Few people think about traumatic brain injury (TBI) unless they have one or know someone who has one. Know the signs and symptoms of brain injuries in adults and children, the common causes of TBI, and how it may impact mental health.

Most concussions are diagnosed in noncombat settings: That’s why it’s time to start thinking about TBI and how to prevent it. It’s everyone’s duty to understand the injury and tell your families, line leaders and health care providers when you think you have been injured.

Myth
TBI in the military occurs most often in combat.
Fact
The majority of TBIs treated by military physicians are diagnosed in noncombat settings.

What is a TBI?

A TBI occurs when a sudden jolt — from something like a motorcycle or bicycle accident, a fender-bender, a gun recoil on the shooting range or a tackle in a friendly game of football — causes the brain to hit the skull. The result can be a mild, moderate or severe brain injury. You may feel woozy or confused, see spots or lose consciousness.

A concussion — a mild form of brain injury — is the most common form of TBI in the military. Unfortunately, the signs and symptoms of a concussion can be the hardest to recognize among the types of TBI.

Sustaining a concussion or any brain injury can lead to changes in cognitive abilities and control of emotions, mobility, speech and senses. Left undiagnosed and untreated, a TBI can have a huge impact on how a person thinks and acts, and on his or her mental health.

If you suspect that you have a TBI, seek help from a medical professional.

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What are the common causes of concussions and other brain injuries?

You might think that the chances of getting a TBI are far higher for those in combat. In fact, according to the Armed Forces Health Surveillance Center, concussions and other brain injuries in service members most often occur from incidents associated with:

  • Motor vehicle collisions
  • Falls
  • Sports
  • Assault
  • Accidental or intentional discharge of weapons
  • Impact with objects

What you need to know: Most of these brain injuries can be prevented.

Signs and Symptoms of Concussions and Brain Injury

When it comes to TBI, the signs — things that you, or others, observe — can be subtle and may not appear immediately. Symptoms — something you experience — can last for days, weeks or longer. No one should return to vigorous physical activity after any type of brain injury, even a concussion, without the approval of a medical professional.

Common symptoms after a TBI may include headache, dizziness, memory loss and confusion. Amnesia can also occur, typically involving the loss of memory of the event that caused the injury.

Signs and symptoms after a brain injury may include:

  • Headache or a sensation of pressure in the head — the most common symptom of TBI
  • Loss of or alteration of consciousness
  • Blurred eyesight or other vision problems, such as dilated or uneven pupils
  • Confusion
  • Dizziness, feeling off-balance or the sensation of spinning
  • Ringing in the ears
  • Nausea or vomiting
  • Slurred speech
  • Delayed response to questions
  • Memory loss
  • Fatigue

Some signs and symptoms may not appear for hours or days, such as:

  • Trouble concentrating
  • Continued or persistent memory loss
  • Irritability and other personality changes
  • Sensitivity to light and noise
  • Sleep problems
  • Mood swings, stress, anxiety or depression
  • Disorders of taste and smell

It’s important to know that not everyone experiences all of these symptoms, and not everyone experiences them to the same degree. For example, if you collide with your teammate at a pickup basketball game and you both hit your heads, you might get a mild headache or feel dizzy; your teammate may have blurred vision or feel confused. Both of you have symptoms of TBI, and both of you need to get checked out.

Those who regularly participate in sports and might have a concussion should not resume play until they have been seen by a health care professional trained in evaluating and managing concussions.

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TBI and Mental Health

Sometimes, a TBI can cause changes in your mood and behavior. For example, if a TBI affects your frontal lobe — the area of the brain that controls your emotions — you may feel as if you can’t manage your own behavior.

These symptoms can be confusing: You might feel elated one minute and down the next. You might feel aggressive one day, and the next day feel “shut down” emotionally. It’s important for you and your family to know that your injury could be the cause of these changes and that some of your actions and feelings might not — for now — be within your control. You may experience any of the following mood or behavior symptoms:

  • Verbal outbursts
  • Physical outbursts
  • Poor judgment
  • Impulsive behavior
  • Negativity
  • Intolerance
  • Apathy
  • Egocentricity
  • Rigidity and inflexibility
  • Risky behavior
  • Lack of empathy
  • Lack of motivation or initiative
  • Depression or anxiety

It’s also important to know that treatment can help. Call the 24/7 DCoE Outreach Center to find treatment options in your area with help from a trained health professional who has expertise in psychological health and TBI. These professionals are trusted sources of information and can respond to your questions and direct you to the resources that fit your exact needs. If the professional can’t answer your question, he or she will connect you with someone who can — whether it’s within the Department of Defense, in other federal agencies or in civilian and community organizations. All calls are free and confidential.

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Symptoms in Children

Just as you look out for your military unit, you need to make sure that your loved ones at home are safe too. Children are at risk of getting a concussion through daily activities, such as sports and games, and brain injury can be difficult to detect because kids may not be able to clearly describe how they feel.

Call your doctor if your child receives anything more than a light bump on the head, especially if you notice:

  • Excessive crying
  • Loss of appetite
  • Loss of interest in favorite toys or activities
  • Sleep issues
  • Vomiting
  • Irritability
  • Unsteadiness while standing

If you’re not sure whether your child is experiencing a concussion, you need to seek medical advice as soon as possible. Children showing signs or symptoms of a concussion should not return to playing or rough-and-tumble activities until a doctor approves.

Bottom line: If your child may have a concussion, do not allow him or her to return to play or regular activities on the day of injury, and get checked out by a health care provider right away.

toy bear with bandaid on head

How Is TBI Diagnosed?

Diagnosis begins when you talk to a health care provider about the injury. Expect to share the following details:

  • How the injury happened
  • What area of the head or body was struck, and with what degree of force
  • Whether the person lost consciousness or seemed dazed; if so, for how long (seconds, minutes, hours)
  • Any changes in behavior, awareness, speech or coordination

Next, a provider will look for signs of brain injury using simple tests that measure cognitive function, including speech, movement, memory and thoughts. Most concussions are diagnosed based on the signs a provider observes, the symptoms you describe and TBI screening by the provider.

More severe brain injury may require in-depth evaluation by a health care professional. Doctors may order imaging — a CT scan or an MRI — to help evaluate the degree of injury. Those scans can show fractures and evidence of hemorrhage, blood clots and bruising or swelling in the brain. If there is swelling, the doctor may use an intracranial pressure monitor to pinpoint the level of pressure changes inside the skull and determine the steps necessary to respond. Learn more about the diagnosis and assessment of TBI.

diagram of human brain