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Brain injury and complications

Posted by Margaret Donohue on September 7, 2014 at 11:55 PM

I've been talking to people about brain injury ever since my second major concussion in 1997.  What surprises me is how isolated people feel, the tremendous amount of misinformation they are provided and the number of failed treatments they undergo that may worsen their condition and slow their recovery.  So here are the common "weird" symptoms post concussion.


Migraines:  Most people with concussion have post-concussive headaches.  These are intense searing pain headaches that may or may not be proceeded by an aura, and may or may not result in changes in vision, smell, and sensory sensitivity (light, sound, movement).  The major differential is that the person's hands don't get cold.  It is not a vascular headache.  It is not a migraine.  It is a post-concussive headache.   It's caused by inflammation and sheering injury to nerve fibers and results in improved brain function following the headache.  There aren't a lot of treatments for it.  It doesn't respond to migraine medication.  These headaches improve over a course of 5 years decreasing in frequency and intensity over time.


Black dots in field of vision:  Occasionally mistaken for spiders, roaches, fruit flies, or small moving dots, these are changes to the aqueous humor of the eyes that have concussed.  These are usually permanent.  People are usually able to adapt in the first 2 to 3 years.  Rule of thumb-if it moves only when you move your head it's internal not external.  It's not a hallucination. 


Balance problems:  When you concuss your brain, you often also concuss your inner ear, eyes and may dislocate your jaw.  The balance difficulties are due to inner ear problems.  Stand and sit slowly.  The nausea and vomitting can be treated with over the counter medications, but it may take some time before everything settles back down to normal-usually within 18 months to 2 years.  


Paranoia:  This phenomena is due to subtle memory difficulties.  It's well described in nursing literature with Alzheimer's patients as a response to memory loss, but it's not well described in the neuropsychology literature.  It exists and is a commen phenomena.


Personality Change:  This is well desscribed in the neuropsychology literature.  In right handed people a right sided brain injury often produces anxiety, while a left hemisphere injury often produces depression.  This may be the same or opposite side in left handed people.  Frontal lobe injuries can result in people much more outgoing and perhaps inappropriate.  Other injuries can result in tremendous self-consciousness and excessive shyness.  In a few cases the person starts speaking with a foreign accent (Foreign Accent Disorder).


Compulsions:  This is better described as stereotypies.  These are repetitive behaviors.  This is well described in animal literature.  There may or may not be an ideational component to the behaviors.  This is not an obsession or a compulsion.  It's a ritualized behavior that's on a loop and is internally reinforcing.  Unlike obsessive compulsive disorder there may not be any underlying thought process other than "i have to do this." Thereare a lot of literature on animals and autistic children with stereotypies.   Not so many articles on head injured.  But there are some.  The syndrome can show up immediately or moths after the injury.  It can also occur in an unusual immune reaction following a staph infection in children called PANDAS.  These are similar and suggest an immune component to the head injury.


Nerve Pain:  Nerve pain shows up in the neuropsychological literature and in the literature on serotonin and norepinephrine neurotransmitters. Nerve pain may or may not be triggered by use of certain types of antidepressants.  Often described as tightening, twisting, shocking, or stabbing pain.  It may be there are minor focal motor dystonias (twisting of nerves) or it may be a reaction to medication (usually SSRI or SNRI medications), or it may be autoimmune in nature.  It can occur immediately or months post concussion.  


GI problems:  There are numerous reports in the literature often in rehabilitation, nursing and in gastroenterology of the link between concussion and the development of IBS, chronic diarrhea, or constipation.  This appears to be a combination of stress, changes in diet and an immune disorder.  There is some evidence to suggest it can be treated with antibiotics, probiotics, and an allergen reducing diet until gastromotility returns to normal.  The condition may require a permanent change in diet.


Bowel and Bladder problems:  There can be difficulty with evacuating the bowel or bladder properly.  There may be problems with muscle tone and nerve sensitivity.  Accidents may occur.


