Serious traumatic brain injuries (TBI) have a profound effect on those who endure them. Not only do they create issues immediately following the TBI, but they leave a lasting impact on just about every aspect of their lives—from physical and emotional well being to overall quality of life. They also pose unique long-term challenges, even when compared with mild TBI (known as concussion) or post-concussion syndrome.
In this post, we take an in-depth look at the those symptoms and side effects of brain injuries that can occur long after the trauma.
Why Moderate or Severe TBI Leads to Problems Later in Life
When you sustain a serious head injury, your brain works immediately to repair the tissue and other internal damage. Some of these restorative processes are highly effective—particularly when combined with direct treatment—as evidenced by one-third of patients recovering favorably within the first six months; physical symptoms are short lived, and the brain and body ultimately return to close-to-normal functioning.
However, some parts of the brain cannot be repaired or endure progressive decline, resulting in long-term or lifetime damage.1 This can translate to complications that begin after injury and last for months or years later; this may even explain the delayed onset of brain injury symptoms for some patients. And we cannot forget about the significant social and emotional costs that affect moderate or severe TBI patients in the years following an injury as well.
Ongoing physical symptoms
One thing we know for sure: people with moderate or severe TBI have multiple physical problems that can last for years. In fact, at least one-fifth of those with more severe injuries have reported difficulties with their physical health—in some cases decades later.2 Below are some of the chronic complications that patients might face.
Headaches and migraines
Not only are frequent, even daily, headaches a common symptom shortly after an injury, but numerous studies show that they also likely to develop and even worsen over time. And the presence of recurring headaches at six months significantly increased the risk at one year and beyond for moderate/severe TBI. Amazingly, head pain may persevere even for those individuals who make an otherwise “full” recovery; 93% still had residual headache disability.3-5
We know how regularly dizziness and related issues (such as vertigo or lightheadedness) can manifest as symptoms for TBI. Incredibly, at least one-third of people have dizziness that lasts for at least five years post injury. However, it’s not all bad news; in at least one study, veterans with a more severe injury were more likely to see improvement in dizziness and vertigo over time.6
Sensitivity to light and noise
Sensory complaints tend to be more common in the acute phase of serious TBI, but that does not mean they cannot be long-term problems for patients. Sensitivity to light and noise—termed photophobia and phonophobia, respectively—have been shown to develop as new symptoms within the first three years. And approximately 25% of patients have these sensitivities after twelve months, which (like other symptoms) can turn into lifelong concerns.6,7
The eyes can be especially impacted by serious head injuries. For example, sustained damage in the brain from TBI can lead to convergence insufficiency, which is the inability of the eyes to focus properly during near vision. Not only can this lead to other eye-related complications like blurry or double vision, but it has been shown to be a prominent risk for patients three years after the injury.8
The more severe the brain injury, the more likely a person will experience worsening physical and mental fatigue following the TBI. What is worse is that its continued presence can lead to emotional symptoms and insomnia as well as negatively influence working status one year after the injury.9 And other complicating factors, such as light sensitivity, may further compound fatigue-related symptoms.
Seizures, post-traumatic epilepsy
Perhaps as many as 40% of individuals with TBI deal with late-stage seizures, with signs pointing to an increased risk for the most severe of injuries. Sustained seizure disorders, specifically post-traumatic epilepsy, can also become a permanent problem for adults or children with TBI—particularly those with other anomalies identified during brain scans. However, it is less clear whether seizures immediately following the trauma can actually indicate the development of this type of epilepsy months or years later.10,11
Ongoing emotional and cognitive symptoms
Beyond just the physical issues, there are numerous emotional and psychological complications of critical TBI—many of which develop and/or last well beyond the initial injury.
More so than any other issue, impaired memory and thought appears to be an ongoing problem for patients; in fact, it is known to last for several years for anywhere between 20-63% of patients. Although there is general improvement in mental functioning over time, many still have noticeable deficits more than a decade later. 2,6
Other non-physical issues that can linger include:
- Sleep difficulties
- Inability to manage time and get things done
- Deficits in attention and concentration
- Depression and anxiety
- Aggression and other personality changes
Certain emotional symptoms also can newly develop after the initial stages of recovery. In particular, irritability is a side effect that is not typically present at the initial time of the injury but which can manifest within the first three years. And it is important to remember these types of mood and emotional changes are impacted by lasting physical problems like chronic pain. The longer these problems continue, the more burden is felt by patients. This makes treating the most troublesome physical complaints a critical part of post-TBI care.
Degenerative brain diseases
As we have already discussed, there tends to be greater damage within the brain as a result of moderate or severe TBI. This can increase the risk for long-term neurodegenerative diseases, such as dementia and Alzheimer’s disease. However, clinical studies have been mixed about just exactly how it likely it is for patients. Generally, experts still agree that the populations with the highest risk are those with the most severe injuries as well as those who have sustained multiple TBIs.12,13
Social and other outcomes
It is probably not surprising to learn that a serious brain injury can have a significant impact on one’s quality of life. Here are some of the most important factors of which to be aware.
