A traumatic brain injury does not always end with the symptoms noticed immediately after a crash.
Some complications can develop hours, days, or even weeks later. These delayed problems may include seizures, blood-vessel injuries, dangerous pressure changes, and fluid buildup around the brain.
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 serious complications that may follow a traumatic brain injury and why continued medical monitoring matters.
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 result from:
- A direct blow to the head
- A sudden jolt
- Rapid acceleration and deceleration
- A fall
- A car accident
TBIs range from relatively mild concussions to severe injuries involving bruising, bleeding, or widespread damage to nerve fibers.
Immediate symptoms may include confusion, loss of consciousness, or memory problems. Longer-term effects can involve seizures, cognitive difficulties, sleep disorders, and changes in personality.
Why Some Symptoms Appear Later
The brain may continue changing after the initial injury.
Bleeding can increase pressure. Damaged blood vessels may weaken or narrow. Scarred brain tissue may disrupt electrical activity. Cerebrospinal fluid may also stop flowing normally.
A person may therefore seem stable at first and develop new symptoms later.
Warning signs should not be dismissed simply because the accident happened several days ago or the person initially felt fine.
Seizures After a Brain Injury
A seizure occurs when abnormal electrical activity disrupts normal brain function.
John discussed two general types.
A focal seizure begins in one area of the brain. It may cause jerking in one part of the body, unusual sensations, or changes in awareness. Some people remain conscious during the event.
A generalized seizure affects both sides of the brain and may cause loss of consciousness, muscle stiffness, and convulsions.
A traumatic brain injury may also worsen an existing seizure disorder that had previously been controlled.
Immediate, Early, and Late Seizures
Post-traumatic seizures may be grouped according to when they occur.
Immediate seizures happen within minutes or hours of the injury.
Early seizures occur during approximately the first week.
Late seizures develop more than a week afterward.
When seizures continue recurring after a traumatic brain injury, the condition may be described as post-traumatic epilepsy.
The timing, type, and frequency of the seizures can affect the medical evaluation and long-term treatment plan.
Eyewitness Accounts Can Be Critical
The person having a seizure may not remember what happened.
That makes information from family members, friends, coworkers, or bystanders especially important.
A witness should try to remember:
- How the seizure began
- Which body parts moved
- Whether the person lost consciousness
- How long it lasted
- Whether breathing changed
- How the person behaved afterward
- Whether another seizure followed
An EEG records electrical activity in the brain, but it may not always capture an event if the person is not actively having a seizure during the test.
A detailed eyewitness description may help the physician understand what occurred.
Testing for Post-Traumatic Seizures
The diagnostic process may involve several tests rather than one immediate answer.
Doctors may use:
- Blood tests
- CT scans
- MRI scans
- Electroencephalograms, or EEGs
- Neurological examinations
- Witness descriptions
- Follow-up evaluations
Blood tests may identify metabolic problems that could contribute to a seizure.
Imaging may reveal bleeding, scarring, or another structural abnormality. An EEG may identify unusual electrical patterns.
Reaching a complete diagnosis can take time, particularly when the events are intermittent.
Seizure Treatment Requires Follow-Up
Treatment may include anti-seizure medication.
The correct medication and dosage vary from patient to patient. Physicians may need to adjust the treatment based on seizure activity, side effects, other medical conditions, and test results.
Patients should not abruptly stop anti-seizure medication without medical guidance.
Suddenly discontinuing certain medications can increase the risk of another seizure or create additional complications.
Seizures may also affect the person’s ability to drive, work around machinery, or complete other activities safely.
Blood-Vessel Injuries After Trauma
A traumatic brain injury may also damage arteries and other blood vessels.
One possible complication is an arterial dissection.
This occurs when a tear develops in the inner lining of an artery. Blood may enter the artery wall, creating a blockage or reducing normal blood flow.
Possible symptoms include:
- Severe headache
- Neck pain
- Vision problems
- Dizziness
- Weakness
- Stroke-like symptoms
An arterial dissection can become dangerous if it interferes with blood flow to the brain.
Traumatic Aneurysms
A traumatic aneurysm occurs when an injured section of a blood vessel weakens and begins bulging outward.
The greatest concern is rupture.
If the aneurysm bursts, it can cause severe bleeding in or around the brain.
Possible warning signs include:
- A sudden, extreme headache
- Nausea or vomiting
- Vision changes
- Loss of consciousness
- New neurological problems
John and Kiley described this as the type of headache a person may recognize as dramatically different from anything previously experienced.
A sudden “worst headache” should be treated as a potential emergency.
Carotid-Cavernous Fistulas
The discussion also covered a carotid-cavernous sinus fistula.
This is an abnormal connection between an artery and a vein near the brain and eye.
The abnormal connection can increase pressure and blood flow in the area.
Symptoms may include:
- A bulging eye
- Vision problems
- Headaches
- Eye redness or swelling
- A whooshing sound in the ear
That whooshing sound may reflect blood moving through the abnormal connection under pressure.
Treatment may require a specialized surgical or radiological procedure.
What Is Hydrocephalus?
Hydrocephalus occurs when cerebrospinal fluid builds up within the brain’s ventricles.
Cerebrospinal fluid normally cushions and protects the brain while circulating through specific pathways.
Bleeding, swelling, or another injury may block those pathways and prevent the fluid from draining normally.
Because the skull is a fixed space, excess fluid can increase pressure and compress brain tissue.
Symptoms may include:
- Headache
- Nausea
- Vomiting
- Balance problems
- Confusion
- Changes in alertness
- Other neurological changes
Treating Fluid Buildup and Pressure
Treatment may involve placing a shunt.
A shunt is a tube that redirects excess cerebrospinal fluid from the brain to another area of the body where it can be absorbed.
Doctors may also use an endoscopic procedure to create a new pathway for the fluid.
In an emergency, a temporary drain may be inserted through the skull to reduce pressure until a longer-term treatment can be performed.
The appropriate procedure depends on the cause, severity, and progression of the hydrocephalus.
Recovery Can Be a Long Process
Delayed brain injury complications may require repeated testing, specialist appointments, medication adjustments, and monitoring over many months.
A patient dealing with seizures, memory problems, fatigue, or neurological changes may also struggle to organize appointments and communicate every symptom.
Family support can be extremely valuable.
A trusted person may help with transportation, medication schedules, appointment notes, and descriptions of changes the patient does not recognize.
When to Seek Immediate Care
A person should obtain emergency medical attention for symptoms such as:
- A seizure
- A sudden severe headache
- Repeated vomiting
- Loss of consciousness
- New weakness or numbness
- Speech difficulty
- Significant vision changes
- Confusion
- A bulging eye
- Rapidly worsening balance problems
These symptoms do not prove that someone has an aneurysm, arterial dissection, hydrocephalus, or another specific condition.
They do mean that prompt evaluation is appropriate.
Do Not Ignore New Neurological Symptoms
Brain injury recovery does not always follow a predictable timeline.
New symptoms may be related to the original injury even when they appear later. Continued communication with medical providers helps create a clearer picture of how the condition is developing.
Patients should attend follow-up appointments, take medications as directed, and report new or worsening symptoms honestly.
Delayed complications may be uncommon, but recognizing them early can help doctors begin treatment before the condition becomes more dangerous.
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