Neuropsychological Implications on Head Injury

Head injury is a general term that refers to potential injury involving the complex of cerebral, cranial, and cervical structures. Mild head injury, specifically, refers to trauma that results in no or brief loss of consciousness, typically less than about five minutes. If the injury effects the cerebral, cranial and cervical areas, post concussion syndrome will be the result. Some of the characteristics of mild/moderate head injury are headache, dizziness, memory and concentration difficulty, amnesia, sleep disturbance, frustration and irritability, mental dullness, emotional and behavioral changes, loss of self-confidence, fatigue and weakness, tinnitus, visual distortions, and slow reactions. Post-concussion symptoms usually become rather intense soon after an injury. Many symptoms lessen or abate altogether with time—often within one year from the injury.

No bones may be broken, no cuts sustained, and that the injured person may look and talk just fine but there may be a real injury. The complex injury involving cerebral contusion and diffuse axonal injury within the brain, trauma and stretching of cervical muscles and supportive tissue, abrasion within the cervical vertebrae, soft tissue injury to muscle and circulatory structures of the head, chronic muscle strain due to guarded behavior in response to pain, changes in cerebral circulation and perfusion, and potential neurochemical and neurotiming changes in brain function provides the foundation for a host of behavioral, emotional, and cognitive changes.

Underdiagnosis or misdiagnosis of the multiple cognitive, behavioral, and somatic complaints following head injury is common. Ultimate recovery and maintenance of a positive attitude toward recovery, as well as adjustment to the emotional trauma of the event that caused the injury is important. The urge to get persons back to work too soon and without comprehensive understanding of the injury often creates emotional and cognitive obstacles and usually worsens the symptoms and outcome due to creation of stress, greater discomfort, chronic re-injury, and feelings of distrust and resentment. Educating the patient, family and others involved in the lifestyle changes caused by brain injury is of extreme importance.

Diminished self-confidence, negative self-reference, inflexibility, desire for withdrawal, slower thinking, emotional unpredictability, and frustration intolerance stem from the complexity of injury. If the patient, family, employer and others do not understand the injury and its consequent dynamics, unreasonable expectations, charges of malingering, and inappropriate treatment will typically follow. Failure to understand and appropriately treat mild to moderate brain injury can result in prolonged and less than desirable ultimate outcome.

Minor blunt head injuries may involve only symptoms of being "dazed" or brief loss of consciousness. They may result in headaches or blurring of vision or nausea and vomiting. There may be longer lasting subtle symptoms including, irritability, difficulty concentrating, insomnia, and difficulty tolerating bright light and loud sounds. These post concussion symptoms may last for a prolonged period of time.

Severe blunt head trauma involves a loss of consciousness lasting from several minutes to many days or longer. Seizures may result. The person may suffer from severe and sometimes permanent neurological deficits or may die. Neurological deficits from head trauma resemble those seen in stroke and include paralysis, seizures, or difficulty with speaking, seeing, hearing, walking, or understanding.

Penetrating trauma may cause immediate, severe symptoms or only minor symptoms despite a potentially life-threatening injury. Death may follow from the initial injury. Any of the signs of serious blunt head trauma may result.

Emergency medical attention should be given if the person subjected to injury vomits more than once, feels confused and drowsy, feels too weak to walk, loses consciousness for more than one minute. Prevent movement of the neck in severe head injury or if the injured person has any neck pain. If the person needs to vomit, carefully roll them onto their side without turning the head. However, it is not important to keep the person awake. Let him sleep.