More subtle signs of head injury may also appear gradually, and may include:

• long- and short-term memory problems

• slowed thinking

• distorted perception

• concentration problems

• attention deficits

• communication problems (oral or written)

• poor planning and sequencing

• poor judgment

• changes in mood or personality

Sometimes, certain behavior may appear long after the traumatic brain injury occurs. These behaviors may include overeating or drinking, excessive talking, restlessness, disorientation, or seizure disorders.


In the past, diagnostic tests were not sensitive enough to detect the subtle structural changes that can occur and persist after a mild head injury. While computerized axial tomography (CAT) scans are widely available in emergency rooms to help diagnose brain bruises, many experts believe these scans may not pick up the subtle damage after a mild head injury. Magnetic resonance imaging (MRI) and PET scan are more sensitive in pinpointing many brain lesions and may be more sensitive in detecting the diffuse shearing and contusions as well.

In many children, however, brain scans cannot detect the microscopic damage that occurs when fibers are stretched in a mild, diffuse injury, as brain axons lose some of their covering and become less efficient. This mild injury to the white matter of the brain reduces the quality of communication between different parts of the brain. In this case, a quantitative electroencephalogram

(EEG)—that measures the time delay between two regions of the brain and the amount of time it takes for information to be sent from one region to another—may help to reveal damage. Evoked potential brain tests are not generally used in children with mild head injury because they are not sensitive enough to document physiological abnormalities unless testing is done within a day or two of injury.


Only a small percentage of children with mild head injury are hospitalized overnight, and instructions upon leaving the emergency room usually do not address behavioral, cognitive, and emotional symptoms that can occur after such an injury. Patients who do experience symptoms should be seen by a specialist. Unless doctors are thoroughly familiar with medical literature in this new field, experts warn that there is a good chance that patient complaints will be ignored. Parents of children with continuing symptoms after a mild head injury should call the local office of the Brain Injury Association (see Appendix I for address) for a referral to a specialist.


Head injuries can be prevented by taking appropriate safety precautions, such as insisting that children wear helmets when biking, riding a scooter, skating, sledding, or skiing. Children also should wear seat belts and ride in the backseats of cars.

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