What is traumatic brain injury (TBI)?
Traumatic brain injury (TBI) refers to damage to the brain caused by an external force. This can occur after a blow to the head during contact sports such as rugby, or from the sudden stop (deceleration) in a car accident. TBIs range from so-called mild TBI, sometimes called a concussion, to very severe injuries requiring neurosurgery.
The impact of a TBI is highly variable. Every injury is different, and every person responds differently, meaning symptoms and recovery paths are unique.
Consultant neurologist Dr Neil Graham shares his insights on concussion and other traumatic brain injuries and shares how we can diagnose and treat patients with TBI at UCLH Private Healthcare.
Why ‘mild’ TBI is not always mild
All traumatic brain injuries are different. Even injuries classified as mild can involve brain damage. This can include situations where a standard scan such as a CT or MRI appears normal.
Think of the brain like a computer: the hardware may look intact, but the software can be corrupted.
This disruption can be highly disabling. Research shows that a significant sub-group of people do not recover quickly. One recent study found that up to 50 per cent of individuals still experience symptoms six months after a ‘mild’ TBI, or concussion.
Advanced diagnostics for traumatic brain injury
Advanced blood tests now allow us to detect proteins linked to brain injury. At The National Hospital for Neurology and Neurosurgery in Queen Square, we can now use these tests in certain patients to quantify neuronal damage (specifically the neurofilament light test, which is most informative at two to four weeks after injury).
How a traumatic brain injury neurologist can help
Doctors often use the term post-concussion syndrome to describe ongoing symptoms after a head injury. These may include:
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Headaches
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Dizziness
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Sensitivity to light and sound
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Nausea and fatigue
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“Brain fog” or difficulty concentrating
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Anxiety, low mood, or irritability
It is not uncommon for GPs to take a wait- and- see approach to these problems, but there are some instances where a more active approach taken a week or two after the injury can make a significant difference to outcomes in the longer term.
Specialist TBI neurologists aim to go beyond a label of post-concussion syndrome, to identify the specific causes of each symptom and treat them directly.
A specific example: dizziness
For example, A head injury can cause tiny crystals in the inner ear to be displaced and lead to patients suffering from dizziness; this is called Benign Paroxysmal Positional Vertigo (BPPV), a debilitating condition which can occur over weeks, months, or in rare cases, years. People with BPPV often trigger dizzy symptoms by rolling over in bed. Through a targeted physical examination, we can confirm the diagnosis and treat BBPV through repositioning manoeuvres, which can cure the dizziness.
Many other post-TBI symptoms have identifiable, specific causes that can be treated with careful assessment.
When should I seek help for concussion?
If you still have symptoms three to four weeks after your injury, and you have already seen a GP or A&E doctor, it may be helpful to consult a specialist TBI neurologist. We can help provide specific diagnoses, rehabilitation support, and targeted treatment.
Note: In the event of progressive, severe, or disabling symptoms, patients are advised to seek assessment in the emergency department.
You can find further information on our traumatic brain injury page.
