Brain injury

Warning signs – note that not every sign and symptom will be present in every person. 

• complaints of neck pain 
• increasing confusion or irritability  
• repeated vomiting (being sick) 
• seizure (fit) or convulsion 
• double or blurred vision  
• sleep difficulties – being very sleepy or difficult to wake 
• lightheaded and dizzy 
• slurred speech 
• strange feelings or a loss of movement down one side of the body 
• leaking blood or fluid from the ears or nose 
• visible skull deformity 
• muscle weakness, tingling or burning in arms or legs 
• fatigue or tiredness 
• decreasing level of consciousness or alertness 
• severe or increasing headache 
• unusual change in behaviour 
• difficulty remembering things. 

If you or someone you care for has had a fall or may have a brain injury, see a healthcare provider as soon as possible. You can also call Healthline free on 0800 611 116 if you’re unsure what to do. 

Note: Signs of brain injury may not appear for 24 to 48 hours due to a gradual increase in swelling or bruising around your brain. 

A brain injury can be caused by: 

• a medical problem, or  
• direct or indirect force to your head or shaking of your head or upper body – this is called a traumatic brain injury or TBI. 

Medical causes of brain injury 

Medical problems that can cause brain injury include: 

• brain tumours
• bleeding in your brain 
• stroke 
• infection, eg, meningitis 
• lack of oxygen to the brain, eg, due to drowning, choking, prolonged seizures or respiratory failure. 

Ongoing alcohol and drug abuse can also cause brain injury, as can poisoning with toxic substances such as pesticides, gases and solvents.  

Traumatic brain injury (TBI) 

A traumatic brain injury (TBI) is caused when an impact (bump or blow) to your head or body causes your brain to shake inside your skull.   

In Aotearoa New Zealand, the most common causes of TBI are: 

• falls  
• sports injuries 
• motor vehicle accidents. 

A TBI can be mild, moderate or severe, depending on how long you’re unconscious for and the amount of memory loss you have.  A mild TBI may or may not affect how your brain functions. A concussion is a mild TBI that does affect how your brain functions.  

Find out more about traumatic brain injury (TBI) and concussion. 

Older people 

The most common cause of brain injury in older people is a fall. If you or someone you care for has experienced a fall, see a healthcare provider as soon as possible to check for the possibility of a brain injury. A brain injury can occur even if the fall is minor or not from a great height. Find out more about falls and how to prevent them. 

The effects of brain injury are different for everyone. How you’re affected depends on which parts of your brain are affected and how seriously. 

If you have a brain injury you may have symptoms such as: 

• headache 
• fatigue (extreme tiredness) 
• nausea (feeling sick) or vomiting (being sick)
• blurred vision 
• dizziness 
• seizures
• ringing in your ears  
• memory problems 
• concentration problems 
• moodiness 
• sleep problems 
• irritability or other changes in behaviour 
• weakness or paralysis on one side of your body 
• coordination and balance problems.  

If you have a moderate to severe brain injury, you’re likely to have some physical, cognitive (thinking) or behavioural disability. About 5% of TBIs in Aotearoa New Zealand are moderate to severe.  

Some symptoms may appear right away, whereas others may not be seen for days or weeks after the trauma or onset of the medical condition causing the brain injury. Some symptoms may disappear after a few hours; some may continue for weeks or months. 

See ‘What is the outlook if I have a brain injury?’ for some of the ongoing problems that may occur after a brain injury. 

Your healthcare provider will ask you about your symptoms and do a neurological (nervous system) examination to check things such as your strength, balance, coordination, reflexes, ability to feel sensations like touch, pain and temperature, and thinking skills. Imaging tests, such as a CT scan, may also be needed to help find out the cause of your brain injury.  

To assess the effect an injury or medical condition has had on your brain, and determine severity, your healthcare provider will use the Glasgow Coma Scale (GCS) to measure your physical, verbal and eye-opening responses. Read more about the Glasgow Coma Scale(external link).

Brain injuries can range from mild to severe according to the GCS, with mild being a GCS score of 14 to 15, moderate 9 to 13, and severe 8 or below. 

