Physical consequences

Physical consequences can be very diverse. Because brain injury involves damage to the brain, we often also speak of neurological consequences.

Some consequences are more visible than others. Some people recover very well after brain injury. Some people recover partially or not at all. It is difficult to predict in advance who will recover and who will not. Rehabilitation can sometimes help with recovery.

The possible physical long-term consequences of a neurological disorder are different for everyone. Every brain injury is different. Many brain injured people have no visible consequences, but do have invisible consequences. On this page we discus the physical, neurological consequences of brain injury.

Physical consequences

• Decline in consciousness and coma
• Delirium is a decreased level of consciousness, acute confusion, or change in cognition, usually due to a physical cause. We discuss causes, symptoms, and treatment on the delirium page.
• Epilepsy
• Muscle twitches (myoclonia) in Lance Adams Syndrome (LAS)
• Paralysis and loss of strength (paresis)
  • Hemiplegia: paralysis of one side of the body.
  • Hemiparesis: partial paralysis or loss of muscle strength on one side of the body.
  • Half-sided sensory disturbances (usually on the paralysis side). It varies per person which feeling is reduced (pain, movement, touch, posture warmth and cold).
• Pain due to brain injury in the shoulder, arms, hand, head, bones, tendons and muscles
• Cramps in hands, arms or legs, also see spasticity
• Spasticity
• Coordination disorders; difficulty with balance and coordination of movements, ataxia etc.
• Proprioceptional disorders balance
• Movement disorders; motor slowness, hypermobility, spasms, involuntary movements such as chorea and huntington
• Parkinsonism is a combination of symptoms first described in Parkinson's disease; difficulty controlling speech, movement, and posture
• Headache, neck pain, migraine
• Pain complaints (nerve pain, pain from coercive position and spasticity)
• Shoulder-hand syndrome with hemiplegia
• Shoulder pain
• Organic fatigue, neurofatigue
  
• Vegetative symptoms related or not to Dysautonomia/POTS
  
  • nausea, vomiting
    
  • pallor
    
  • headache
    
  • sweating
    
  • palpitations or low blood pressure upon standing related to
    Dysautonomia/POTS
• Disturbances in sense of touch (gnostic sensibility) and temperature
• Disturbances in body temperature regulation/feeling unwell at high temperatures, particularly with brainstem injury
• Motor dysfunction / motor function
• Other sensory impairment: 
  • smell, taste
  • vision
  • hearing (suddenly deaf)
  • overstimulation of the nervous system / sensory overstimulation
• Swallowing disorder (dysphagia)
• Neglect (reduced perception / attention on affected side of the body) Also called: Visuospatial neglect, Not perceiving what is happening on the affected side and in space
  
• Visuospatial and visuoconstructive problems, two problems with important cognitive functions for complex visual-spatial tasks and planning
  
• Visuospatial neglect, not perceiving what is happening on the affected side and in space
• Language, speech and articulation disorders; aphasia, dysarthria, speech apraxia
• Speech disorders: speech is difficult to understand if the muscles of the mouth are paralyzed or cannot move in a coordinated manner (dysarthria)
  • Language disorders: difficulty in finding words, problems in forming or understanding language (aphasia); use of weird words and sentences; use of long sentences or talking too much; take information literally instead of figuratively, speaking too much, not being able to stop speaking, verbosity
  • See also the pages:
    
  • Aphasia (receptive aphasia)
  • Aphasia (expressive aphasia)
  • Dysarthria (difficulty articulating)
  • Apraxia of speech (difficulty speaking purposefully)
  • Pragmatic language disorder
  • Taking language literally
  • Word-finding problems
  • Foreign accent syndrome (FAS)
  • Listening can be extremely tiring
  • Akinetic mutism (stopping speaking or reduced speaking)
    
  • Speaking too much, being unable to stop speaking, or verbosity
• Disorders of the function of the bladder and the intestines, incontinence or not being able to urinate properly
• Sexual dysfunction
• Sleep disorders and CSAS; Central sleep apnea syndrome (if the brain does not control the lungs sufficiently)
• Dysautonomia-POTS: Postural Orthostatic Tachycardia Syndrome, in which the heart rate increases dramatically within 10 minutes of standing. People may become unwell from standing. Blood pressure and heart rate are no longer properly regulated.
  