Higher likelihood of death
We cannot ignore that people with a moderate or severe TBI have a higher likelihood of death due to the injury and related complications. Unfortunately, the presence of depression and other psychiatric comorbidities has led to an increased risk of suicide. In addition, older patients are more susceptible to issues like pneumonia, sepsis and brain-related diseases like Alzheimer's and dementia. CTE, or chronic traumatic encephalopathy, also appears to be linked to repetitive, critical TBI—including for professional athletes. However, it is important to stress that advancements in treatment have significantly improved the mortality rates for patients.1
Lower rates of employment
When compared with mild traumatic brain injury patients, people with severe TBI have more difficulty in getting back to work over the long haul. In fact, one study showed less than one-third of participants were working full time several years after the trauma, and there was a general struggle with financial management.14
Reduced participation in activities
Only 40% of people with this type of severe trauma report that they are able to engage in the leisure and recreational activities from before the injury. Persistence of physical symptoms and other diminished functioning has been linked to social isolation—which contributes to a lower quality of life for survivors.
It is important to bear in mind that individual patient experiences can vary tremendously. While the later life outcomes may frequently take a turn for the worse in many individuals, there are a meaningful percentage of people who improve and even return to almost-normal functioning. In fact, there is encouraging data that shows improvement as late as ten years after an injury, perhaps indicating a longer lifecycle for recovery.15
Outcomes can be significantly impacted by things like: great medical care, especially immediately after the injury; the age of the patient, with youth being an advantage; and of course things like the health of the patient prior to the injury and determination and continued vigilance afterward.
The key is to not give up after a moderate or severe TBI. There are countless of social and medical resources available to help patients through the healing process.
1Stocchetti N, Zanier ER. Chronic impact of traumatic brain injury on outcome and quality of life: a narrative review. Crit Care. 2016;20(1):148. Published 2016 Jun 21. doi:10.1186/s13054-016-1318-1
2Brown AW, Moessner AM, Mandrekar J, Diehl NN, Leibson CL, Malec JF. A survey of very-long-term outcomes after traumatic brain injury among members of a population-based incident cohort. J Neurotrauma. 2011;28(2):167-76.
3Nampiaparampil DE. Prevalence of chronic pain after traumatic brain injury: a systematic review. JAMA. 2008 Aug 13;300(6):711-9. doi: 10.1001/jama.300.6.711.
4Walker WC, Seel RT, Curtiss G, Warden DL. Headache after moderate and severe traumatic brain injury: a longitudinal analysis. Arch Phys Med Rehabil. 2005 Sep;86(9):1793-800.
5Rimel RW, Giordani B, Barth JT, Jane JA. Moderate head injury: completing the clinical spectrum of brain trauma. Neurosurgery. 1982 Sep;11(3):344-51.
6Brickell TA, Lange RT, French LM. Three-year outcome following moderate-to-severe TBI in U.S. military service members: a descriptive cross-sectional study. Mil Med. 2014 Aug;179(8):839-48. doi: 10.7205/MILMED-D-14-00016.
7Dikmen S, Machamer J, Fann JR, Temkin NR. Rates of symptom reporting following traumatic brain injury. J Int Neuropsychol Soc. 2010 May;16(3):401-11. doi: 10.1017/S1355617710000196. Epub 2010 Mar 1.
8Cohen M, Groswasser Z, Barchadski R, Appel A. Convergence insufficiency in brain-injured patients. Brain Inj. 1989 Apr-Jun;3(2):187-91.
9Beaulieu-Bonneau S, Ouellet MC. Fatigue in the first year after traumatic brain injury: course, relationship with injury severity, and correlates. Neuropsychol Rehabil. 2017 Oct;27(7):983-1001. doi: 10.1080/09602011.2016.1162176. Epub 2016 Apr 1.
10Chen W, Li MD, Wang GF, Yang XF, Liu L, Meng FG. Risk of post-traumatic epilepsy after severe head injury in patients with at least one seizure. Neuropsychiatr Dis Treat. 2017;13:2301-2306. Published 2017 Aug 30. doi:10.2147/NDT.S141486
11Keret A, Shweiki M, Bennett-Back O, Abed-Fteiha F, Matoth I, Shoshan Y, Benifla M. The clinical characteristics of posttraumatic epilepsy following moderate-to-severe traumatic brain injury in children. Seizure. 2018 May;58:29-34. doi: 10.1016/j.seizure.2018.03.018. Epub 2018 Mar 20.
12Nordström A, Nordström P. Traumatic brain injury and the risk of dementia diagnosis: A nationwide cohort study. PLoS Med. 2018 Jan 30;15(1):e1002496. doi: 10.1371/journal.pmed.1002496. eCollection 2018 Jan.
13Weiner MW, Crane PK, Montine TJ, Bennett DA, Veitch DP. Traumatic brain injury may not increase the risk of Alzheimer disease. Neurology. 2017 Oct 31;89(18):1923-1925. doi: 10.1212/WNL.0000000000004608. Epub 2017 Oct 4.
14Colantonio A, Ratcliff G, Chase S, Kelsey S, Escobar M, Vernich L. Long-term outcomes after moderate to severe traumatic brain injury. Disabil Rehabil. 2004 Mar 4;26(5):253-61.
15Fleminger S, Ponsford J. Long term outcome after traumatic brain injury. BMJ. 2005;331(7530):1419-20.
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