Mild Traumatic Brain Injury

Ohgodaspider

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What are some symptoms of mild traumatic brain injury (in this case sustained by a fall), and how would you go about treating it, and for how long? The more detail, the better. Character is 15, he gets punched and his head hits the pavement.
 
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zanzjan

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What are some symptoms of mild traumatic brain injury (in this case sustained by a fall), and how would you go about treating it, and for how long? The more detail, the better.

I got a concussion in March of last year when a teenager decided traffic lights didn't apply to him and slammed into the side of my car. Here's what I can tell you about it:

1. I lost several seconds worth of memory, from the time when the light turned green and I entered the intersection, to sitting in my stopped car trying to figure out what had just hit me in the head (the airbag). I also lost my hearing on that side of my head for a minute or two. In the hospital, after I'd been transported and was lying on a backboard all by myself in some little room off the ER, the entire left side of my body started twitching and shaking uncontrollably for several minutes. It had stopped by the time the nurse came back in, and though I mentioned it, no one seemed to care.

2. I had a constant headache for 10 1/2 months. Sometimes it was migraine intensity, sometimes it was just angry background static, but it never let up in all that time. Not even vicodin could do more than just take the edge off it. Frequently I would have problems focusing my eyes, particularly if I needed to focus on anything for more than a few moments. Reading was almost impossible for months, and even now I find I have to read books in short stints with breaks.

3. For the first few days, I was loopy as all hell. My sense of the passage of time was practically non-existent, and is still a bit wonky.

4. For several months, I had little bits of memory go missing at random. At first I thought I was having tiny blackouts, but eventually I decided that there wasn't any sort of loss of physical control or consciousness during these episodes, just a failure for some small bit of time to get recorded in the brain-log. These were, however, extremely disorienting and scary. At the peak I was having thirty or forty of these episodes a day.

5. There was substantial disruption to my physical memory. Tasks I didn't even think about anymore -- typing my password, dialing my parent's phone number, flipping omelets -- I had to stop and think through step by step. Vestiges of this remain, 16 months after the accident, and I have had to teach myself to be in a state of heightened mindfulness to get through any extended, complex physical tasks.

6. There are entire memories gone. For example, my favorite ever series, which I've read several times, I couldn't even vaguely tell you the plot of anymore. A new book came out last fall, and I haven't read it yet, because I have realized I have to go back and reread all the others first, and that's really depressing. People's names. There are vacations I took that I can't remember any real details of anymore. It's jarring when I run across something I should remember well and it's just gone or some blurry little indistinct turd left in my mind.

7. Likewise, my ability to self-organize is still severely impaired. A lifetime of self-taught coping mechanisms for being ADD has helped me here, but has not been sufficient. I have to write more stuff down, and can't rely on my memory for organizational things (appointments, shopping lists, etc.) at all anymore.

8. I had, and still have, word loss and a good amount of homonym confusion (won vs. one, etc.)

9. I also had difficulty with strong emotions, and was much easier to become angry, upset, sad, etc. This is still somewhat true.

10. I am now very prone to bad headaches, even though the Headache from Hell is gone. I never used to get headaches unless I was getting sick, but I now have two or three a week bad enough to require meds to function on. I also tire more easily, and when I'm tired, the remaining symptoms are exacerbated (clumsiness, word swapping, dropping words, forgetfulness, etc.)

11. I feel like I've become stupider than I used to be.

And, ah, that's been my mild traumatic brain injury so far. Treatment was time, rest, instructions to "not think so much", and drugs to damp down the headache.

Hope that helps.
 
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Bufty

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The more detail the better, huh?

Why not give the good folk here some more detail to go on?

Did your character fall off a chair, a bicycle, a wall, out of a window?

Was it a fall or did he get pushed?

Did he fall onto grass, wood, tarmac, concrete?

Is your character sixteen or sixty?

Are they healthy? Fit?

Why do you need to know this information? Do you want your character to be immobilised for a certain period of time?

Is the information going into the narrative or is there a doctor in your cast? Why do you need lots of detail?

Who is the character that needs to know this?

Is there a doctor who is going to spout on about this?

If you don't know what you're talking about in a medical scenario it's sometimes better to touch on the detail as little as possible.

What are some symptoms of mild traumatic brain injury (in this case sustained by a fall), and how would you go about treating it, and for how long? The more detail, the better.
 
