I want to specifically talk about brain injuries in relation to emergency rooms because I have had too many experiences with them.
I know how challenging it can be to have a TBI recognized and how very important this is, especially in the case of the brain injury being caused by an accident that eventually becomes a legal case.
My brain injury education
Early in my sophomore year of college, I got an email from my mother, telling me that one of my younger sisters had been dragged out of a barn by a horse she’d been leading, and had hit her head on the base of a fence post as a result. She needed stitches.
It was weird to me that my mom would send me an email about this, rather than calling, but I shrugged it off, figuring it couldn’t be that bad if she’d mentioned it as casually as she did.
A few weeks later, I was chatting with her twin and I got to know how severe things actually were.
Our sister was in constant pain. She’d stayed home the first week or so after the accident, and upon her return to school tried to go back to everything, including the track team they were both on.
If she tried to run, she actually had so much pain in her head that she physically couldn’t keep going.
She wasn’t communicating well either – always the sharp and witty one, with an instant response to any questions, now she was hesitant and slow, responding ‘I don’t know’ to most questions.
There was more, but it took a long time to unravel the severity of the damage.
As my parents realized how bad the damage truly was, my sister ended up taking the rest of the year off of school, spending her mornings four days a week getting intensive cognitive, physical, and occupational therapy and afternoons recuperating from it all.
She had had an ambulance called and was taken to the hospital right away, received stitches and a CT scan, and sent home with a diagnosis of ‘concussion’, and ended up permanently affected by that accident.
Scanning for a Traumatic Brain Injury
So, as I’ve mentioned, ER’s hate things that they can’t prove with a test or scan.
If a brain injury is severe enough to show up on a CT scan, the likelihood of you ever having a ‘normal’ish life is pretty much gone.
Once the damage is bad enough to show on a scan, brain injuries are generally considered to be ‘moderate’ or ‘severe’ – those levels the damage is generally life-altering, and in many cases could prevent you from ever living independently.
For a percentage of patients whose injuries do show on a CT scan, surgery is immediately required to prevent death.
There are exceptions, but those are few and far between.
If the ER can’t see the brain injury on a CT scan, they often won’t bother listing ‘concussion'(the appropriate term for ‘mild’ level damage for the first 6 months following the event), even if your primary symptoms are headache, dizziness, confusion, and other symptoms of the concussion.
What you need to do if you or a loved one may have a concussion
If you do have a concussion and go to the ER, make sure that they note that you have a concussion.
This is something to really push them on, and be sure to double-check the report before you leave.
Brain injuries are already difficult to prove in court, so you want every bit of documentation you can get every step of the way. Why am I so focused on this?
Because most TBI’s are the result of an accident(most frequently a car accident), and often there is a possibility of suing for damages if the injury is severe.
Even ‘mild’ brain injuries can have some permanent effects, so you want to document things from day one, just in case it’s needed.
Unfortunately, there isn’t really much of anything to be done immediately following a concussion, once the doctors confirm that you don’t have a brain bleed or similar scannable damage.
Basically, if you do have a concussion, spend the first few days post-concussion sleeping at much as possible and minimize stresses to your brain.
A concussion is your brain itself being bruised, and just like other parts of your body hurt if pressure is put on the bruise, that’s what your brain does too – so the less you use it, the smaller the likelihood of extra pain.
What if it does show up in a scan?
Unfortunately, I have experience with that scenario too. My father died from a severe TBI, and my step-father’s son was in a car accident shortly after he started his first year of college, and had his entire life path completely changed as a result.
My step-brother has spent over half his life living with a brain injury. He currently uses a wheelchair, needs to be prompted to use the toilet, often loses track of conversations, and often gets car sick when traveling.
When I first met him, I was very young(we went to the same church), and his mother kept him very active in the faith.
He was in the choir and sometimes was part of the procession at the beginning of the service.
He shuffled along, walking at about half the speed of the rest of the group. But people slowed down for him, helped him to his seat, and otherwise made sure that he was involved.
As the years have passed, his balance has worsened, leading to his use of a wheelchair most of the time.
His independence has decreased, and his needs increased.
His father has done the best he can, which has been to set him up in a community program that provides housing with several other adults with moderate to severe impairments and staff on hand 24/7.
I think in general, he’s reasonably happy with his life, but it certainly wasn’t what anybody had expected for him before his accident.
What to do after the emergency room
If somebody has had CT or similar scan in the ER and then is sent home, that doesn’t mean that they are ok, and it doesn’t mean that they are irreparably damaged.
What it does mean is that they, and their family or friends, need to think about how they do the first few weeks to months after their injury.
