A brain injury is damage to brain tissue. It can be the result of trauma or medical problems. The effects of brain injury are different for everyone. How you react depends on which parts of your brain were injured and how seriously.
A brain injury is damage to brain tissue. It is different from congenital disorders, which are problems with the brain that you are born with.
A brain injury can be the result of trauma such as a blow to the head or impact that causes your brain to shake within your skull.
It can also be caused by a medical problem, such as a stroke, brain tumour, lack of oxygen or infection, or by substance abuse or poisoning.
A brain injury can have a dramatic impact on your family, job, social and community life.
There is support available for those living with brain injury.
Need urgent medical help?
If someone is unconscious or unable to move all or some of their limbs or is complaining of neck pain call 111 immediately.
Don’t move the person (unless it’s dangerous to leave them where they are).
Get immediate medical help if you or someone you are caring for:
has received a hard bang on the head (say, from a major fall)
appears dazed or loses consciousness, even momentarily
seems unwell or vomits after the injury or shows any of the warning signs below:
• Complaints of neck pain • Increasing confusion or irritability • Repeated vomiting • Seizure or convulsion • Double vision
• Muscle weakness, tingling or burning in arms or legs • Deteriorating conscious state • Severe or increasing headache • Unusual behaviour change
Brain injury can also be caused by medical problems, such as:
bleeding in your brain
lack of oxygen.
Ongoing alcohol and drug abuse can also cause brain injury, as can poisoning with toxic substances such as pesticides, gases and solvents.
How is brain injury diagnosed?
To assess the impact an injury has had on your brain, your doctor will use the Glasgow Coma Scale (GCS) to measure physical, verbal and eye-opening responses. Read more about the Glasgow Coma Scale
Brain injuries can range from mild to severe as determined by the GCS, with mild being GCS 14–15, moderate 9–13, and severe 8 or below.
Concussion is on the mild end of the traumatic brain injury spectrum.
What are the effects of brain injury?
The effects of brain injury are different for everyone. How you react depends on which parts of your brain were injured and how seriously.
About 5% of traumatic brain injuries in New Zealand are moderate to severe. If you have a moderate to severe brain injury, you are likely to have some level of physical, cognitive (thinking) or behavioural disability.
Some symptoms may appear right away, whereas others may not be present for days or weeks after the injury. Some symptoms may disappear after a few hours; some may continue for weeks or months.
Because the brain is so complicated, it is difficult to know exactly what the long-term outcome will be. Most people keep getting better slowly over time, but some people never recover to be exactly as they were before the injury.
Some ongoing problems include:
cognitive problems, eg, difficulties with thinking clearly, maintaining concentration, problem-solving and completing projects
memory problems particularly with learning and remembering new information
physical problems, eg, with sense of balance, fatigue causing reduced mental and physical stamina, slower reflexes and headaches
sensory problems, eg, lower tolerance to light and noise, or problems with taste, smell and touch
communication difficulties making it difficult to express yourself and understand others
Stephen works with Axis Sports Medicine Specialists in their dedicated sports concussion clinic. His interest in concussion was generated from 15 years involvement in provincial and national rugby and has led to an education role with NZ rugby for community-based rugby and referees.
Stephen is a subject matter expert in concussion and head injury.
Credits: Health Navigator Editorial Team . Reviewed By: Dr Stephen Kara, MBChB, FRNZCGP, Dip Sports Med, Dip Obs, MPhil (Hons)
Last reviewed: 27 May 2019
What is a concussion?
A concussion is a type of mild traumatic brain injury (mTBI). It occurs when a bump, blow or shake to your head or body causes your brain to shake inside your skull, causing your brain to be bruised in a similar way to other parts of your body.
You don't have to get a blow directly to your head itself – impact anywhere on your body that causes your head to shake violently can lead to a concussion.
You also don't have to be knocked out to get a concussion. In fact, loss of consciousness only happens with 10% of concussions.
