Watch for These Signs of Severe Brain Injury After Bumping Your Head

Comedian Bob Saget’s January death was recently revealed by his family and the Florida medical examiner’s office to be a result of accidental head trauma. “They [the authorities] have concluded that he accidentally hit the back of his head on something, thought nothing of it and went to sleep,” his family’s statement said. “No drugs or alcohol were involved.” According to ABC News, Saget was found “lying face up on his bed; his left arm was across his chest and his right arm was resting on his bed.”

The news was jarring, to say the least. How can a bump to the head feel benign enough to disregard in favour of some shut-eye, then wipe you out while you sleep? Aren’t there signs it’s serious?

Can you have a traumatic brain injury (TBI) and not know it?

According to the Heersink School of Medicine at the University of Alabama, yes:

Many people who have problems such as poor memory, difficulties in learning and behavioural issues are unaware they are experiencing symptoms resulting from an ‘unidentified’ traumatic brain injury (TBI). An unidentified TBI usually stems from a past trauma, and medical treatment was not sought. Sports injuries and physical abuse are two of the more common examples.

As ABC News Chief Medical Correspondent Dr. Jennifer Ashton told Good Morning America, “We often hear about traumatic brain injuries in sports or in military settings, but people can slip and fall in their own homes.” (Indeed, the chief medical examiner for Orange and Osceola counties said Saget’s “injuries were most likely incurred from an unwitnessed fall.”) While Ashton said it is rare, she added, “This is a very unforgiving organ for trauma. It’s a closed space: Between the hard skull and the soft brain, a little bit of bleeding can cause compression on the brain, and in some cases, can be fatal.”

So how often does it happen? According to the CDC, there are an estimated 1.5 million traumatic brain injuries every year; in 2018, 223,000 people were hospitalized as a result. In 2019, there were nearly 61,000 deaths due to traumatic brain injury. (People age 75 and older had the highest rates of TBI-related deaths at 28% and males were three times more likely to die from a TBI than females.)

What are the warning signs of severe head trauma?

The tricky part is, some of the signs of concussion — a comparatively “mild” brain injury — overlap with those of more severe head trauma. According to the American Academy of Family Physicians, concussion symptoms may include headache, dizziness, nausea and vomiting, confusion, concentration and memory problems, and sluggishness, while the Mayo Clinic lists the following as symptoms of moderate to severe TBI:

• Loss of consciousness from several minutes to hours
• Persistent headache or headache that worsens
• Repeated vomiting or nausea
• Convulsions or seizures
• Dilation of one or both pupils of the eyes
• Weakness or numbness in fingers and toes
• Loss of coordination
• Profound confusion
• Agitation, combativeness or other unusual behaviour
• Slurred speech

When assessing a loved one, also look for: unequal pupil size, bleeding or fluid leakage from the nose or ears, bruising below the eyes or behind the ears, or any change of consciousness of more than a few seconds. If you notice any of these signs or aren’t sure how severe the injury is, seek medical care. A brain bleed is an emergency and needs to be taken care of immediately.

Should you go to sleep after a head injury?

For many years, the prevailing wisdom was not to let a concussed person fall asleep, to prevent them from lapsing into a coma. While associate professor of Emergency Medicine, Neurology, and Neurosurgery at the University of Rochester Dr. Jeffrey Bazarian says this is no longer recommended, he also notes that “Anyone getting very sleepy within six hours of a brain injury should be brought immediately to an emergency department for a head CT scan.” At a bare minimum, it seems prudent to keep a person awake for a few hours after the injury to see if any of the above symptoms develop.

Dr. Ashton notes, “It’s important for people to understand that when you talk about the brain, you always want to err on the side of caution…We all minimise our symptoms, and we don’t like to bring attention to ourselves. But this is a situation where you want to seek medical attention.”