Treatment for brain injuries initially focuses on letting the brain heal then shifts to rebuilding the paths destroyed by the injury.
This can involve neuropsychology, psychological therapy, cognitive rehabilitation(and associated therapy), physical therapy, occupational therapy, medications for additional damage, and/or additional therapies(such as speech therapy), depending on what part of brain function was damaged and how badly.
There are treatments that can help, and each brain injury is unique.
Damage lasting more than those initial few weeks aren’t necessarily going to become permanent, but the longer symptoms last, the less likely the person is to have a full recovery – and the more stress they are under, the harder it might be(or longer it might take) to fully recover.
As a loved one, all that you can do is advocate for their treatment and show as much patience as you can with them.
One of the worst things about having a brain injury is that often you KNOW what you were like before, but can’t do that now due to something you can’t control(and sometimes can’t understand).
Brain injuries are relatively common and very difficult to manage.
Al’s post-concussion syndrome
When Al had a concussion after a car accident, he slept most of the first week or so. It was what he needed, but it was a scary time for me, given my prior experiences with TBI’s.
He was given muscle relaxants and other pain medications after the accident, most of which had the side effect of causing drowsiness.
Sleeping was the best thing for him to do, but as the days and weeks went by, I became more and more concerned about how severe the damage might be.
He felt dizzy much of the time and had a severe headache that wouldn’t stop.
He shifted from being a calm, laid-back person to losing his cool and yelling, hitting things, or hanging up on people.
His ER visit made no references to any brain injury symptoms despite his going to the hospital primarily due to a severe headache.
I was able to make an appointment for him with a neurologist and convinced him to go to my chiropractor’s office for a PT evaluation(we both knew and trusted the physical therapist there).
He had vestibular(balance associated) problems and started getting treatment for that shortly after his evaluation.
He spent months unable to drive, and once we were able to get him in to see a neuropsychologist after the neurologist agreed that he had a concussion, he spent over a year participating in a treatment program to help him recover from the neurological trauma.
All of this is filed under the title of ‘concussion’ until he had all of those symptoms for over 3 months, after which the title was ‘post-concussion syndrome‘.
To this day, he still has a constant headache, though it isn’t as bad as it was initially.
All things considered, he got off relatively lightly from his ‘mild’ TBI even though now, 8 years after that accident, there is no reason to expect anything to improve.
Neuropsychologists
If you or a loved one is still not recovered after a few weeks, then I recommend making an appointment with a neurologist to discuss symptoms and possible treatments.
If the person’s memory or thought process is damaged, a neuropsychologist is often helpful in evaluating the damage and finding the right treatment.
Al’s neuropsychologist actually went to med school specifically to work for people with brain injuries, as he had one himself after he finished high school.
He was a wonderful doctor, but part of the damage from the brain injury was that he had no mental filter about what should or should not be shared with who.
This meant that part of the conversation we had at that first appointment included politics(he’s extremely politically conservative), his lack of filter and the fact that he absolutely loves to go to court since he hadn’t been able to go after the person who caused his own brain injury.
Obviously, his brain injury was also mild.
Conclusion: Brain injuries are very challenging for all involved and are one of the more commonly ignored reasons to go to an ER.
Whether you or somebody else in your family has or may have a brain injury, more mild cases are often challenging to get diagnosed while being extremely damaging to a person’s life. Sometimes the damage is permanent, but often some gains can be made post-injury.
While a CT or similar scan is important to check for physical damage to the brain, a clear scan does not indicate that the problems are over, but only that surgery is not required.
Mild TBI damage can still be significant, sometimes life-altering, and sometimes permanent.
Severe brain injuries often cause death, and if somebody does survive it, they likely will experience life-altering effects.
I lost my father to a severe brain injury, have a step-brother who had a moderate one and have watched my sister and my partner struggle through the long-term damage of mild brain injuries that were much worse than a typical concussion.
Emergency rooms rarely acknowledge concussions or any brain injuries that don’t require surgery, even though the damage from these types of injuries can be severe.
Time and rest are the primary forms of treatment for a brain injury, but if the damage continues for more than a few weeks, it makes sense to look into diagnosis and treatment options.
The neurologist confirms the TBI diagnosis and suggests treatments for the more physical problems, while a neuropsychologist is often consulted to evaluate the type and degree of mental and/or emotional issues.
Depending on the type(s) of damage, additional professionals may also be part of the treatment plan, with the goal being to bring the individual with a brain injury as close as possible to their functionality prior to the physical trauma that caused their brain injury.
I am sharing my hard-won lessons on TBI’s because I know how many people(including medical professionals) downplay, ignore, or just fail to help or understand TBI’s.
