VIRGINIA COMMONWEALTH UNIVERSITY

NATIONAL RESOURCE CENTER
FOR TRAUMATIC BRAIN INJURY

Neuropsychology and Rehabilitation Psychology Division Department of Physical Medicine and Rehabilitation.

Pat #9

DEAR PAT:

I have a large bump on my head as a result of a car accident. I thought I was OK after the accident, but now I get a little dizzy and my vision is sometimes blurry. My head feels sensitive. Should I be concerned?

PAT'S RESPONSE

The bump and sensitivity could be skin problems (i.e., bruising from the impact) or they could indicate deeper problems; the dizziness and vision disturbance are warning signs. Read on....

Many people who sustain head injuries are seen in the Emergency Room and released, not admitted to the hospital. At the time of the injury, you may have been unconscious for an indeterminate period of time, dazed, dizzy or confused. You may have gone to the Emergency Room, been examined by a doctor, given a CT scan (Computerized Tomography), and been told that you were well enough to go home. If you felt fine, you went on your way. For most people who sustain a mild, closed head injury, the above scenario is typical. Most mildly injured people experience no further problems. However, some people who sustain mild HEAD injuries also sustain mild BRAIN injury. This occurs when the brain bounces around inside the brain; nerves in the brain may be stretched and broken, brain tissue may be bruised and broken by impacting the bony skull. It is very difficult to tell if an Emergency Room patient with a mild head injury has sustained BRAIN injury. Believe it or not, CT scans often DO NOT detect mild brain injuries.

How do you know if you are going home with a brain injury? First, look for the following problems in the first 24 hours after the injury; contact your doctor if you experience any:

1. Weakness in one arm or leg.
2. Vomiting more than once.
3. Continuing or worsening headache.
4. Neck stiffness or pain.
5. Unequal pupil size.
6. Vision changes (e.g. seeing double).
7. Clear or bloody drainage from the ear.
8. Convulsions ("fits" or seizures).
9. Difficulty swallowing or speaking.
10. Difficulty in arousing or waking.
11. Loss of consciousness.
12. Confusion.
13. Failure to improve.

In children, also look for:

1. Restless or fussy.
2. Cannot pay attention.
3. Forgetful.
4. Difficulty learning.
5. Lethargic (takes longer to do things).
6. Tires easily or wants to sleep extra.
7. Does not act the same; personality or mood changes.
8. Easily upset or loses temper a lot.
9. Impulsive; acts before thinking.
10. Drops things a lot.

It can take several hours up to several weeks for problems to resolve, so if you experience any of the above symptoms at any time after the injury, consult your physician. A simplified way to determine whether a head injury may have caused a brain injury requiring further attention is to consider whether you or your child are behaving differently since the accident. The change may be so subtle that you cannot specifically identify the problem, but if you just know that "something is wrong, something is different" then further attention may be warranted. While most MILD BRAIN injuries do resolve, some people experience problems for up to a year or more. Some people with mild brain injuries experience difficulties for an indefinite period of time. Long-term effects of mild brain injury include memory loss, difficulty learning, fatigue, head or neck pain, sleep changes, difficulty focusing attention, depression, and other changes. There is help available for people who have long-term problems after a mild brain injury; contact your state Brain Injury Association or your physician for advice and consider seeing a neuropsychologist for assessment and treatment recommendations (see FAQ's for more on neuropsychology).

References: (1) "Head Injury Precautions." The Emergency & Trauma Center, Fairfax Hospital, Virginia. (2) "Head Injury." Sentara Hospitals, Virginia. (3) "When Your Child Goes Home After Being Examined For Head Injury In An Emergency Department." Research and Training Center, New England Medical Center, Boston, MA.

DEAR PAT

I had a brain injury in February 1995. I am 27 years old. Would it be extremely harmful to go out and have a few drinks with friends?

PAT'S RESPONSE

It depends on the drinks and the friends. Pink lemonade is OK; Yoo Hoo is great; Shirley Temples -- go for it. If you are referring to alcoholic beverages, think again. And while you're at it, think about your friends. If you drink alcohol, true friends will designate a non-drinking driver. If you decide not to drink, true friends will support this. Pat recommends the latter.

A brain injury can result in many cognitive and physical impairments -- problems which become worse under the influence of alcohol and other drugs. According to research from the Ohio Valley Center for Head Injury Prevention and Rehabilitation, the following is true:

* The use of alcohol or other drugs impairs recovery from brain injury. Keep in mind that recovery can occur for years after the injury.
* Brain injuries can cause problems in balance, walking, and/or talking which get worse when a person uses alcohol or other drugs.
* Brain injuries can cause a person to act impulsively, without thinking first. Judgment may be impaired. Alcohol and other drugs definitely exacerbate this, significantly compromising a person's decision-making ability.
* Brain injuries can impair cognition, causing difficulties with concentration and memory. Alcohol and drugs can make problems like these even worse.
* People with brain injuries can become depressed; alcohol and drugs can make someone more down. The high is only temporary, and the subsequent low is REALLY low!
* Alcohol and drugs can cause someone with a brain injury to have seizures.
* Alcohol and drugs can be dangerous when used in combination with prescription medications, (which many people with brain injuries may be taking).
* A person who uses alcohol or other drugs after a brain injury is more likely to experience another head trauma.

Think about that last statement, and consider this: alcohol is present in more than half of all head injuries. Alcohol alone is a factor in 66% of head injuries resulting from motor vehicle accidents, the leading cause of brain injury. To all: think before you drink. To those with brain injuries: think about not drinking.

Resource: User's Manual for Faster, More Reliable Operation of a Brain after Head Injury. Ohio Valley Center for Head Injury Prevention and Rehabilitation,1166 Dodd Hall, 480 W. 9th Avenue, Columbus, Ohio 43210. www.ohiovalley.org

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