Brain Injury Awareness: Understanding Common Brain Injuries and Measuring Symptoms

Brain injuries may seem like rare occurrences, but the Brain Injury Association of America (BIAA) reports that an estimated 2.8 million people in America sustain traumatic brain injuries every year, and over five million are living with permanent brain-injury related conditions. These injuries can take many forms, which highlights the importance of recognizing the symptoms of a brain injury and raising awareness about their effects.

March is Brain Injury Awareness Month, and the BIAA has designated the campaign theme for 2025 as “My Brain Injury Journey.” This month draws attention to an important topic and provides an opportunity to support people who have experienced brain injuries. That’s why this Brain Injury Awareness Month, we’re taking this chance to increase awareness about brain injuries and enhance understanding of how certain tools can measure symptoms effectively to improve patient outcomes.

What are Brain Injuries?

According to the BIAA, someone in the U.S. sustains a brain injury every nine seconds. However, there are still many misconceptions about these injuries, their symptoms, and their effects. Not all brain injuries look the same, and there are different types. These are:

• Traumatic brain injury (TBI) – These brain injuries happen when an external force disrupts normal brain function. This can occur if the head is struck by an object or if the head impacts something due to incidents like falls, car accidents, assaults, and other events. There are numerous causes of TBI, and it can manifest in various forms.
• Concussion - Often called a mild traumatic brain injury (mTBI), a concussion is typically not life-threatening. It occurs when a bump, jolt, or blow to the head causes the brain to move or twist within the skull. Despite being labeled as mTBI, the symptoms and effects on the individual can be quite significant and should not be considered mild.
• Acquired brain injury – Acquired, or non-traumatic, brain injuries result from internal factors that damage the brain. These factors include a lack of oxygen, exposure to toxins, and pressure caused by a tumor.

In addition, congenital (non-acquired) brain defects may occur before birth, leading to conditions that can look similar to those caused by brain injuries. Brain injuries can vary in degree, and their symptoms often vary depending on the severity of the injury and the part of the brain affected. Because each area of the brain coincides with a different function, the person who sustained the injury may experience a variety of effects that impact their daily life based on the injury’s location.

What are the Symptoms of a Brain Injury?

The specific symptoms vary case by case, but common signs of a brain injury include:

• Headaches or migraines
• Nausea (sometimes leading to vomiting)
• Dizziness
• Temporary loss of consciousness
• Blurred or double vision
• Ringing in the ears
• Confusion
• Trouble concentrating
• Mood swings
• Sensitivity to sound and/or light
• Irregular sleep problems
• Depression and/or anxiety
• Slow reaction times
• Loss of consciousness for longer periods, from several minutes to hours
• Persistent headaches
• Convulsions or seizures
• Frequent vomiting or nausea
• Profound confusion
• Inability to wake from sleep
• Dilation of one or both pupils
• Clear fluids draining from the nose or ears
• Slurred speech
• Changes in personality
• Weakness/numbness in the fingers and toes
• Loss of coordination
• Agitation or other unusual behavior

The symptoms of a brain injury are not always obvious, especially in cases of mild injuries when the signs may be easy to overlook. This is why it’s important to seek care as quickly as possible after an injury occurs, even if it appears to be mild. Patients that come in with symptoms of a brain injury may undergo a variety of tests, and psychological assessment tools are often used to measure the severity of symptoms.

What are the Causes of a Brain Injury?

There is no singular cause of a brain injury, although most concussions and TBIs happen because of sudden bumps, jolts, or strikes to the head. Common causes of these injuries include:

• Slips or falls
• Sports or recreational activities
• Combat
• Car accidents
• Workplace accidents
• Assault
• Accidental mishaps (such as walking into a door)

Acquired, non-traumatic brain injuries are caused by other, typically internal, factors such as:

• Stroke
• Aneurysm
• Near-drowning
• Tumor
• Infectious disease affecting the brain (such as meningitis)
• Lack of oxygen supply to the brain
• Exposure to toxins

Excessive drug and alcohol use has also been linked to brain injuries, and substance use can worsen an existing injury.

Treating Brain Injuries: Why Measuring Symptoms Matters

If brain injuries are not properly recognized and treated, they can lead to serious and even life-threatening problems. There are different treatments for different types of brain injuries, and for different levels of severity. Mild injuries typically require no treatment other than rest and possible pain-relieving medication, but the condition should still be monitored closely for any persistent, worsening, or new symptoms.

