The effects of a traumatic brain injury may continue long after the initial car accident.
Some complications appear quickly, while others develop gradually as the injured person attempts to return to work, family responsibilities, and normal daily activities. Problems involving memory, movement, sleep, mood, and physical stamina can continue for months or longer.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, treatment coordinator and registered nurse Kiley Como spoke with attorney John Mobley of Shane Smith Law’s concussion and brain injury group. They discussed several possible long-term TBI complications and why ongoing medical care and detailed documentation are so important.
What Is a Traumatic Brain Injury?
A traumatic brain injury, or TBI, occurs when an external force disrupts the brain’s normal function.
That force may come from:
- A blow to the head
- A sudden jolt
- Rapid acceleration and deceleration
- A fall
- A car accident
- A penetrating injury
TBIs range from concussions to more severe injuries involving bleeding, bruising, or widespread damage to the brain’s nerve fibers.
The symptoms depend partly on which areas of the brain were affected. An injury involving language pathways may cause difficulty finding words, while damage involving memory systems may interfere with short- or long-term recall.
Diffuse Axonal Injuries Can Disrupt Communication
A diffuse axonal injury involves widespread stretching or tearing of the brain’s nerve fibers.
These fibers help different parts of the brain communicate with one another and send information between the brain and body.
When those connections are disrupted, the person may experience difficulties involving:
- Consciousness
- Memory
- Attention
- Movement
- Speech
- Behavior
- Emotional regulation
The extent of the symptoms depends on the location and severity of the damage.
Infections After Severe Brain Injuries
Infections are not typical of every concussion or closed-head injury, but they may become a concern after skull fractures, penetrating injuries, surgery, or other severe trauma.
John discussed meningitis, an infection involving the protective membranes surrounding the brain and spinal cord.
Potential symptoms may include:
- Severe headache
- Fever
- Stiff neck
- Light sensitivity
- Confusion
- Nausea or vomiting
Meningitis can become life-threatening and requires prompt medical treatment.
Subdural Empyema and Brain Abscesses
A subdural empyema is a collection of infected material between protective layers surrounding the brain.
A brain abscess is a localized infection within the brain tissue.
Both conditions can increase pressure inside the skull and cause serious neurological symptoms.
Possible warning signs include:
- Fever
- Severe or worsening headache
- Weakness
- Speech difficulties
- Confusion
- Seizures
- Nausea
- Changes in consciousness
Treatment may require antibiotics, surgical drainage, or other intensive medical intervention.
These complications are serious but uncommon. The discussion emphasizes why new neurological symptoms following a significant head injury should be evaluated rather than ignored.
Why Brain Swelling Is Dangerous
The skull provides strong protection, but it also creates a fixed space.
When the brain swells, there is limited room for expansion. Increasing pressure can compress brain tissue and interfere with blood flow and oxygen delivery.
In severe cases, a surgeon may perform a craniectomy or craniotomy to relieve pressure.
This can involve temporarily removing part of the skull so the brain has room to swell. The skull section may be replaced during a later procedure after the swelling has decreased.
These treatments demonstrate how a traumatic brain injury can require care extending far beyond the original hospitalization.
Cognitive Decline Is a Common Long-Term Concern
John described cognitive difficulties as some of the complications most likely to affect brain injury survivors over time.
Short-term problems may include:
- Confusion
- Poor concentration
- Difficulty remembering recent events
- Slower thinking
- Trouble organizing tasks
- Difficulty completing several steps in order
These symptoms may improve over weeks or months.
For some patients, however, cognitive problems continue and significantly interfere with daily life.
Small Cognitive Changes Can Have Major Effects
Difficulty concentrating may sound minor until it affects someone’s ability to perform their job.
A previously productive employee may begin missing deadlines, making mistakes, or struggling to follow conversations during meetings.
At home, the person may have difficulty managing appointments, paying bills, preparing meals, or keeping track of family schedules.
Brain injury symptoms often affect several areas at the same time. Memory problems, poor sleep, headaches, and emotional changes can combine to make even familiar activities feel overwhelming.
Changes in Personality and Social Life
Family members and friends may notice that the injured person is no longer behaving like they did before the accident.
Someone who was previously outgoing may begin avoiding social activities. Another person may become unusually irritable, anxious, depressed, or emotionally withdrawn.
They may stop attending:
- Family gatherings
- Book clubs
- Sports activities
- Religious services
- Community events
- Social outings
These changes may result from headaches, light sensitivity, fatigue, depression, anxiety, or difficulty keeping up with conversations.
They should not automatically be dismissed as a lack of effort or interest.
Repeated Head Trauma and CTE
The episode also discussed chronic traumatic encephalopathy, commonly known as CTE.
CTE has received significant attention because of its association with repeated head impacts in certain athletes.
Reported symptoms may include memory loss, confusion, depression, behavioral changes, and personality changes.
