I just meant that brain injuries, in general, are baffling.

Why is there so much variation in how much, and how rapidly, different patients recover?

How can patients, with broadly similar injuries, have such vastly different outcomes?

Why, on occasion, do those with serious injuries (lose of consciousness, skull penetration) recover better than those who suffered seemingly minor concussions?

It's extraordinary, really.

You stated "(the second impact thing: cant find the med site. It wasn refing Second Concussion Sydrome but rather that the inititial impact and subsequent swelling (mins, hours or days later) are considered seperate events. Sometimes the second doesnt occur and the inured just has a mild concussion rather than TBI)"

In my years of researching concussions, I have never heard anything like this. Concussions are known to cause a cascade of events with some symptoms not manifesting for days or weeks. Those that consider later swelling a separate event are not up to the medical knowledge. In fact, one expert chastises the ER docs and others who see the patient first of the need to note in the chart that a head impact was suffered, whether there are current concussion symptoms or not. This way subsequent issues can be properly tied to the head impact.

Unfortunately, many doctors focus on the bleeding and obvious contusions without addressing the possibility of a concussion.

There is solid evidence that shows that the presence or absence of short term Loss Of Consciousness (a few minutes) has no bearing on the severity of the injury. What is more important are the symptoms that show on a thorough neurological assessment. It appears you had many observable symptoms that should have caused the doctor to either admit you or at the least schedule a follow-up exam the next day or two. A simple phone conversation would have been a good indicator of your mental state. Standard protocol dictates following a patient like you for 24 hours at the minimum, even if that following is by phone.

I don't think that your first doctor would have been much better at all even if you have more specific information. He already had enough information to help you but chose not to.

Cheers Hockey. Thought that was what you meant but wanted to check in case my story was more confused than i realsied. Been thinking some more and i do have a few more vague memories.

On the journey home,in the car, is when i think i was trying to get changed and got a bit naked. My sister was asking me what i was doing and insulting me. I also think i tried to get out of the a when it was moving, feeling trapped and wanting to get away from her. I still had my seatbelt on and she shouted at m to close the door then put the child lock on. My son confirmed the dressing part said i just wanted to get warm and dry. Think he was asleep for the latter.

Mark-

I think we're talking about the same thing. Breaking down and labeling changes/developments as 'events' is very typical of scientific language. you your self mentioned a cascade of events.

1st- what is your intrepatation of concussion? My understanding,much like in music when two cymbols crash and it is termed a concussive sound, is that a concussion is the brain knocking against the skull. This can be caused by an object striking the head or by the head moving at great force-whipping back and forth.

A brain inury may result from this, if enough force caused physical damage to the brain tissue. But with a concussion it is often the subsequent swelling that puts pressure on the brain and causes furthr symptoms as particular regions are squeezed.

A brain inury is physical damage to the actual tissue, either by blunt force trauma, penetrating inury of an object or bone splinters. Which can also be further exacerberated by subsequent swelling.

In th instance of bleeding/CSF leak:

If this does not happen straight away at impact t may be that the brain swelling does not leave enough room in the skull for everything that normall presides there and so CSF will leak out of passages that already exit- the sinuses.

Sooner CSF leak or bleeding implies that something has torn, often in the ear where your canal leads to the part of the brain which deals with auditory processes, or nose which frontal lob damage or strike to the back of the head. If the something torn is only a minor vessel your body may be able to heal this on its own, if it is something more major, or in the protective sheath this can lead to continued leak/possibility of infection, a lack of vital supply to brain regions.

I think there is also the possibililly that the brain swelling can essentially block these tears for awhile, hiding their presence. There is also the possibility that your brain is directing energy/physical response to other areas that it deems need help more and so repair is delayed. Or tht the regions that control thee activites have experianced cell death and your brain is not producing these impulses/guidence for your body as it used to.

So the type of impact, where that occured, the force experiance and the way and time events/physical reactions (or the phycolgical manifestation of such) is very important. Not just to ascertain immediate dangers but also for future prognosis/care.

This is probably why short term loss of consciousness isnt a great indicator. I thought i had only lost con' for a few mins but it seems i slipped into a coma like state for a hour-ish and had severe other symptos, the post traumatic amensia, in bouts that lasted a few hours (possibly days) as well.

