Traumatic brain injury history and symptoms

The symptoms of TBI are diverse and can range from an asymptomatic mild TBI to instant death. The wide spectrum of the disease makes it possible to present in several different ways. Here in this section, we discuss a few important historical findings and symptoms of the TBI. For the purposes of this discussion, we will only be referring to symptomatic TBI.

• The most important information to obtain in the history of any TBI patient is the nature of the injury, baseline patient’s health, presence or absence of syncope, the evolution and the progression of symptoms.

• The nature of the injury is one of the most important information to obtain as that gives an insight of possible underlying effects of the trauma. Often times, the nature of injury in elderly people could be as simple as an unwitnessed fall. In younger population, especially athletes, the nature of injury is often unnoticed. Hence, it is really important for a provider to try to get as much information as possible about any history of contact sports in young athletes and in elderly patient’s an unnoticed detail of a sheer force such as a rapid deceleration, a bumpy ride can itself be the reason for intracranial hematomas such as subdural hematomas.

• The baseline patient’s health is important to know in the history as that will guide the acute management and also the importance of the long term follow-up. An elderly patient who is otherwise functional may benefit from surgical intervention, if required, compared another patient who is at baseline bedridden and can’t take care of themselves.

• With respect to symptoms, loss of consciousness is the single most important symptom, as the duration of syncope prior to resolution is one of the ways the severity of TBI is defined. It also helps predict the long term prognosis and the chances of complete functional recovery. Other symptoms which can present in acute moderate to severe TBI patient’s are:
  • Headache and/or associated nausea with projectile vomiting,
  • Altered mental status,
  • seizures,
  • Dizziness or lightheadedness or feeling goofy,
  • Diplopia,
  • blurry vision,
  • Tinnitus,
  • Nasal dripping (especially if there is dispersion of cribriform plate),
  • Cranial nerve palsies or other gross motor,
  • Sensory deficits such as limb weakness,
  • Loss of co-ordination, gait disturbance etc., depending on the area of injury in the brain.

One of the most important thing to differentiate in history, is to try to understand if a patient has global cerebral dysfunction versus focal deficits.

In patient’s with mild TBI or concussion, symptoms may widely vary depending on when they present after the injury. Patient’s may present with all the symptoms of acute moderate to severe TBI and fatigue, change in sleeping patterns, behavioral or mood changes, personality change, early onset dementia.

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