Synopsis: Traumatic brain injuries, even mild ones, may produce cognitive and personality changes months later, when that “bump on the head” has been forgotten. An expert explains these injuries and how to prevent some of the consequences.

Host: Nancy Benson. Guest: Dr. Sandeep Vaishnavi, neuroscientist, Duke University Medical Center, Director, Neuropsychiatric Clinic, Carolina Partners and co-author, The Traumatized Brain: A Family Guide to Understanding Mood, Memory, and Behavior After Brain Injury

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Nancy Benson: Sometimes people do things that you just can’t figure out. Let’s say your loving spouse or your best friend suddenly blows up at you over nothing, in a way they never have before. Maybe he or she apologizes, but before long, it happens again. And again. Vitriol gets spewed at you day after day, and you can’t figure out why. You’re frightened. Hurt. Bewildered. But think back. Did that person experience a bad bump to the head a few months ago?

Dr. Sandeep Vaishnavi: People can have personality changes. They can become agitated easily. They may become aggressive. They may have problems maintaining their impulse control.

Benson: That’s Dr. Sandeep Vaishnavi, a neuroscientist at the Duke University Medical Center, director of the Neuropsychiatric Clinic at Carolina Partners and co-author of the book, The Traumatized Brain: A Family Guide to Understanding Mood, Memory, and Behavior After Brain Injury. He says we know of as many as 2.5 million traumatic brain injuries each year in the United States, but the number is likely higher.

Vaishnavi: After the person recovers to some extent, what we see in the long term often times, especially with moderate to severe brain injuries is neuropsychiatric symptoms. I could characterize that as mood symptoms, behavioral symptoms, behavioral symptoms and cognitive symptoms. Under the mood category things like irritability, depression, trouble maintaining their mood. All of these things can occur. Then cognitively, what we can see is that people have trouble with processing speed; they think more slowly, they speak more slowly, they may have trouble multitasking, whereas before they never had problems doing that. They may have trouble paying attention appropriately, and they may have trouble with memory, especially short-term memory.      

Benson: However, those effects don’t necessarily happen right away. Sometimes they take months to show up. Moderate to severe brain injuries account for about 30 percent of all TBI’s. The great majority are mild injuries.

Vaishnavi: To have a traumatic brain injury, to meet that definition, what that means is that you’ve had some alteration in your awareness at that point when you had your head hit. It could be that you become dazed momentarily, or confused momentarily, but there has to be some alteration of awareness at that point in time. For mild traumatic brain injuries, you don’t have to have anything much more than that. It could be just a transient alteration in awareness, being dazed or confused. With more severe traumatic brain injuries it could be where you lose consciousness, or you go into a coma. It depends on the severity level.

Benson: But can just one mild concussion cause drastic mood or personality changes in the future?

Vaishnavi: Chances are that people will recover and not have permanent consequences. However, it does seem there’s evidence accumulating now that if you have multiple mild traumatic brain injuries, or multiple concussions, that can actually add up over time and perhaps lead to more permanent problems. There is a pathological diagnosis which is a bit controversial still, but something called chronic traumatic encephalopathy, C-T-E, which is thought to be basically where people have brain changes and brain damage due to the accumulation of multiple mild traumatic brain injuries. So if you have many of those mild brain injuries over time, they may very well accumulate and cause permanent problems. In fact, this is a really hot topic right now because of football season and in general because of sports.

Benson: In fact, on Christmas day, the movie Concussion opens, with Will Smith playing the neuropathologist who first published findings of C-T-E in the brains of deceased football players. But what about the rest of us? When should you be concerned about a bump on the head? Should you rush to the hospital if you bang your head walking into the low tool shed door?

Vaishnavi: It depends on what symptoms occur afterwards. If it’s just a bump on the head you’re momentarily dazed, that may be fine. Most people do recover from that quite well. If someone were to bump their head and get dazed and confused, we tend to be more conservative now than in the past, especially if there are things like they are dizzy or cognitively they’re impaired, they’re having memory problems, they’re having attentional problems, trouble focusing for example, or they’re nauseous or throwing up. All those things would probably necessitate a visit to the hospital.

Benson: Vaishnavi says after a traumatic brain injury — even a mild one — victims can enhance their own recovery by observing these basic guidelines.

Vaishnavi: Avoiding alcohol and certainly avoiding drugs, because those agents can definitely worsen recovery, that’s number one. Number two is that exercise in a graduated fashion as you are able to exercise, is important. Exercise, actually aerobic exercise especially, has a physical benefit; it has mood benefits and it may have benefits it terms of brain recovery as well, so that’s number two. Number three is that certain nutrients can be important, like omega-3 fatty acids, found in fish oil and other agents like that, B-complex vitamins may have some benefit as well. So we generally recommend patients take them. Number four is meditation. Meditation is actually an very important piece, or tool as it were for recovery after brain injury we have found.

Benson: And, of course, there’s a whole gamut of medications that can be used.

Vaishnavi: With the cognitive aspects where people are having processing difficulties, they’re slower, they’re having trouble with their attention and focus, stimulant medications may be helpful. With people who have, especially frontal lobe injuries and they are very impulsive and disinhibited, there’s actually an old medicine called amantadine that we use a lot. It originally was used for the flu.

Benson: And finally, depending on how agitated or aggressive a person may be, or for someone who exhibits psychotic symptoms, Vaishnavi says there are plenty of mood stabilizing medicines available.

Vaishnavi: One of the things we’ve learned from traumatic brain injury is that psychiatric symptoms, meaning mood, behavior, and cognitive symptoms, are part and parcel of neurological disorders. So traumatic brain injury is direct damage to brain, obviously. It’s a neurological disorder, but these mood, behavioral, and cognitive symptoms, these psychiatric symptoms are part of that whole syndrome. They happen because of damage to certain circuits of the brain. If people understand that, people will blame themselves less after a traumatic brain injury.  They won’t find themselves at fault because their behavior is not what it normally would be. Or family members would be more understanding, and friends would understand that this is not the person trying to be bad or agitated or aggressive. This is because of certain circuits being damaged in their brain because of the brain injury.

Benson: You can learn more about Dr. Sandeep Vaishnavi and his book The Traumatized Brain by visiting our web site at Our writer this week is Polly Hansen. Our production director is Sean Waldron. I’m Nancy Benson.


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