Traumatic brain injury: symptoms and recovery

A traumatic brain injury is an injury to the brain caused by trauma to the head. Road traffic collisions, assaults, falls and accidents at home or work are all common causes, according to Headway. The term covers a very wide range, from a brief knock that causes nausea and dizziness to an injury that leaves someone in a coma.

Concussion sits at the milder end. The NHS describes concussion as a temporary brain injury that can last a few weeks. Doctors reserve the label of moderate or severe brain injury for people who lose consciousness for longer, or who have a prolonged spell of memory loss after the injury.

Headway explains three ways the head can be hurt. Closed injuries, where the skin is not broken, are the most common. The brain is shaken inside the skull and nerve fibres can be twisted or stretched across a wide area. Open or penetrating injuries are less common. Crush injuries are the least common and often affect the base of the skull.

After a minor head injury the NHS says symptoms can last for up to 2 weeks. Rest, ice on the bump and a responsible adult staying nearby for the first 24 hours are the usual advice.

Some symptoms need urgent help. The NHS says to call 999 if someone who has hit their head has any of the following:

• Been knocked out and not woken up, or cannot stay awake or keep their eyes open.

• Had a fit (seizure).

• Fallen from a height of more than 1 metre or 5 stairs, or been in a high-speed accident.

• Clear fluid coming from the ears or nose, bleeding from the ears, or bruising behind the ears.

• New numbness or weakness in any part of the body.

• Problems with vision, hearing, walking, balance, understanding, speaking or writing.

• A head wound with something inside it, or a dent in the head.

• Changed behaviour, such as being more irritable or distracted.

Severity is not decided by how dramatic the accident looked. Headway notes that even a mild-looking closed injury can cause damage across the brain, and that an apparently terrible open injury may have a better outcome if the damage is limited to one place.

Doctors consider how long consciousness was lost, how long post-traumatic amnesia lasts, what the scan shows, and how the person responds in the first hours. Headway describes post-traumatic amnesia as the period after unconsciousness when the person is awake but confused, may not recognise familiar people and cannot form continuous memories.

Their advice for relatives is to stay calm, keep the surroundings quiet, avoid correcting or forcing memories, and make sure the person is kept safe, because the phase will pass.

NICE guideline NG232 aims to get people to the right centre quickly, to give timely CT head scans and neck imaging when needed, and to give tranexamic acid, a medicine that controls bleeding, within 2 hours of injury where it is needed. It also covers referral for suspected pituitary injury and clear discharge information for patients and families.

Headway explains why early treatment matters. Paramedics work to keep the airway open and blood pressure normal because lack of oxygen can add to the first injury. In hospital, pressure inside the skull is monitored carefully, as swelling has little room to expand. Blood clots (haematomas) can follow even minor injuries, so patients may be observed until that risk has passed.

Physiotherapists are involved early, even when a person is unconscious, to prevent chest infections, pressure sores and stiffening of joints. Sitting up, a tilt table and supported standing come later.

Headway groups the effects into physical, cognitive, emotional and behavioural. It says no two experiences are the same, and memory problems and fatigue are among the commonest. Damage to the frontal lobes can lead to loss of insight and self-restraint, while injury to one side of the brain can affect speech and language.

Physical recovery is often better than people fear. Headway says most people make an excellent physical recovery, but ongoing physical problems can still affect daily life. Cognitive effects include slower thinking, difficulty concentrating, trouble solving problems and problems using language.

Many people say they feel like a different person afterwards. Headway adds that effects can improve with rehabilitation and support, but some may be lifelong and need adjustments or equipment.

Headway explains that brain cells do not regenerate once destroyed, but the brain can reorganise. Other areas take over some activities, and new pathways can form from undamaged cells. Rehabilitation aims to help the brain learn alternative ways of working and helps the person and family cope with remaining difficulties.

Its guidance on timing is cautious. In the first month or two after a severe injury the outcome can only be guessed. At six months the picture is clearer, and Headway suggests waiting until about a year before making major life decisions. Psychological recovery can take longer than physical recovery.

Rehabilitation units are run by the NHS or private firms. Headway says most units, including private ones, accept NHS referrals and are funded by the NHS, although availability and funding vary. Headway's early-rehabilitation guidance describes physiotherapists working on movement, posture and balance, alongside help with memory, concentration and fatigue.

Headway says anyone with a brain injury who drives must inform the licensing authority. As a general rule, it says drivers with an ordinary car or motorcycle licence should stop driving for 6 to 12 months after a traumatic brain injury, depending on factors such as post-traumatic amnesia, seizures and clinical recovery. Each case is considered individually.

The NHS minor head injury advice says not to drive until you feel fully recovered, to avoid contact sports for at least 3 weeks, and to speak to a GP if you are unsure about driving or going back to work, school or sport.

For longer-term difficulties, support groups, occupational therapy and employer adjustments can help. Headway runs a nurse-led helpline and local groups across the UK.

Emergency care, scans, neurosurgery and intensive care after a head injury are delivered through NHS emergency departments and hospital trauma and neurosurgical teams. Private hospitals are not the route for a serious acute injury.

After discharge, a GP can refer to neurology, neuropsychology or community rehabilitation. Some people seek a private neurologist, neuropsychologist or rehabilitation unit to shorten waiting times or access a longer programme. Whatever the route, ask who will coordinate the plan.