Meningeal sensitivity:  People often complain of increased sensory experience following a concussion.  It's too bright, too noisy, too hot, too cold, to spicy in taste, or too odorous.  In some cases sensory experience is diminished.  If this is only with the sense of smell and taste then it's more likely related to the first cranial nerve that controls smell.


Loss of sense of taste and smell:  I was mugged and beaten in 1985.  The robber broke my glasses into my face and partially severed my olfactory nerve (CN-I or first cranial nerve).  I lost 80% of my ability to smell and more than 50% of my ability to taste.  Five years later the nerve started to regenerate and I got pack some of my loss senses.  Nerves grow back over different rates over prolongued periods of time.  That fact is now in much of the neuroplasticity literature.  In 1985 no one thought nerves could improve or regenerate.


Hormonal changes:  One of the things that happens with a concussion is that the brain sends a lot of hormones out to try to manage inflammation, bleeding, and the amount of ripped nerves known as sheering.  Changes in hormone functions are common.  These produce a cascade of effects from weight gain, and sleepiness, or insomnia, loss of appetite, and restlessness.  In extreme cases they can contribute to heart attack, stroke, and the onset of diabetes, and thyroid disorders.


Increased frequency of illness:  Because the immune system tries to repair the damage caused by the injury and the inflammation following the injury, the immune system is weakened.  The brain is using up nutrients to attempt to repair itself.  Loss of magnesium, and increases in sugar may contribute to an increased frequency of illnesses like colds and flu symptoms.  It may also increase the development of autoimmune disorders.


Sleep Apnea:  Hormonal changes, changes in appetite, and weight gain are common post concussion.  These can contribute to the development of sleep apnea.


Seizures:  Seizures can occur up to 18 months post head injury.  Seizure likelihood can be increased by the use of stimulant medication, alcohol, exposure to flashing lights and sleep deprivation.  The use of medication for "adult onset ADD" following a concussion may increase the potential for seizures.  After 18 months post injury, seizure onset is unlikely.


Sudden death:  Apart from situations in which the person experienced a slow and progressive bleed into the subarachnoid space of the brain, following a head injury, there is a small subset of people that may have problems following a degree of gravitational force to the brain for up to 5 years post head injury.  This includes motor cycle riding, horseback riding, roller-coaster riding, or any thing that moves a person through space quickly.  It may also be the consequence of a second head injury in a short period of time.  It may be preceeded by nausea and vomitting and a headache described as a "mule kicking me in the head" or "being struck by a thunderbolt."  My advice to people that have had a head injury is not to engage in any of those activities for 5 years post injury.


Fatigue:  It's going to take you twice as long to do half as much.  You've banged your brain into your skull.  It needs time to heal.  Sleep helps.


So what can you do following a concussion?  

  • Join a support group.  
  • Eat vegetables, fruits and lean protein.  
  • Avoid anything you may be allergic to or sensitive to.  New allergies are common.  
  • Limit anything that contributes to hormonal fluctuations like sugar, or sugar like products.  
  • Limit exposure to anything that increases bleeding (anti-inflammatories) or Aspirin or any SSRI products or monitor symptoms carefully when using these.  
  • Limit or use at the lowest dose possible any psychiatric medications.  
  • Sleep more.  
  • Limit caffeine.  
  • Put cue cards together to help with starting, stopping and going through multiple step tasks.
  • Be patient with yourself.  You're a newly disabled person and it takes time to learn how to do things.
  • Believe you are having common symptoms.  The symptoms above are NOT UNUSUAL.
  • Avoid anything that puts you at risk for another head injury.  Unless you are a professional athlete, try not doing an at risk behavior for five years post injury.  

Feel free to do a google search of (Insert name of symptoms here) and brain injury or concussion.  These are common and are well documented.  Most people with head injury will have one of more of these.  There are other symptoms that are less common.  The more you can connect with others with head injury the more you can understand how common these are.


We can help you document your injury, symptoms, and can work with your physician, attorney or school to help you recover.  Feel free to contact us. 



Categories: Brain Injury, General Psychology, Health Psychology

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