Moderate to severe brain injuries, especially TBIs, should be treated with emergency care. The treatment for these injuries focuses on ensuring that the person has enough oxygen and blood supply as well as keeping blood pressure steady and preventing further injury to the head or neck. A doctor may also recommend medications, such as anti-seizure drugs or diuretics, to limit secondary damage to the brain immediately following the injury. Surgery may be needed to remove clotted blood, repair skull fractures, stop bleeding in the brain, or relieve pressure in the skull. Most people who have severe traumatic brain injuries will require rehabilitation. The type and duration of this rehabilitation will vary for each individual, but they will have rehabilitation specialists to oversee their care during this process.

Among the rehabilitation specialists who assist patients undergoing treatment for brain injury are physiatrists, occupational therapists, physical therapists, rehabilitation nurses, and neuropsychologists. It is the neuropsychologist’s role to assess the cognitive impairment and performance of the person, help them manage behaviors and learn coping strategies, and provide additional treatment recommendations as needed for emotional and psychological wellbeing.

While psychologists play an important role in the rehabilitation process, they can also aid in treatment even for mild brain injuries. Psychological assessment tools are highly useful in this stage, including tests designed to screen for symptoms of concussion and measure potential memory problems.

Screen for Concussion Symptoms with the ACE

The Acute Concussion Evaluation (ACE) is a free patient assessment tool designed to help providers quickly measure the presence or absence of concussion symptoms. Developed and incorporated as part of the Center for Disease Control’s HEADS UP: Brain Injury in Your Practice Toolkit, the ACE is a valuable tool used in the diagnostic process. This assessment  uses a standardized protocol via a symptom checklist that assesses key elements of concussion, including headache and visual problems, difficulty concentrating, fatigue, irritability, and more.

The ACE also gathers information about the cause and description of the injury and helps identify patient risk factors to assist clinicians with diagnosis and inform follow-up recommendations. No special qualifications are required to administer the ACE, making it accessible for various healthcare providers. Using the ACE together with other members of the ConcussTrack family, such as the PostConcussion Symptom Inventory-2 (PCSI-2) and the PostConcussion Executive Inventory (PCEI), allows for a multimodal evaluation of concussion. 

Assess Additional Brain Injury Symptoms with the BVMT-R and HVLT-R

The Hopkins Verbal Learning Test Revised™ (HVLT-R™) is a psychological assessment tool used for assessing verbal learning and memory. Developed by Jason Brandt, PhD, and Ralph H. B. Benedict, PhD, the HVLT-R is easy to administer and score, making it well-tolerated even by significantly impaired individuals. This assessment has been validated within brain-disordered populations, such as those with Alzheimer’s disease and amnestic disorders, and is a reliable measure of verbal learning and memory. The HVLT-R generates scores for:

• Total Recall
• Delayed Recall
• Retention (% retained)
• Recognition Discrimination Index

The high test-retest reliability and established validity make the HVLT-R a valuable tool for clinicians.

Similar to the HVLT-R, the Brief Visuospatial Memory Test–Revised™ (BVMT-R™) measures visuospatial memory and is designed for easy administration in clinical settings or at the bedside. The BVMT-R is particularly useful for assessing patients with head trauma, psychiatric disorders, adult learning disabilities, and mixed diagnoses such as stroke, vascular dementia, and chronic alcoholism. This assessment consists of six geometric figures printed in a 2 × 3 array on separate pages, and it can be administered face-to-face via tablet using In-Person e-Stimulus Books and Kits. The BVMT-R provides reliable change scores and discrepancy scores, with normative data included for all new scores.

Both the HVLT-R and BVMT-R are valuable tools for healthcare providers treating or assessing individuals who have experienced a brain injury. These assessments offer detailed insights into a patient's cognitive and visuospatial memory functions, aiding in the diagnosis and management of brain injuries. By incorporating these tools into their practice, clinicians can better understand the extent of a patient's impairments and tailor their treatment plans to support recovery and improve patient outcomes.

Raising Awareness and Enhancing Brain Injury Care

Brain Injury Awareness Month is a crucial time to highlight the significance of understanding and addressing brain injuries. These injuries can have profound effects on individuals, impacting their daily lives and overall well-being. By raising awareness about brain injuries, we can foster a better understanding of their symptoms, causes, and treatments.

Assessments like the Acute Concussion Evaluation (ACE), Hopkins Verbal Learning Test Revised™ (HVLT-R™), and Brief Visuospatial Memory Test–Revised™ (BVMT-R™) play a vital role in the diagnostic process. They provide healthcare providers with valuable insights into a patient's cognitive and memory functions, aiding in the diagnosis and management of brain injuries. Early detection and proper management are key to improving patient outcomes, and these tools help clinicians tailor their treatment plans to support recovery.

During this Brain Injury Awareness Month, let us continue to advocate for the use of these assessments in clinical practice. By doing so, we can ensure that individuals who have experienced brain injuries receive the care and support they need to thrive.