Read more about diagnosis of concussion, which is classified as a mild traumatic brain injury. 

Read more about diagnosis of a head injury, which includes injuries to your skull and scalp as well as traumatic brain injuries. 

The management of a brain injury will depend on what’s caused the damage to your brain. 

If your brain injury is caused by a medical condition, treatment will focus on that condition and will include rehabilitation from the effects of the brain damage that you experience. 

If you have a traumatic brain injury, treatment will depend on the type and severity of the injury. Read more about treatment of traumatic brain injury, including concussion. 

Recovery from brain injury takes time. As well as physical effects, you may experience impacts on your emotional and social wellbeing.  

It’s important to take care of yourself.  

• Do things you enjoy. You may find you enjoy doing something you wouldn’t have tried before.
• Ask for help when you need it, eg, from whānau, friends, or your healthcare provider. 
• Stay healthy through diet, regular exercise and rest. 
• Learn relaxation techniques. You might like to look at some meditation and mindfulness apps or mindfulness videos. 
• Stay in touch with friends and try to make new support networks. You could join a support group, eg, with your local Brain Injury Association(external link).

Read about things you can do if you’ve had a traumatic brain injury or concussion. 

Apps reviewed by Healthify

You may find it useful to look at some concussion apps, stroke apps and falls prevention apps. 

Your future progress after a brain injury will depend on the cause, extent and severity of the damage to your brain. 

If you have a medical cause for your brain injury, your outlook will depend on the particular condition that you have. 

Most people with a mild traumatic brain injury (TBI) recover at home without specific treatment. You may have mood or behaviour changes, but if you have a good understanding of your symptoms and can make some changes to your lifestyle while you recover you can make a full recovery. See our concussion page for things you can do to help you recover from a mild TBI.  

If you have a moderate or severe TBI, you may require hospital admission and more intensive rehabilitation. 

Because the brain is so complicated, it’s difficult to know exactly what the long-term outcome will be. Most people keep getting better slowly over time, but some people never recover to be exactly as they were before their brain injury. 
 
Possible ongoing problems include: 

• cognitive problems, such as difficulties with thinking clearly, concentrating, problem-solving and completing projects 
• memory problems, especially learning and remembering new information 
• physical problems, such as headaches, balance or coordination problems, fatigue that makes you feel less energetic both mentally and physically, slower reflexes and headaches 
• sensory problems, eg, you might be more sensitive to light and noise, or have problems with taste, smell and touch or with your hearing or vision 
• communication difficulties making it difficult to express yourself and understand others
• personality changes, such as irritability, intolerance, depression, anxiety, socially inappropriate behaviour and mood swings
• loss of contact with friends and associates. 
  
  

Older people 

The effects of a brain injury in older people can be serious and long term. These can include: 

• a greater risk of cognitive decline (problems with thinking and memory) 
• longer recovery 
• other consequences, eg, fractures (broken bones).  

More than two-thirds of older adults with mild brain injury recover fully. Older people who are most at risk of poor recovery from a mild brain injury include those who: 

• are frail 
• have been diagnosed with dementia 
• have a history of cancer 
• are taking or have taken blood-thinning medicines in the past. 

A brain injury can have a dramatic impact on your family, job, social and community life.     

When someone in your family has a brain injury, the whole whānau is affected. 

This could involve the following:  

• The initial shock of the brain injury. This can include coping with intensive care treatment. 
• Dealing with ACC, hospitals, WINZ and other agencies. 
• Adjusting to the changes in the person with the brain injury and how these may affect other family members and friends.
• Coping with financial and legal problems. 
• Stress related to caring for the person. 

Brain Injury New Zealand(external link) has a range of resources for living with brain injury. It represents regional Brain Injury Associations across Aotearoa New Zealand. They provide advocacy, education, and support to people affected by brain injury and their whānau. They organise support groups and can help with paperwork (eg, for ACC and WINZ), meetings and finding out about support systems. 

Read about coping with brain injury for family and friends(external link).