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angeluscado

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I've never had a concussion (thanking my lucky stars here) and I'm neither a doctor nor do I work in the medical field, but I work in a law office that exclusively represents people injured in car accidents, medical malpractices and slip and falls. The team I work on has the majority of the brain injury clients. Zanzjan pretty much hit it on the head(no pun intended) - the most common treatment I've seen is rest, time and drugs for pain. Headache, fogginess (cog-fog), word finding difficulties, memory problems, sensitivity to light and sound - all of these are fairly common with TBI/concussive injury. Some people have their symptoms clear up in six months, others it takes longer, and some still have difficulties several years later.
 

auriel

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I minored in exercise physiology so I took some classes in first aid, especially for sports-type injuries, including concussions. The only thing you can do is rest and wait. The first 12 hours after head injury are a critical watch period for subdermal hematoma, a slow brain bleed. The person needs to be woken up every few hours at night to assure that his cognitive abilities haven't declined. ( i.e. he still knows his name, where he is, etc.) Pressure can build up so slowly that symptoms might not be noticeable if people are already unconscious; the pressure can eventually cut off the blood supply to the brain stem, causing death. People with subdural hematomas can go to bed fine and just not wake up. If there's any impairment at all they need to do a CAT scan or MRI to determine the extent of the injury and what, if anything, needs to be done. The treatment for subdural hematoma is a surgical decompression of the skull.

If you pass a full day without any cognitive impairment (in general), rest is all you need. And for your character, he might need stitches from the fall.

If it's only a mild concussion, there may be some confusion, nausea, etc for a few days until the brain heals. Afterward the person is at an increased risk for more severe results, including death, for any future blows to the head. There have been athletes with a history of concussions outright dying on the field after they'd been hit in the head.

I had a professor who had a relatively minor traumatic brain injury from Vietnam. Obviously it's been years since the injury, but his side effects still popped up. He had what he called "brain seizures," where his thoughts kind of froze and he could not do or think anything untill it passed. It happened once during class, and he literally stopped talking in the middle of a lecture - just froze and broke out in a sweat. He had to sit down, but couldn't talk for about thirty minutes, not even to explain what was happening. Gradually his speech came back, but it was pretty scary even though all of us knew what was going on. There's really not any sort of treatment they can do for that.
 
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JayMan

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cGreat info/advice above.

Minor thing that came to mind that I didn't see anyone else touch on: pupillary response. Brain injury can cause things like one (or both) pupils being unreactive to light, or can cause one (or both) pupils to constrict.
 

zanzjan

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Brain injury can cause things like one (or both) pupils being unreactive to light, or can cause one (or both) pupils to constrict.

Very true. Although, if you're the one with the injury, you don't feel that.

I interpreted the OP's question as looking for subjective information, b/c there's oodles of googleable objective data out there on the subject and I assume folks aren't quite that lazy. But yes, there's a whole host of signs and symptoms that medical folks look for with the initial injury, and later on during followup. Perhaps the OP will show up again and clarify.
 

Ohgodaspider

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Hey everyone, I appreciate all your assistance greatly. I found some great info here, and wikipedia and webmd, this project is on hold until further notice. Again I thank you all for your assistance.
 
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zanzjan

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You're very welcome, and I'm glad we could be of some assistance. Good luck with your project, whenever you get back to it. :)
 

shaldna

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What are some symptoms of mild traumatic brain injury (in this case sustained by a fall), and how would you go about treating it, and for how long? The more detail, the better. Character is 15, he gets punched and his head hits the pavement.

I have horses, so I've several concussions and one quite bad skull fracture - not nice.

Mostly, with concussion, I've been aware that I've hit something (the ground) and there's a moment where everything goes blank, then I'm aware that I'm on teh ground, and I'm sore, and dizzy and nothing seems to work properly. I've vomited for all bar one of these incidents.

Everything was a bit disorientated, while at the same time being very, very clear.

When I fractured my skull I had fallen from a horse, hit the ground so hard that I bounced and my riding hat compacted and split - this should give you an indication of how hard I landed - and then I was dragged behind the horse for half a mile - I had a foot caught in the stirrup.

I don't remember any of this.

I remember that we were hunting and I was heading for the next hedge to jump, and then the horse dropped her shoulder and I remember pitching sideways, and then that's it until I was in the hospital. Although apprently I was lucid and talking during the whole thing, consious and speaking from the time someone caught the horse to the time the ambulance came, and during the ride I was apparently sitting on the chair, rather than on the stretcher. I don't recall ANY of this.

