Mild Traumatic Brain Injury: From Diagnosis to Treatment and Recovery
A mild traumatic brain injury (TBI)—a term often used interchangeably with “concussion”— is typically caused by a bump, blow or jolt to the head or a violent shaking of the head and body.
According to the Centers for Disease Control (CDC), falls are the leading cause of mild TBIs, accounting for close to half of the total. In order of frequency, the remainder are caused by being struck by or against an object (i.e., injuries incurred while playing sports, assaults or other injuries); and motor vehicle accidents.
Upwards of 90 percent of all TBIs are considered mild. That’s because they’re usually not life-threatening. However, the effects of a mild TBI or concussion can sometimes be serious.
In what follows, Dr. Joan Stilling, a specialist in general neurorehabilitation and Assistant Professor of Clinical Rehabilitation Medicine at Weill Cornell Medicine, explains the complexities of these injuries, along with how they’re diagnosed and treated.
What occurs in the brain after a mild TBI?
After a mild TBI, there may be disruption in the chemical functioning of the brain, changes in how one part of the brain “talks” to another part (functional connectivity) or damage to brain tissue.
What are its typical symptoms?
Shortly after sustaining a mild TBI, you may:
- feel dazed, confused or hazy;
- have difficulty with concentration and memory;
- experience a sensation of head pressure or a headache;
- have problems with balance, blurry or double vision or sensitivity to loud noises or bright lights;
- have nausea or vomiting;
- experience fatigue, a change in mood or a change in your sleep pattern.
Note that it may be difficult to sort out your symptoms at first, as they are similar to other health problems. Some people may not recognize or admit that they’re having problems. And sometimes, these problems can be overlooked by friends and family members.
What distinguishes a mild TBI from a more severe one?
Both mild and more severe TBIs share many of the same symptoms. The difference lies in how long these symptoms last, and in how patients perform on a specialized test that evaluates their overall motor, visual and verbal ability.
A patient with a TBI may lose consciousness, but the injury is considered mild when that lasts less than 30 minutes.
Similarly, if that patient experiences any loss of memory, it’s classified as mild if the loss dissipates in fewer than 24 hours after the injury.
Are there any “danger signs” a person with a mild TBI should look out for?
Danger signs in both children and adults include such neurological changes as:
- Significant drowsiness or inability to wake up
- Slurred speech, numbness, weakness or difficulty with coordination
- Asymmetry in the size of the pupils (one larger than the other)
- Repeated episodes of vomiting, shaking/twitching or seizures
- Significant restlessness, agitation or confusion
- Severe headache that keeps getting worse
What treatments are available for people with a mild TBI or concussion?
We assess each person’s memory, mood, vision, cranial nerve function, strength, balance, sensation, reflexes, coordination and walking ability. We also note headaches, problems with attention and sleep changes. Depending on the problems a patient is experiencing, we treat each issue separately or use rehab therapies in combination.
For example, we may refer a patient to a physical therapist to work on strength, walking, balance and spatial orientation.
We prescribe occupational therapy for problems with vision, thinking and memory; for modifications that need to be made to a patient’s home environment; for sensitivity to light and noise; and for modifications to be made at work.
We can refer the patient to a psychologist to help with attention, memory, thinking and mood.
And if a patient has a headache or attention, memory or sleep problems, a rehabilitation specialist can recommend lifestyle changes, order special equipment or prescribe medication. We can order any further tests, such as blood work or imaging, to help diagnose specific problems that could be contributing to your symptoms. Your doctor can also provide advice on how to get back into the swing, including sports and work- or school-related activities.
What is it like to recover from a mild TBI? What can patients expect?
Most patients recover from a mild TBI within 3 months. However, from 5 to 40 percent may continue to experience persistent post-concussion symptoms, including:
- Changes in vision
- Balance difficulties
- Ringing in the ears
- Sensitivity to light or sound
- Behavioral issues such as fatigue, irritability, anxiety, depression and sleep problems
- Cognitive changes—difficulty concentrating, memory problems, slower processing speed and “brain fog”
Dealing with any or all of these post-concussion symptoms requires a multi-disciplinary team composed of physicians, nurses, therapists, psychologists, social workers and case managers. At Weill Cornell Medicine, we assemble a team tailored to the needs of every patient we treat.
What further tests may be needed to make sure a patient’s recovery is on track?
Continued follow-up and assessment by a doctor—particularly one who specializes in mild TBI—is highly recommended. Patients may also require imaging, bloodwork or other tests, depending on symptoms and recovery trajectory following the head injury.
The CDC suggests the following steps to speed your recovery:
- Avoid activities that can put you at risk for another injury to your head and brain.
- Stay connected to friends and loved ones, and speak with them about how you’re feeling.
- Ask your health-care provider about medications that are safe to take during recovery, such as ibuprofen or acetaminophen for headaches.
- Limit screen time and loud music before bed, sleep in a dark room and stick to a fixed schedule for bedtime and wake-up time.
Please visit here to consult with a rehabilitation medicine physician with expertise in mild TBI.