The most common cause of brain injury in older people is a fall. If you or someone you care for has experienced a fall, see a doctor as soon as possible to check for the possibility of a brain injury. A brain injury can be possible even if you have a low-level or a same-level fall.
The consequences of a brain injury in older people can be serious and long term. This can include:
greater risk of cognitive decline
worse consequences, eg, fractures (broken bones).
More than two-thirds of older adults with mild brain injury recover fully. Older people who are most at risk of poor recovery from a mild brain injury include those who:
have been diagnosed with dementia
have a history of cancer
are taking or have taken blood-thinning medicines in the past.
What are the signs of a brain injury?
Symptoms and signs of brain injury can be wide-ranging and are not always obvious. They include:
severe or worsening headache
multiple episodes of vomiting
fits or displays seizure-like activity
weakness in any of your limbs
tingling or numbness in any of your limbs
double or blurred vision
fatigue (tiredness) – usually more tired than you would normally be
difficulty remembering things
lightheaded and dizziness
sleep difficulties, either getting to sleep, waking through the night or longer sleep periods
emotional changes including irritability, sadness, tearful sensitivity to noise and light
feeling slowed down as if things around you are going faster and you cannot keep up
loss of consciousness – but it is important to remember that a person can have a concussion without losing consciousness
Not every sign and symptom will be present in every person.
What should I do if I have a fall or a brain injury?
The two Rs – recognise and refer is the principle.
Older people, their caregivers and whānau need to help recognise and be aware of the signs and symptoms of a brain injury.
If you or someone you care for has experienced a fall, see a doctor as soon as possible to check for the possibility of a brain injury.You can also call Healthline free on 0800 611 116 if you are unsure what to do.
Warning signs to watch for
The first 24 hours after having a brain injury are crucial. You should seek urgent medical help (either go to A&E or call 111 for an ambulance) if you or someone you are caring for:
has a headache that gets worse, that is not relieved with simple pain relief like paracetamol
is very sleepy or difficult to wake
is confused or doesn’t recognise you
has fits or seizures (repeated jerking movements of arms, legs or face)
has strange feelings or loss of movement down one side of the body
slurs their speech
has blurred vision bad enough to stop seeing properly
has double vision
is increasingly irritable or restless
repeatedly vomits (more than 1 vomit for an adult, any vomit for a child)
complains of neck pain
has behavioural changes
How can I reduce the risk of a fall and a brain injury?
Maintain core strength and balance
Keeping active and exercising regularly is important for older people to maintain core strength and balance. This helps to keep you steady on your feet and reduce the risk of a fall and prevent a possible brain injury, as well as other consequences such as fractures. Lack of exercise can lead to weak legs, which increases the chances of falling.
Any increased exercise is helpful. Start with 5 minutes a day and build up.
Key information about post-traumatic headache provided by Dr Pyari Bose, neurologist, Auckland
Post-traumatic headache (PTH)is the most frequent symptom after mild traumatic brain injury (mTBI). It is estimated that annually 69 million suffer from TBI worldwide, mostly attributable tomTBI.InNew Zealand it is estimated that up to 36,000 people suffer TBIs each year, of which 95% are mild.
The leading causes of TBI in New Zealand are falls,mechanical forces, driving-related accidents andassaults.Just over 20% of all TBIs in New Zealand are sustained through sport-related activity.(7)
The underlying cause of PTH is not fully known. It is thought thatmechanisms related toboth migraine and traumatic brain injury (TBI) are implicated. These include impaired descending paincontrol networks in thebrain,neurochemicalchanges, neuroinflammation, cortical spreading depression, and release of thepain protein-calcitonin gene-related peptide (CGRP).
The treatment would be determined by evaluation of the underlying headache phenotype. Common patterns of PTH include migraine type and tension type headache patterns. Part of the management also includes addressing if patients are overusing pain medications.
Headachesmay resolve within 3 months of the traumatic brain injury but in some patients this may last longer.