However, CTE is associated with repeated exposure to head trauma rather than being a routine expected result of one car accident. It also cannot currently be definitively confirmed in a living patient through a standard clinical test.
The larger lesson is that repeated brain injuries may carry cumulative risks and should be taken seriously.
Movement Disorders After Brain Injury
Traumatic brain injuries can affect the brain systems controlling movement, muscle tone, balance, and coordination.
John discussed tremors, which may occur while the body is at rest or during intentional movement.
A tremor may appear as rhythmic shaking involving the:
- Hands
- Arms
- Head
- Legs
- Voice
Treatment depends on the cause and severity and may include medication, therapy, or selected procedures.
Dystonia and Abnormal Muscle Contractions
Dystonia involves involuntary muscle contractions that produce repetitive movements or unusual postures.
It may affect one area, such as the neck or hand, or involve several parts of the body.
Potential treatments include:
- Physical therapy
- Medication
- Botox injections
- Selected surgical procedures
Botox is often associated with cosmetic treatment, but it also has several medical uses. It may help relax specific muscles involved in dystonia, spasms, or certain headache conditions.
Parkinson-Like Symptoms
The episode also discussed symptoms resembling those associated with Parkinson’s disease, including:
- Slowed movement
- Muscle stiffness
- Tremors
- Balance problems
- Changes in walking
A brain injury survivor experiencing new movement problems should be evaluated by a qualified medical provider.
These symptoms may have several potential causes, and their presence does not automatically mean the patient has developed Parkinson’s disease.
A neurological evaluation can help identify the likely cause and appropriate treatment.
Fatigue That Does Not Improve With Rest
Post-traumatic fatigue is more than feeling tired after a busy day.
A brain injury survivor may experience persistent exhaustion that does not improve after sleeping or resting.
Possible contributing factors include:
- The brain’s recovery process
- Chronic pain
- Emotional stress
- Reduced activity
- Sleep disruption
- Medication side effects
- Depression or anxiety
Fatigue can make it difficult to work, drive, exercise, complete household tasks, or participate in rehabilitation.
Treatment may require addressing several underlying causes rather than relying on rest alone.
Sleep Disorders Can Affect the Entire Recovery
Brain injuries may disrupt the systems that control sleeping and waking.
Some patients struggle to fall asleep. Others wake repeatedly or sleep for long periods without feeling refreshed.
Potential problems include:
- Insomnia
- Sleep apnea
- Excessive daytime sleepiness
- Irregular sleep schedules
- Difficulty reaching restorative sleep stages
Poor sleep can worsen headaches, memory, mood, pain, reaction time, and concentration.
A sleep study may be appropriate when the provider suspects sleep apnea or another underlying disorder.
Healthy Sleep Habits May Help
John discussed several basic sleep-hygiene practices that may support better rest.
These include:
- Following a consistent bedtime routine
- Reducing screen use before bed
- Keeping the bedroom dark
- Using blackout curtains when needed
- Reading under low light
- Creating a quiet sleeping environment
These habits may not resolve every neurological sleep disorder, but they can help remove environmental barriers to rest.
Some patients may also require a CPAP machine, medication, or treatment from a sleep specialist.
Long-Term Complications Affect a Legal Claim
A traumatic brain injury claim must account for more than the initial emergency room bill.
Long-term complications can affect:
- Future medical treatment
- Rehabilitation costs
- Lost income
- Ability to work
- Household responsibilities
- Independence
- Relationships
- Quality of life
The full value of the case may not be clear immediately after the accident.
Attorneys and medical providers may need time to understand whether the symptoms are improving, continuing, or becoming permanent.
Family Members Can Help Explain the Changes
Some brain injury survivors have difficulty recognizing or communicating how they have changed.
Memory problems and reduced self-awareness may make it harder for them to provide a complete history.
A spouse, parent, friend, or coworker may be able to explain:
- How the person behaved before the accident
- Which responsibilities they previously handled
- What symptoms appeared afterward
- How work performance changed
- Whether the person withdrew socially
- Which tasks now require assistance
These observations can help medical providers understand the patient and help document the injury’s effect on everyday life.
Do Not Try to Tough Out Neurological Symptoms
John emphasized that a person experiencing possible brain injury symptoms after a serious crash or fall should seek medical care.
Severe headaches, confusion, repeated vomiting, weakness, speech problems, seizures, loss of consciousness, or worsening neurological changes may signal an emergency.
Waiting can be dangerous when bleeding, swelling, infection, or pressure is involved.
Even when testing does not reveal a life-threatening condition, getting evaluated creates an opportunity to identify the injury, begin treatment, and document the symptoms.
A traumatic brain injury can affect how a person thinks, moves, sleeps, works, and interacts with others. Recognizing those long-term complications is an important part of helping survivors obtain appropriate care and understand the full consequences of the injury.
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