I do remember being really woozy, and being sick, and the paramedics taking a huge interest in my ears - I learned later that I was bleeding from one of my ears, which is a sing of a pretty bad head injury.

For the most part though, in my considerable experience with these sort of injuries (both as a rider and an instructor) you'll head to hospital to be checked out, if you aren't in immediate danger then they will send you home. Those folks with concussion are usually kept awake until they can be checked over - in case of a more severe injury.

For the most part it's sleep and painkillers.
 

shaldna

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People with subdural hematomas can go to bed fine and just not wake up.

This is the reason why doctors etc don't like patients with any sort of head injury to be allowed to go to sleep, and why they recommend that a patient with a head injury is kept awake until they can be seen to.

If there's any impairment at all they need to do a CAT scan or MRI to determine the extent of the injury

Just want to point out that even an 'emergency' MRI or CAT scan can take up to a week - the waiting lists are insane on the NHS, and if you are brought in with a head injury you can usually get a scan withing 2-3 days. Non emergency cases have a standard waiting list of 9 months atm - trust me, I know. I've been dealing with an non-injury related headache problem for several years now.

And for your character, he might need stitches from the fall.


A cousin of mine once dived into the swimming pool at the shallow end and hit her head off the bottom at some speed. Two surgeries and 40 odd STAPLES later she was let home. and was also bald.


If it's only a mild concussion, there may be some confusion, nausea, etc for a few days until the brain heals.

For me the nausea was the worst. It was horrific, worse than the pain in my head, and caused almost as much disorientation.

I had a professor who had a relatively minor traumatic brain injury from Vietnam. Obviously it's been years since the injury, but his side effects still popped up. He had what he called "brain seizures," where his thoughts kind of froze and he could not do or think anything untill it passed. It happened once during class, and he literally stopped talking in the middle of a lecture - just froze and broke out in a sweat. He had to sit down, but couldn't talk for about thirty minutes, not even to explain what was happening. Gradually his speech came back, but it was pretty scary even though all of us knew what was going on. There's really not any sort of treatment they can do for that.

I do this, but not as a result of any of the injuries I've had, but instead it's brought on my a medical condition I have. I suffer from very severe stabby headaches that last for 20-30 seconds each, but are crippling. I can have as many as 40 of these a day. It's like being stabbed in the head. I can't do anything when they happen. I can't move, can't think, can't function. But as soon as they are over they are gone. There is no lingering trace of them at all.

Most of the time I function as a normal human being and folks around me don't realise, don't even notice when I'm having a headache.

But sometimes, when they are really, really bad, I can't function. I can't think. I shake, mostly down the right side of my body (which is controlled by the left side of my brain, which is where I get all of my headaches. The docs are agreed that it's related, but have no fucking idea what to do about it) I can't pick up a cup of water without sloshing it around. I can't hold a pen, or write my name.

When It's really bad I can't even speak. Words don't come out right, or don't come at all. I struggle to make myself understood.

In the past I've been accused of being drunk, and I can fully understand why people might think that - a lot of the symptoms are the same - confusions, imbalance, slurred speech, struggling for words etc.

Fortunately I now have a team of people around me who are aware and who understand and can tell when things are bad without having to be told. Likewise, my husband and daughter are super aware, and they can tell, just by the look on my face, when I'm having a headache, and my hubby never makes my coffee too hot incase I can't hold it and burn myself, and my daughter always pauses in the middle of one of her long-winded stories to wait on me when she sees the look of pain (no matter how much I try to hide it)

The worst thing though isn't the pain, it, for me, is not being able to get the words out. I know what I want to say, but I can't find the right word. The only way I can describe it is like your body being blind drunk while your mind is stone cold sober.
 

Spy_on_the_Inside

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Something interesting about head injuries is that a lot of people don't know is they have the potential to cause psychotic symptoms. I once had a client in the group home I worked who developed psychosis after a brain injury, and still suffers from it twenty years later.

It's an after-effect not a lot of people know can happen, but it can.
 

Canotila

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I lost my ability to recognize people's faces. A couple of Sundays ago I was at church with my mom and completely lost her in a crowd of older ladies with short curly hair. 4 or 5 of them had decided to wear a purple blouse with a black skirt that day and it was enough. This from a massive head injury when I was 10. I can still recognize male vs. female faces, children vs. adults, younger people vs. older people (though that one is iffy, I'm still not sure if some of my acquaintances are in their 30s or their 50s).

On the plus side, I've developed very refined voice recognition to compensate.