|Posted by Margaret Donohue on March 10, 2015 at 7:50 PM|
Head injuries are classified as mild, moderate, or severe based on length of loss of consciousness. There is no concussive injury that should not be taken seriously. So the attorney that asked me in court "Your injury was only mild right?" didn't seem to understand that even a so-called "mild" head injury can produce significant and life-altering symptoms.
The Center for Disease Control uses this definition:
The definition focuses on the actual injury or symptoms, not the possible consequences. For many people, there are challenges in getting an accurate diagnosis and treatment, especially when there is no documented or observed loss of consciousness. There does not need to be a loss of consciousness for a brain injury to occur.
Severity of Brain Injury
Emergency personnel typically determine the severity of a brain injury by using an assessment called the Glasgow Coma Scale (GCS). The terms Mild Brain Injury, Moderate Brain Injury, and Severe Brain Injury are used to describe the level of initial injury in relation to the neurological severity caused to the brain. There may be no correlation between the initial Glasgow Coma Scale score and the initial level of brain injury and a person’s short or long term recovery, or functional abilities. Keep in mind that there is nothing “Mild” about a brain injury—the term “Mild” Brain injury is used to describe a level of neurological injury. Any injury to the brain is a real and serious medical condition. There is additional information about mild brain injury on our mild brain injury page
Glasgow Coma Scale (GCS)
The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person). A GCS score of 13-15 is considered a "mild" injury; a score of 9-12 is considered a moderate injury; and 8 or below is considered a severe brain injury.
Mild Traumatic Brain Injury (GCS of 13-15)
Some symptoms of mild TBI include:
Moderate Brain Injury (GCS of 8-12)
A moderate TBI occurs when there is a loss of consciousness that lasts from a few minutes to a few hours, when confusion lasts from days to weeks, or when physical, cognitive, and/or behavioral impairments last for months or are permanent. Persons with moderate TBI generally can make a good recovery with treatment and successfully learn to compensate for their deficits.
Severe Brain Injury (GCS Below
Severe brain injury occurs when a prolonged unconscious state or coma lasts days, weeks, or months. Severe brain injury is further categorized into subgroups with separate features:
Following a concussive injury the person remains at risk for seizure for a period of 18 months. To lessen risk of seizure or a second head injury the following are recommended:.
Post Concussive Headaches
These headaches are of migraine intensity, but are not vascular (the hands do not get cold). There is no effective treatment. These occur as a result of sheering injuries and tearing of nerves and nerve fibers. Many people notice improved functioning following these headaches.
Memory Loss and Paranoia
Memory loss produces a sense of helplessness and confusion. Sometimes when people do not realize they have a brain injury, they believe other people are hiding their things, lying to them, or trying to make them feel confused. Labeling items and where they go, having a routine, using a system to track items, and assistance with evaluating thinking like Cognitive Behavioral Therapy, can help people manage memory difficulties.
Depression and Anxiety
In right handed people left hemisphere injuries tend to produce depression, while right hemisphere injuries tend to produce anxiety. Most right handed people with left hemisphere injuries know something is wrong and may complain of forgetting things, being emotional, having difficulty with speaking, writing or understanding people. This sense of something being wrong, knowing it is, and feeling helpless can lead to feelings of depression.
In right handed people right hemisphere injuries tend to produce anxiety. These people may not recognize any changes following the injury but are not able to do things they once were able to do. Since the difficulties are not as easily recognized there is a vague sense of something being wrong, but no clear idea of what it may be. It' only when they attempt to do a task they used to be able to do and can't that they get upset. Mindfullness, meditation, or returning to an easier and well matered task may lessen anxious symptoms.
Long term changes
In severe or moderate head injuries, or multiple mild head injuries there may be changes that occur with blood pressure, blood sugar, and hormonal changes. It's not unusual to find heart attacks or strokes following severe or moderate brain injuries. The development or worsening of diabetes, thyroid or immune problems are also noted. Seizures may be a complication of head injury.
Most brain injuries improve significantly over the first several years. While the person may not get back to who they were and how they functioned prior to their injury or accident, they improve significantly from the initial days after the injury.
Cognitive rehabilitation can be extremely helpful in recovery. Psychological counseling and interacting with other people with head injury can also be helpful.