Lt Col Reynolds
The symptoms of moderate to severe TBI are very serious and can have an effect on many aspects of a patient’s life. With moderate injuries, loss of consciousness may last up to 24 hours. With severe TBI, a coma is not uncommon. As the patient regains consciousness or emerges from the coma, they may have a range of physical, cognitive, behavioral, or emotional symptoms. Dr. Freeman, can you tell us about some of the possible symptoms of a moderate to severe TBI?

Dr. Freeman
Certainly, Dr. Reynolds. The symptoms of moderate and severe TBI can be categorized as physical, cognitive, behavioral, or emotional. Patients may experience any combination of any number of these symptoms.

Physical symptoms of moderate to severe TBI can include:

  • A headache that gets worse or does not go away
  • Dizziness
  • Pain
  • Fatigue or drowsiness
  • Repeated vomiting or nausea
  • Convulsions or seizures
  • Difficulty waking up from sleep
  • Problems falling asleep or staying asleep
  • Dilation of one or both pupils of the eyes
  • Blurred vision or double vision
  • Sensitivity to light or sound
  • Ringing in the ears
  • Clear fluid draining from the nose or ears
  • Slurred speech
  • Bad taste in the mouth
  •  Weakness or numbness of the arms, legs, or face, and
  •  Loss of balance or coordination

Cognitive symptoms, which are symptoms affecting the way a person thinks or processes information, can include:

  • Confusion or disorientation
  • Problems with attention, concentration, and focus
  • Difficulty thinking clearly
  • Slow speed of processing
  • Difficulty with judgment and decision-making
  • Problems with executive control, which includes the ability to determine right from wrong and to override or control reactions when appropriate, and
  • Memory problems, including post-traumatic amnesia

Post-traumatic amnesia, or PTA, is memory loss related to the trauma. How long amnesia lasts helps determine how badly the brain is injured. If PTA lasts more than one week, long-term problems with thinking, planning, behavior, and personality are more likely.

Behavioral and emotional symptoms of moderate to severe TBI can include:

  • Restlessness
  • Agitation
  • Mood swings or changes
  • Combativeness
  • Depression
  • Anxiety, and
  • A lack of energy or motivation

Some symptoms are immediately apparent at the time of injury or shortly thereafter, and resolve over time. Others develop more slowly and appear later. Many can leave a patient with severe and permanent disability. But keep in mind that symptoms vary greatly from one patient to another, depending on the severity of the TBI.