Can You Have a Mild TBI and Not Even Know It?

Helmet-to-helmet tackles in football. Knockouts in boxing. Explosive blasts in combat. These are the types of incidents most people associate with concussions and traumatic brain injuries (TBIs). But you don’t have to be involved in a skull-crushing incident, and you don’t have to lose consciousness to cause damage to your brain. In fact, many people have what the medical field calls a “mild TBI” and in these cases, you may not even realize that you’ve suffered a brain injury. This is bad news because suffering a mild TBI can cause a host of lasting psychiatric, behavioral, and cognitive consequences. Suffering a mild TBI can cause a host of lasting psychiatric, behavioral, and cognitive consequences.

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Why Does Mild TBI Go Undetected So Often?

Statistics on head injuries don’t tell the whole story. According to the CDC, there are over 2.8 million TBIs in the U.S. each year. But that’s only counting the people who visit the emergency department, are hospitalized, or die from their injuries. There are millions of others who experience a blow, bash, or bonk to the head but never seek medical help because they don’t think their injury is serious enough. And there are countless more who endure repetitive bangs to the head, such as hitting a soccer ball with your head, who don’t think they require treatment. These people are never diagnosed with a concussion or mild TBI. Surprisingly, many people forget they’ve had a significant head injury in childhood or as an adult. That’s why at Amen Clinics, patients are asked multiple times if they have suffered any type of head trauma. Even if patients initially answer “no,” their physicians at Amen Clinics will keep digging, asking a series of probing questions: Have you ever fallen out of a tree, fallen off a fence, or dove into a shallow pool? Did you play contact sports? Have you ever been in a car accident? It’s shocking how many people think their head injuries were too insignificant to mention. For others, they simply do not remember the incident, as amnesia in head trauma is a common occurrence. For example, one Amen Clinics patient had insisted multiple times that he had not suffered a concussion, but after being asked a fifth time, he put his hand on his forehead and said, “Oh yeah! When I was 5 years old, I fell out of a second-story window.” He isn’t the only one. Many other people forget they went through windshields, fell out of moving vehicles, or were knocked unconscious when they fell off their bicycles. Have you suffered a head injury? Think back in your own history to see if you recall experiencing any of these common causes of mild TBIs:

• Falls—falling out of bed, slipping in the bath or shower, falling down steps, falling off ladders
• Motor vehicle-related collisions—involving cars, motorcycles or bicycles; also, pedestrians involved in accidents
• Violence—caused by gunshot wounds, assaults, domestic violence, or child abuse
• Sports injuries—besides football, they are common in soccer, boxing, baseball, lacrosse, skateboarding, hockey, cycling, basketball, and other high-impact or extreme sports
• Explosive blasts and other combat injuries

If you don’t remember any of these events, ask your parents if they recall such an incident. They may remember something you don’t.

What Happens to the Brain in a Mild TBI?

Suffering a concussion or mild TBI can impact the brain in many harmful ways. Here’s why. Many people think the brain is rubbery and fixed within the skull, but it isn’t. Your brain is soft, about the consistency of soft butter, tofu, or custard—somewhere between egg whites and gelatin. It floats in cerebrospinal fluid and is housed in a very hard skull that has many sharp bony ridges. As such, it is easily damaged. Whiplash, jarring motions (think Shaken Baby Syndrome), blast injuries, and blows to the head can cause the brain to slosh around, slamming into the hard ridges inside the skull. Here is what happens in the brain after physical trauma:

• Bruising
• Broken blood vessels and bleeding
• Increased pressure
• Lack of oxygen
• Damage to nerve cell connections
• Ripping open brain cells that spill out proteins like “tau” that cause inflammatory reactions

On top of that, the pituitary gland (which regulates your hormones) sits in a vulnerable part of the skull, so it is often hurt in head injuries, causing major hormonal imbalances. In many cases, the brain heals over time after an injury. In other instances, lingering damage remains. On brain SPECT imaging, which measures blood flow and activity in the brain, one of the most common findings in people who have experienced head injuries is low blood flow in certain regions within the brain. Often, in people who have suffered a TBI, the brain region nearest the point of impact isn’t the only area where damage is seen. For example, if you get into a car accident and your forehead hits the steering wheel, it can injure the front part of the brain, but that’s not all. As your brain sloshes backward after impact, it can also cause damage on the opposite side. This is called a contrecoup injury. On SPECT, this is suspected when there is low blood flow on opposite sides of the brain. Low blood flow on SPECT has been seen not only with TBI, but also with depression, suicide, bipolar disorder, schizophrenia, ADD/ADHD, hoarding, murder, substance abuse, seizure activity, and more. Low blood flow is the number one brain imaging predictor that a person will develop Alzheimer’s disease, according to research in Nature Communications.

TBI, Mental Health Problems, and Cognitive Dysfunction

What makes undiagnosed and untreated head injuries so troublesome is that they are associated with a wide range of psychiatric illnesses and cognitive problems. Research shows that head injuries increase the risk of depression, anxiety, panic disorders, psychosis, post-traumatic stress disorder (PTSD), substance abuse, ADD/ADHD, personality disorders, aggression, learning problems, and suicide. It also raises the odds of dementia. In the database of tens of thousands of patients at Amen Clinics, SPECT imaging reveals that 40% had a significant brain injury before they sought treatment for psychiatric, behavioral, or cognitive issues. Most of them had no idea that an underlying brain injury was contributing to their issues. In the database of tens of thousands of patients at Amen Clinics, SPECT imaging reveals that 40% had a significant brain injury before they sought treatment for psychiatric, behavioral, or cognitive issues.

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Anyone who is experiencing psychological or cognitive symptoms that aren’t getting better with standard treatment may want to investigate if a hidden mild TBI may be contributing to those issues. For these people, following a concussion rescue protocol to heal the brain can make a significant improvement in symptoms. Undetected, untreated, or misdiagnosed head injuries can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, remote clinical evaluations, and video therapy for adults, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.