You are too focused on brain swelling as a defining condition of concussion or brain injury.

Every concussion is a brain injury . There is diffuse axonal injury, contusions (bruising), etc. CNS leaks require some sort of tearing.

Researchers have tried to create a repeatable matrix of injury forces, immediate symptoms (LOC, amnesia etc. GCS) and treatment protocols,and recovery times and have not been able to show a reliable direct connection. Some people can be knocked out for 5 minutes and regain consciousness with minimal ongoing symptoms. Others can have no LOC and manifest severe symptoms.

Actually, a few years back, the US Department of Defense awarded a multi-million dollar contract to a research clinic to 'define a concussion.' They wanted to be able to accurately diagnose a concussion in clinical situations.

As it stands, a concussion is currently defined as an mTBI resulting from trauma forces to the head/brain resulting in any number of specific symptoms within the cluster of symptoms common to concussion. These trauma forces do not need to be caused by an impact but can be the result of non-contact whipping (whiplash) or jarring.

The delayed symptoms are not limited to swelling. Often, these symptoms are the result of cellular death as the brain shuts down neural pathways that are malfunctioning. There is often damage to the glymph system resulting in a build-up of metabolic waste and waste related to the absorption of dead cells. Often, the capillary system has been damaged or strained resulting is poor blood perfusion. There may be swelling but often all there is is a inability for the brain to control fluid (blood, CNS) pressure within the brain. This is different from inflammatory swelling. Both can occur. Damage to the myelin sheath covering the axons and other neural fibers also causes symptoms.

There is technology to image these different injuries but there is no established protocol for treating these injuries based on those images. They still must rely on symptoms to guide treatment. A neurological exam is used to determine the severity of the injury and the possibility of a need for immediate intervention/investigation to treat a bleed or other focal injury. The mechanism of injury may help direct the investigation but it is an unreliable means of diagnosing.

In your case, it sounds like you suffered a crushing force to your skull and possible impact forces that jarred your brain within your skull. These can combine to cause a complex cluster of symptoms.

btw, We have had people here on NT who have had CNS leaks without elevated ICP (IntraCranial Pressure) .

Quote by Mark IN Idaho

In my years of researching concussions, I have never heard anything like this. Concussions are known to cause a cascade of events with some symptoms not manifesting for days or weeks. Those that consider later swelling a separate event are not up to the medical knowledge. In fact, one expert chastises the ER docs and others who see the patient first of the need to note in the chart that a head impact was suffered, whether there are current concussion symptoms or not. This way subsequent issues can be properly tied to the head impact.


I have to definitely agree with Mark on this. I went months without a concussion diagnosis, even though every record of doctor visits, ER visits, all have documented issues. Add to that, the fact that I was rearended at 65 mph.

I happen to be one of the people who really didn't realize there was issues going on concussion wise... it wasn't until the neurosurgeon put it into perspective for me that it made sense.

[QUOTE=Hockey;1109677]When they say, "don't trust what you think you know about your injury," I think they are also referring to the fact that TBI patients can often be unaware of their own deficits. In fact, sometimes it's the worst affected who most believe they're $100% okay.

There have been cases of TBI patients being unable to acknowledge such seemingly obvious things as blindness in one eye. We've had members here assert that they are not cognitively damaged - in jumbled posts that are clearly the products of disoriented, confused minds.

Before I was tested, I thought I was aware of all of my issues. Not so. Prior to being tested by a neuro-psychologist and a neuro-optomologist, I had no idea that I was repeating myself, had lost my ability to see patterns, was completely inattentive to a significant area of my visual field, etc..., etc...,


After 2 years of not knowing I was really symptomatic, it was my reliance on the doctors to tell me how I was doing. Still to this day I become aware of new oddities that I have that are due to the injury. Every time I see my doctor I say, "Oh yeah, and I do this and I do that and I'm super hungry, and I'm not sleeping, and I can't see straight," etc. It's not that I mean to leave symptoms out, it's that sadly with many TBI patients, I forget what symptoms I have!

So I think it is absolutely necessary that you continue seeing doctors that are well versed in neurology and brain injuries so you don't get worse as time goes by. They will be able to put the story together for you that you may not be able to do currently.

Sounds like a really bad situation. I hope you are recovering ok. What are your main symptoms?