caregivers can feel as if the person is impossible to reason with, which could result in the breakdown of family ties and important social bonds.

• Apathy – Stroke survivors may be content with sitting around for hours without doing nothing at all. While this lack of motivation may be alarming to caregivers, apathy is a consequence of damaged brain areas. Stroke survivors may lack initiative and show little feeling or interest in activities. It’s important to note, however that apathy is different than being tired or depressed: An apathetic person feels content with their state of being, whereas a depressed person feels despair.

• Depression – Depression is a common reaction following any life-altering event, including stroke. Survivors may feel a sense of sorrow for activities they were previously able to do. Many question their self-worth; people value themselves through their activities. A loss of identity can result in depression, anger and frustration. Both patients and family members may cycle through the stages of the grieving process (denial, anger, bargaining, depression, and acceptance).

Post-stroke depression is characterized by:

• Feelings of sadness
• A sense of hopelessness or helplessness
• Increased irritability
• Changes in eating, sleeping and thought patterns

Treatment for post-stroke depression may be necessary. If the person’s depressive symptoms worsen over time, interfere with daily functioning, or include suicidal thoughts and ideation – consult a medical professional immediately. A range of therapies and treatment options are available to help.

Are post-stroke personality changes permanent?

Personality changes that occur after a stroke are often the hardest to deal with. Luckily, not all changes are permanent. As the recovery process advances, some reactions may disappear. The person may “mellow out” over time as he or she builds coping skills and adjusts to life as a stroke survivor.

How to cope with changing behaviors after stroke:

• Be patient. Have understanding that your loved one is facing many challenges and in most cases, cannot help behaving in undesirable ways.
• Remind yourself that these behaviors are a part of the brain injury. Stay strong for your loved one – your support is important.
• If your loved one is having angry outbursts, try to find what triggers him or her. It could help prevent future incidents.
• Stay calm. Avoid raising your voice when you talk to the person and take a time out if you need to deal with the problem alone.
• Talk with other family members about the changes your loved one is going through. Educate them on what to look for and how they can help if your loved one is having an especially bad day.
• Seek counseling or join a support group. Working through your frustrations with others who are in similar situations can be helpful and healing.
• Discuss personality changes with your healthcare provider. You doctor can help you assess your loved one’s health condition and provide recommendations on post-stroke recovery.

Source: Your Medical Guide