Some questions regarding Traumatic Brain Injury
 

Last year during the summer I had an accident while I was hiking in the mountains.I felt around 15 meters and besides numerous contusions, broken ribs etc I fractured my skull and had a concussion, to this day I don't remember what happened in that day or the day before, only what my friends told me.
In the day of the accident and the next day, I never loss consciousness but my mind was mess, I kept asking for water and asking what had happened over and over again, I also didn't knew who my friends were anymore.In the second day and forward I recovered my mind and could remember my friends.
This all happened in Morocco, so medical care wasn't that great.When I got back to my country I did a cat scan and all seemed normal (although at the time the doctors were more worried with my pneumothorax).
A year has passed and I feel more or less back to normal, I read about some of the symptoms a person that suffers brain injury could have and I dont think I have any of them besides my memory not being so good or a bit more difficulty having a good night sleep.
Now for the questions.

1) Should I consult an expert in this field to do a follow up? Doing another cat scan, comparing it with the oldest one, or is it not really needed since I am not feeling the symptoms?

2) I love doing sports, do I still limitations in terms of things I can or can't do because of my accident, or since a year has passed, can I do pretty much everything again?


P.S - English is not my first language so I am sorry if any of my writing seems a bit funny.

Carlos,

Welcome to Neuro Talk. Your English is fine. Better than some mTBI people who know English as their mother tongue.

That is a good sign. You bi-lingual skills shows your brain is functioning well. But, this does not mean your brain can handle another impact. You are healed enough to not have to worry about Second Impact Syndrome (can be lethal) but Multiple Impact Syndrome will be a real risk for the rest of your life.

You would be wise to sit down with those who are close to you and discuss your future. Do you have responsibility over/for others? i.e. A wife and family, etc. You have residual injuries to your brain. They will show up when you are under stress. Your family and others need to know this.

You need to make the hard decision about contact sports. Soccer can be very dangerous. Heading the ball is a know risk for head injury. Head to head collisions during an attempt to head the ball can be very dangerous. But, it is a decision you need to make. Nobody can decide for you. The risks are real.

I am assuming soccer is one of your favorites. I played on a high school soccer team with immigrants from Portugal. We/they were the best in the state.

Many risks can be managed with some simple modifications of how you participate in the sport. Good helmets are a must but will not protect your injured brain as well as needed.

So, go ahead and live your life but take precautions to prevent any more head impacts. You have experienced serious symptoms of head injury. You do not want them back in a permanent way. Living with memory or other cognitive struggles can make for a miserable life sometimes. Find the new activities that do not put your brain at risk and enjoy your life.

A second CT would not be any help. There are not any 'experts' that can help you at this point. A neuro-psychological assessment will show if you have any residual symptoms. If you find you are struggling at work, etc. a neuro-psych assessment would be worthwhile. It can help you understand your limitations so you can devise ways to work-around those limitations.

Be aware than you may have some personality changes. Understanding them can help you respond to others, especially in stressful situations.

So, just be good to your brain. Keep it safe but enjoy your life.

My best to you.

Thanks for your reply, I am 26 year old, still with no family, still in university, I play soccer and I did boxing. Since the accident I stopped going to boxing completions and just do the workout and spar a bit, guess I need to think better about what I should and shouldn't do.
I would like to know more about what you said regarding the appearance of residual injuries during stressful situations?

Carlos,

There are a variety of stresses that can cause a return or increase in symptoms. Just about anything that puts extra burden on the brain to function will cause an increase in symptoms.

The external stressors are things like high altitude (2000 to 2500 meters elevation or more), over-stimulation such as loud or multiple sounds (a noisy public address system or multiple voices speaking at once at a social function). Even echos can be a stressor. Bright or flashing lights can cause visual over-stimulation. A party or celebration environment with multi-colored decorations in all ranges of view can cause visual overload. Any impact or sudden movement of the head can cause a wide range of symptoms.

Your sparing is a serious concern. Boxing head gear does not protect you. Heading a soccer ball, especially repeatedly, can be very dangerous.

Poor or inadequate nutrition, hypoglycemia (low blood sugar, either from a bodily malfunction or lack of consuming adequate calories.) alcohol ingestion (the acceptable rule is one serving of alcohol per meal), recreational drug use, all can challenge the recovering brain to perform the correct bio-chemical processes.

Overworking such as intense reading, too much need to pay attention to complex processes, multi-tasking pressures, and anything that causes the brain to try to work at a high level without adequate recovery time (naps, routine sleep or relaxation)

Emotional stressors such as relationship struggles, depression, anxiety, uncertainty about the future (job or others), public commotion and disasters (auto accident or serious injury/illness to self or others), can cause a build up of stress toxins in the brain needing time to clear.

Illness, high fever, etc can cause a reaction just like receiving a new concussion.

So, basically,you need to stop boxing and be disciplined with your soccer play. No heading the ball or getting physical in tackling an opponent to gain control of the ball.

You have likely used up most of your brains ability to rewire or reorganize around damaged areas. Head blows in boxing have likely been a serious strain on your brain. I would not be surprised if you have symptoms from quick head movements.

I have almost zero tolerance for alcohol. My time at noisy social functions is seriously limited. I may survive the function but pay for it with the need of a few days or even weeks to recover.

If you are not already experiencing these limitations, your brain is likely getting to the critical mass threshold of physical damage/limitations. If you reduce or eliminate the stressors listed and any others, you can go on to have a full and functional life. It is a matter of choosing the correct priorities. You will trade short term risks for long term symptoms.

I am not trying to scare you but instead give you a sense of the reality of cumulative brain impacts. Dementia pugilistica is the medical term for 'punch drunk.' It is well understood. Poor memory, difficulty controlling outbursts of anger/aggression, emotional struggles (crying) and many others symptoms can drastically change your life. You have an opportunity to limit the impact of this dementia by making good choices for your future.

I knew of my sensitivity to head impacts and tried to limit my risks since I was 16 years old. No contact sports or other physical risks of a head bump, etc. I still endured many head bumps due to just an active life. At 46 years old, my final head bump changed my life forever. I have learned many ways to still function at a high level but don't let my posts fool you. I need the screen as my short term memory to keep track of my thoughts so others can understand me.

My driving is severely limited. I can't be in noisy environments without getting overloaded. No shopping at the mall at Christmas. My ability to endure social gatherings is severely limited.

And, I tried diligently to avoid further head bump risks.

You can choose to avoid the know risks so that your brain can somewhat tolerate the unknown risks. There is still lots of life to enjoy. Go enjoy it with an eye for the future.

My brain is exhausted. Time for a nap.

My best to you.

I thank you for such an informative and complete answer to my question.
As much as I gonna miss it, I am gonna quit boxing, as for soccer I will probably just stop going for high balls with my head.

Best regards, Carlos

Carlos, I like your answer. No matter how good one gets at heading the ball, it is the footwork that keeps control of the ball.

My best to you.

welcome
 

welcome carlos

no more head impacts is the only good advice that can be given, if you value your future , most sports peaple are good at other sports say golf tennis , who knows you maybe a world champ