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Complications
By Mayo Clinic staffSeveral complications can occur immediately or soon after a traumatic brain injury. Severe injuries increase the risk of a greater number of complications 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 progress to a vegetative state.
- Vegetative state. Widespread damage to the brain can result in a vegetative state. While the person is unaware of his or her surroundings, he or she may groan or have open eyes or reflex responses. It is 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 evidence of self-awareness or awareness of one's environment. It is often a transitional state from a coma or vegetative condition to greater recovery.
- Locked-in syndrome. A person in a locked-in state is aware of surroundings and awake, but he or she can't move or speak. The person may be able to communicate with eye movement or blinking. This state results from damage limited to the lower brain and brainstem.
Seizures
Some people with traumatic brain injury will have seizures within the first week. More-serious injuries may result in recurring seizures, called post-traumatic epilepsy.
Infections
Skull fractures or penetrating wounds can tear the layers of protective tissues (meninges) that surround the brain, thereby enabling bacteria to enter the brain. An infection of the meninges (meningitis) can be especially dangerous because of its potential to spread to the rest of the nervous system.
Nerve damage
Injuries to the base of the skull can damage nerves that emerge directly from the brain (cranial nerves). Cranial nerve damage may result in:
- Paralysis of facial muscles
- Damage to the nerves responsible for eye movements, which can cause double vision
- Damage to the nerves that provide sense of smell
- Loss of vision
- Loss of facial sensation
Cognitive problems
Most people who have had a significant brain injury will experience changes in their cognitive skills. Traumatic brain injury can result in problems with any of these skills:
- Memory
- Learning
- Reasoning
- Problem solving
- Speed of mental processing
- Judgment
- Attention or concentration
- Multitasking
- Organization
- 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 an injury, as well as family members, friends, care providers and medical personnel. Communication problems may include:
- Difficulty understanding or producing spoken and written language (aphasia)
- Difficulty deciphering nonverbal signals
- Inability to organize thoughts and ideas
- Inability to use the muscles needed to form words (dysarthria)
- Problems with changes in tone, pitch or emphasis to express emotions, attitudes or subtle differences in meaning
- Trouble starting or stopping conversations
- Trouble with turn taking or topic selection
- Trouble reading cues from listeners
- Trouble following conversations
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
- Inaccurate self-image
- Difficulty in social situations
- Verbal or physical outbursts
Emotional changes
Emotional changes may include:
- Depression
- Anxiety
- Mood swings
- Irritability
- Lack of empathy for others
- Lack of motivation
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 or a bad smell
- Persistent tingling, itching or pain
- Trouble with balance or dizziness
Degenerative brain diseases
A traumatic brain injury may increase the risk of diseases that result in the gradual degeneration of brain cells and gradual loss of brain functions. These include:
- Alzheimer's disease, which primarily causes the progressive loss of memory and other thinking skills (dementia)
- Parkinson's disease, which primarily causes the progressive loss of motor skills
- Dementia pugilistica — most often associated with repetitive blows to the head in career boxing — which causes dementia and Parkinson's symptoms
- Living with brain injury: Education. Brain Injury Association of America. http://www.biausa.org/education.htm. Accessed July 8, 2010.
- Heads up: Facts for physicians about mild traumatic brain injury. Centers for Disease Control and Prevention. http://www.cdc.gov/concussion/headsup/physicians_tool_kit.html. Accessed July 7, 2010.
- Traumatic brain injury: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm. Accessed July 8, 2010.
- Ling GS, et al. Management of traumatic brain injury in the intensive care unit. Neurologic Clinics. 2008;26:409.
- Nolan S. Traumatic brain injury: A review. Critical Care Nursing Quarterly. 2005;28:188.
- Living with brain injury: Treatment and rehabilitation. Brain Injury Association of America. http://www.biausa.org/treatmentandrehab.htm. Accessed July 8, 2010.
- Traumatic brain injury. Family Caregiver Alliance. http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=579. Accessed July 21, 2010.
- Coping with behavior problems after head injury. Family Caregiver Alliance. http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=396. Accessed July 21, 2010.
- Brown AW (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 11, 2010.
- Traumatic brain injury in the United States: Emergency department visits, hospitalizations and deaths, 2002-2006. Centers for Disease Control and Prevention. http://www.cdc.gov/TraumaticBrainInjury. Accessed Aug. 16, 2010.
- Military & veterans. BrainLine.org. http://www.brainline.org/landing_pages/categories/military.html. Accessed Aug. 23, 2010.
- Thinking/cognitive symptoms. BrainLine.org. http://www.brainline.org/landing_pages/categories/cognitivesymptoms.html. Accessed Aug. 23, 2010.
- Barbara Woodward Lips Patient Education Center. Understanding brain injury: A guide for the family. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2008. http://mayoresearch.mayo.edu/mayo/research/tbims/upload/ubi_families.pdf. Accessed Aug. 23, 2010.
- Moessner AM (expert opinion). Mayo Clinic, Rochester, Minn. August 16, 2010.
- Behavioral and emotional symptoms. BrainLine.org. http://www.brainline.org/landing_pages/categories/behavioralsymptoms.html. Accessed Aug. 23, 2010.
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