Moderate to Severe Concussion –

Complications and Prevention

After a blow to the head symptoms of a concussion appear. Concussions can range from moderate to severe and there will be complications. Hopefully, you had an opportunity to read concussion – TBI where we looked recognizing a mild concussion and mild concussion symptoms if not a link has been provided.

Moderate to severe concussion, or traumatic brain injury, can create prolonged or permanent change to someone’s intellect, communication, perception, physical movements, sensory issues, social interactions, behavior, emotional state and consciousness. Long term consequences to repeated and severe TBI may increase the risk of degenerative brain disease. The person you once knew is completely different and although they may look the same, they are not who they once were. It is difficult to understand everything that is happening physically, cognitively, socially and emotionally. Frustration, anger, sadness and hopelessness are not uncommon emotions. There are support groups for caregivers and people living with people suffering from a TBI and we encourage you to reach out for support, resources, and finding someone who understands can go a long way while you help support your loved one.

Physical complications from a concussion

Complications from a moderate to severe TBI include:

Headaches are extremely common and may begin shortly after the injury and persist for months.
Vertigo which is the feeling of dizziness
Hydrocephalus which is a fluid buildup in the spaces of the brain causing swelling and pressure.
Infections from the fractures or if there were penetrating wounds that cause bacteria to enter the brain. These infections can be dangerous as they could spread to the entire nervous system.
Damaged Blood vessels that could contribute to increased risk of stroke, and blood clots.
Seizures. These may only occur in the early stages or years after the injury. If they continue to persist, they are referred to as post-traumatic epilepsy.

These symptoms might linger for weeks or months after an injury and are referred to as persistent post-concussive symptoms or post-concussion syndrome if the symptoms last for extended periods of time.

Cranial nerve damage is when there is an injury to the nerves at the base of the skull. Some of the damage may result in:

Dizziness
Difficulty swallowing
Hearing loss
Ringing in the ear
Double vision or vision loss
Sense of taste may be lost or changed
Sense of smell may be lost of changed
Sense of feeling or paralysis of the face

Intellectual Changes:

Often people with a severe brain injury will have difficulty intellectually. Common issues experienced are difficulty with focus, processing is slower, memory, reasoning, and judgement.

Executive functioning which are important in everyday activities may also be impacted and include things like problem solving, planning, making decisions, beginning and completing tasks, organization, and multitasking skills. This is like those people struggling with ADHD.

Communication Problems:

Communication is not limited to difficulty speaking it can also impact cognition or understanding speech, writing and comprehension of written words, following or participating in conversations, and an inability to organize thoughts and ideas.

Social problems:

How difficult it is to watch someone you love struggling with social skills that were once natural and easy. Victims of TBI often experience trouble with social skills, like autism, such as, taking turns in conversations, understanding nonverbal cues, knowing when to start or stop conversations. Other problems like, misunderstanding pitch, tone, emphasis or expression of emotions, and subtle differences in meaning in language and interaction with others.

It would be reasonable to see why there would also be behavioral changes as well. Common problems are:

Self-control difficulty
Risk taking behavior
Social issues
Verbal and physical outbursts
Inability to understand your limits on ability

There are also sensory issues experienced like:

Chronic ringing in the ears
Difficulty with recognizing common objects
Balance or dizziness
Skin sensitivities like tingling, pain or itchy sensation
Sense of smell and taste can be difficult or be bitter or foul
Hand-eye coordination may be impaired
Sight may be limited or double vision

These behaviors are directly related to the cognitive impairment, sensory issues and are also intensified with emotional changes from frustration, overstimulation and confusion. It is reasonable then to see how victims of TBI will also exhibit changes in:

Mental health
- Depression
- Anxiety
Anger management
Mood swings
Irritability
Sleep disorder, such as insomnia
Lack of empathy

After suffering a moderate to severe traumatic brain injury, a there are 4 changes to someone’s consciousness that may be impacted.

Coma. This is when a person is unconscious, and unaware or able to respond to stimulus. Coma is usually a result of extensive and widespread damage to all parts of the brain. This state can last a few days, weeks or longer. It is not possible to predict when someone will regain consciousness from this state

Vegetative State. Like a being in a coma, this person is unable to respond to stimuli, but they may open their eyes, make sounds, show reflex response or even move. Often this will become a minimally conscious state, but it can become permanent.

Minimally Conscious State: This is when someone is exhibiting severely altered states of consciousness, some signs of self-awareness and their surroundings. There are more than one state of consciousness and often this occurs as someone transitions from coma, or vegetative state to some state of recovery.

Brain Death. The brain and brain stem no longer produce measurable activity. When this happens any life support such as respirators will be removed, breathing will stop, and heart failure will occur.

Research is now suggesting that repeated trauma or severe brain injury may increase the risk of developing degenerative brain diseases such as Alzheimer’s, Parkinson’s, and Dementia and Chronic Traumatic Encephalopathy. CTE. We will look at CTE in future blogs.

Prevention of Concussion

Children under the age of 4 are particularly at risk for concussion but there are many things you can do around your home and outside to help prevent these injuries.

Safety gates at the top of staircases or into areas that have things to climb
Secure area rugs to the floor
Look for playgrounds that use shock absorbing materials
Install window guards that prevent falls out of windows
Never let children play on balconies or fire escapes in apartments
Hold their hand on slippery surfaces like pool decks
Never let them climb on cabinets
If they can climb out of cribs put mattresses on the floor
Use bathmats in the shower
Always wear a helmet

Other precautions are

Make sure that handrails are secure
Light walkways
Get your vision checked
Keep stairs clear of clutter
Wear a helmet

IF YOU ARE NOT SURE OR ARE CONCERNED THAT YOU OR A LOVED ONE MAY BE SUFFERING FROM A CONCUSSION ALWAYS SEEK MEDICAL ATTENTION AS SOON AS POSSIBLE. This post and website is not intended to be used as medical, legal advice or diagnosis it is for information purposes. The information provided is basic and does not cover all the causes, symptoms or consequences of a concussion or any injury. If you are injured call 911, get someone to take you to an emergency room at the hospital, or see your physician as soon as possible.

There are many different types of concussions. This blog focuses on the basic understanding and an introduction to concussions. If you would like to learn more about the different types of concussions, please visit the GF Strong website for more detailed information or ask your family doctor.

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