Trauma: Long Term Consequences of Traumatic Brain Injury
Guest: Dr. Angela Hays - Neurosciences
Host: Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Angela Hays who is
Assistant Professor of Neurosciences her at the Medical University of South
Carolina. Dr. Hays, in an earlier
podcast we talked about how a bump on the head can potentially lead to
traumatic brain injury, and you talked, in that podcast, about some of the
warning signs that might be a bleed, but let’s talk about a different kind of
scenario. Let’s imagine that nothing
acutely worrisome happens, but let’s say there has been loss of consciousness,
for whatever period of time, short or long, and now the patient is complaining
of long-term symptoms. What are some of
the long-term consequences of traumatic brain injury?
Angela Hays: Probably the single most
common difficulty is with short-term memory.
And that holds pretty much across the spectrum, although it’s more
common with a severe brain injury than the less severe. Other complaints people typically present
with are feelings of dizziness, headaches, and, actually, head trauma can cause
migraine-type headaches, acutely certainly.
Sometimes it takes several days to weeks for those to resolve. Also, depending on what part of the head
sustained most of the injury, people can have alterations in their sense of
smell and taste because the olfactory nerve, the cranial nerve that’s most
responsible for the sense of smell, runs along the edge of the skull and is
very susceptible to trauma. So, people
often complain that their food doesn’t taste right, and their sense of smell is
lost immediately after a head injury. In
most cases, that will improve with time, although, unfortunately, sometimes
Linda Austin: Now, when you say, improve with time, I’ve seen cases of
traumatic brain injury where the symptoms really persisted for quite a while,
even a year or two. Is that common?
Angela Hays: It certainly is. And we’re seeing that more and more with
members of our armed services who have injuries as a result of blast explosions
and that kind of thing. Right over the
olfactory nerve are the bilateral frontal lobes which are responsible for a lot
of the decision-making capability. A lot
of our personality derives from tissue in that region. Those portions of the brain are, again, very
susceptible to trauma, and there are some patients who will actually have
personality changes following a significant head injury.
Linda Austin: What kinds of personality
Angela Hays: Depression is not
uncommon. People can also develop a
syndrome that’s called abulia, which means they have depressed executive
function, meaning, they can’t take the initiative to get up and get it done,
more or less, to put it in layman’s terms.
And that, as you can imagine, is an extremely disabling problem for
people. They find that a person who was
previously driven and able to take care of a number of activities at once will
find that they simply lack the motivation or the will just to get up and take
care of things that used to be easy for them.
And, unfortunately, although research is ongoing at this point, we don’t
have a really good way of treating those kinds of symptoms. Although, like I said, there those of us out
there who are hoping to continue to improve that field as time goes on.
Linda Austin: So, what is your advice
for someone who has sustained a traumatic brain injury?
Angela Hays: I think the first thing to
do is to find a good neurologist or a PM&R specialist.
Linda Austin: Physical medicine and
Angela Hays: Yeah, who might be able to
determine whether there’s anything else going on that might be contributing to
the symptoms. I think the first place to
start is a good head scan to make sure that there isn’t any bleeding, as we
talked about in our previous session.
Another thing to be on the lookout for is the possibility that seizures
could be contributing to the problem because a certain percentage of patients,
after a head injury, will develop seizures.
It’s not terribly common, but it does happen. And, posttraumatic epilepsy can contribute to
all of those symptoms that we spoke about.
Seizures can often present with a sense of an abnormal smell or
taste. They can sometimes result in mood
changes. And, seizures don’t necessarily
have to be the dramatic kind of thing that we often think of when somebody
talks about a grand mal seizure or generalized tonic-clonic event. Sometimes they can be much more subtle and
can present as just a staring spell or losing track of conversation in some
cases. If somebody’s having persistent
symptoms long after a mild to moderate head injury, an EEG might be part of an
appropriate workup, and a visit with a good neurologist can help to sort that
Linda Austin: And it sounds like it’s
important for the patient and family to be very patient during this time,
frustrating though it may be.
Angela Hays: That’s definitely
true. The brain, in a lot of ways, holds
many mysteries for us and we’re actively trying to sort those out. But, the fact of the matter is, we don’t have
optimal therapies for a lot of the things that patients face coming out of a
traumatic brain injury. There is help
out there, but we may not be able to fix all the symptoms and we probably won’t
be able to do it fast. The best advice I
can give at this point would be to rule out things that might be life-threatening
or that might cause further injury and then try to treat the symptoms on a
Linda Austin: Dr. Hays, thank you so
Angela Hays: You’re welcome.
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