• Compulsive crying and compulsive laughing (pseudobulbar affect)
• Other causes of crying after a brain injury

Early physical consequences of brain injury

Each brain injury differs so that the early consequences, immediately after the occurrence of injury, also differ. These consequences can disappear.

• Decline in consciousness
  
• Coma
• Bleeding and haemorrhage (epidural, subdural, subarachnoid, intracranial)
• Cerebral edema; Just as with a bruise elsewhere in the body, fluid comes out of the bloodstream here. This fluid can put brain tissue under pressure, the brain pressure (intracranial pressure) can rise. This swelling due to moisture is called brain edema, which must be properly addressed.
• Abscess in specific situations
• Failure of physical functions
• Paralysis (left or right)
• Loss of power
• Headache
• Nausea and vomiting
• Fever in specific situations

Skull injury

In addition to neurological damage, there may also be skull injury; linear skull fracture (skull burst), impression fracture (locally pressed skull due to sharp violence, with the risk of bone splinters), or a skull base fracture (with the risk of ruptured meninges, which can cause colorless brain fluid to flow from the nose and ears). The base is the bottom of the skull - the skull bottom - that rests on the spine.

• Anterior skull-base fracture is often accompanied by spectacle hematoma; bruising around the eyes.
• Middle skull-base fracture is often characterized by blood ejection behind the ear, but also blood and cerebrospinal fluid from the ear. Also characterized by hearing and balance problems and problems with facial muscles. 
  
  A doctor will always perform a neurological examination in the event of neurological damage.

Pain caused by brain injury

• central pain syndrome after a stroke (post stroke pain)
  
  • Déjerine-Roussy syndrome or thalamic pain
    
  • central pain syndrome in Wallenberg syndrome
    
• complex regional pain syndrome (CRPS)
  
  • shoulder-hand syndrome with half-sided failure
    
• pain due to spasticity
  
• headache/neck pain
  
• neuropathic pain, pain in damaged nerve pathways; numbness,
• prickling, tingling, intense stabbing, shooting or burning pain or a 'freezing' feeling.
  
  • hyperesthesia/hyperalgesia
    Hypersensitivity to pain, feeling too much pain due to changes in nerve pathways. For example, when touching the paralyzed half of the body
• pain in bones, muscles and tendons (musculoskeletal pain):
  
  • shoulder pain
    
    • shoulder subluxation. With a subluxation of the shoulder joint, the upper arm partially dislocates. This occurs a lot, shortly after a stroke. The weakened muscles and low muscle tone (tonus) cause a gradual overload of the joint capsule. After this, 
      this can lead to an incorrect position of the head of the upper arm (humerus). This can cause the arm to dislocate.
      
  • tense muscles of the shoulder girdle. pain between shoulder blades
    
  • forced position of joint or muscles/contractures. If someone cannot move, or cannot move with difficulty, due to the brain injury, the joints can
    and muscles become very stiff. The muscles shrivel and therefore become shortened. This can cause a forced position or contracture. This is amedical term for a restriction of movement in the joint or muscles. Over time, the patient can no longer use her or his muscles properly, use or stretch the arm or fingers.
    A contracture or forced position is very painful. It hinders normal functioning. Examples: a hand that is in a forced position of a
    fist, you can no longer use it. A stuck shoulder makes it impossible to get dressed and grab something.
    
  • broken bones at the time of the injury such as a broken neck
    
  • fibromyalgia. Fibromyalgia is a condition that causes pain in connective tissue and muscles. This concerns the parts of it
    musculoskeletal system. A new study using brain scans has shown that patients with fibromyalgia have an abnormal blood supply is. Researchers from the University Medical Center in Marseille think that fibromyalgia is associated with a processing problem of pain throughout the brain. There is no evidence yet that brain injury is a cause.

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