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Interviewer: You experience some sort of a traumatic brain injury earlier in life, and then you receive treatments and your symptoms have been reduced or gone away, and then years later you start to notice some symptoms again that you might think have something to do with that traumatic brain injury you had earlier in your life.
Dr. Derrick Allred is at the Neilsen Rehabilitation Center at University of Utah Health. And I guess the first question for this is can somebody experience symptoms later from an injury that they had to their brain earlier in their life?
Late-Onset Symptoms Following Brain Injury
Dr. Allred: The answer to that question is, "Well, it depends." So people typically think of traumatic brain injury in its most common form, which is a concussion, or a mild traumatic brain injury. But the scope of brain injury and the damage that you can do can be on the milder side or it can be on the more severe side.
The one common complaint that I see in the clinic is someone who, let's say, in high school had a bunch of concussions playing football. Ten years later, they're starting to have headaches. And so they say, "Doc, I had these concussions. Now I'm having headaches. I'm worried it's from my old traumatic brain injuries." And then we'll go through a series of, "Well, let's see if we can find other causes. Is it something in your diet? Are there other stressors or are there other issues that are contributing to the headaches?"
The same can be said for cognitive issues, mood issues, and sleep issues. Those are the typical problems that we see in clinic, after someone has sustained a concussion and they come back several years later with concerns after the fact.
Linking Current Symptoms to Past Trauma
Interviewer: And when somebody comes in and they're concerned that a concussion earlier in their life is causing some issues later in their life, what does that conversation with them look like? And what do you do to try to figure out if that's the case or not?
Dr. Allred: Well, the first thing we would do is get a very complete and comprehensive history of the event surrounding the brain injury. As much as the patient can remember, the mechanism of what transpired, the symptoms that occurred afterward, how long they dealt with those symptoms, and what the recovery looked like.
And then we would take what symptom, say, a headache or a mood disorder, and we would really dig down with questioning and physical exam to try and tease out other potential possibilities of what could or could not be causing the symptoms that the patient is presenting with.
Because it's attributing something to a brain injury, whether it be mood, cognition, pain, sensory disturbances, or functioning in any regard, is a diagnosis of exclusion. So we just have to be thorough and comprehensive in making sure that we are familiar with other potential causes before we would attribute it to a brain injury.
And so that's part of what the workup is. It's not so much to attribute it to the brain injury as much as it is to make sure that it's not something else that's going on.
Interviewer: Do you find that patients that come in tend to think that these new symptoms are a result of the brain injury they had, and then you find that, no, actually it was something else?
Dr. Allred: The vast majority of the time, if someone truly did just have a single concussion . . . And there are complaints in the clinic that most of the time we can find other potential causes. However, that also depends on the nature of the brain injury.
Sometimes people will say, "Well, I had a concussion," and then actually maybe the nature of their brain injury was a little more severe than what they thought. There are protocols and there are things that we look at in terms of testing that we would pursue depending on what your history and symptoms are.
Treatment Approach: Addressing Symptoms Holistically
Interviewer: And then after you figure that out, what's your kind of rate of success of being able to uncover that mystery and solve that mystery and help the patient with whatever it is they happen to be suffering from?
Dr. Allred: Well, I'm biased, but I think we do a good job. We are fortunate in my field to not work in a silo. So in rehabilitation management, particularly in brain injury management, we have multiple disciplines to address specific needs, whether it be psychologists, or therapists of varying specialties, to really look at the patient holistically and take both pharmacologic and non-pharmacologic approaches to manage patients.
Every patient is different. I tell patients that everyone's brain injury is different. No two brain injuries are alike. And so we really have to take inventory of what that patient's presentation is and what they need to do to get back to what they would deem normal life and really structure a rehab and treatment program to help them reach their goals.
Managing Patient Concerns and Expectations
Interviewer: It would seem to me that this is kind of . . . you're solving a mystery, right? You're really trying to figure out, "What is the cause here?" Does that usually take a long time or does it take a short time? I mean, generally, what kind of timeframe are you looking like?
Dr. Allred: It doesn't generally take too long, but again, everyone is different. We are thorough. If we can address issues in short order, then great. Sometimes we have to go down rabbit holes to help the patients and we’re more than willing to do that. So it just depends.
Interviewer: And I know it could also be frustrating to patients too, right? Somebody comes in and they're like, "Well, why don't you just fix this problem?" But sometimes it's a little bit more complicated than that and some detective work has to be done. Oftentimes it's not, but sometimes it is.
Dr. Allred: And sometimes there isn't an answer. Medicine isn't an exact science. But we always strive to do our best to at least make sure that serious issues aren't occurring and then go from there.
Interviewer: Yeah, and try to take care of the symptoms as best one can even if there isn't an answer, trying to help that patient manage those and live their life as normal as possible.
Dr. Allred: There is no shame in seeking out medical attention when you have worrisome symptoms. The vast majority of patients, when they've had a concussion, if later in life they're having some symptoms that they may attribute to a potential brain issue, then come. Let us evaluate that and we can tease out whether or not it is related to the brain or if there are some other things that we can do to intervene to help you get back the reassurance or to address any issues that need to be treated or dealt with.
Interviewer: And I could imagine for patients, sometimes it could be worrisome when all of a sudden, years later, they develop these symptoms that they think might be a result of a brain injury that they had earlier in their life. And then that could be kind of concerning. I mean, is this going to lead to something worse? Generally, does it, or generally does it not?
Dr. Allred: Generally speaking, in the setting of a concussion or even in the setting of a few isolated concussions, most patients end up being okay. And I think getting that reassurance is probably one of the more important things.
But I don't want patients to think that they had a concussion and so they shouldn't worry about being seen. Any time you have a concern, I mean, it's certainly an appropriate step to reach out to a provider to make sure you go through an evaluation.
If there's a concern of something going on in the brain years after a concussion, then we are more able and willing to do an investigation to make sure that, one, there isn't something else occurring, and addressing those issues as they come up.
updated: March 7, 2024
originally published: December 7, 2022