Brain Damage

A January 18th, 2018 article from the Washington Post describes recent medical research where head injuries without concussion symptoms can cause brain damage.

This is a new finding and an important distinction. The terms “concussion” and “TBI” (traumatic brain injury) often get mixed together. The medical thinking has been that when a person gets hit in the head, a significant impact will cause a concussion. Patients usually complain of immediate dizziness, confusion, headaches, and seemed dazed. They often perform poorly on immediate tests of brain function.

Of course, most of these people eventually return to normal. But the initial diagnosis of concussion has been important at the sidelines of football games and in emergency rooms. These patients need to be followed through to recovery. Some of these individuals develop chronic symptoms, and even a neuro-degenerative disease of the brain called CTE (chronic traumatic encephalopathy).

This new research from Boston University now shows that even more minor head injuries, those that don’t even cause concussions, can do long-term brain damage. This has been demonstrated in teenagers and in a mouse experimental model.

I have previously discussed the importance of concussion, TBI, and CTE. This new information shows that a person doesn’t need to have a concussion to develop brain damage.

As an ophthalmologist who focuses on TBI this is important clinical information. I used to believe a person needed to first experience a concussion to have any concern about long-term brain injury. As I have previously discussed, most patients with concussion have visual difficulty.

As an ophthalmologist, I now need to be concerned about any patient who experiences head trauma. If long-term brain injury occurs, these individuals will usually have visual difficulty.

I see many head injury patients after motor vehicle accidents who develop visual problems. Some of these patients never complained of acute symptoms of a concussion. Now, such patients must be thoroughly evaluated even months or years after the initial accident or head trauma. Chronic brain damage and its visual manifestations can remain hidden.

The world of head injuries is changing, and current research is raising new red flags.


Steven H. Rauchman, M.D. is an eye physician and surgeon who has been in private practice for 30 years. He has served as an Traumatic Brain Injury (TBI) medical/legal expert for the last 6 years specializing in the area of personal injury and related traumatic brain injuries.

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