Angina

Disease Description (Causes and Symptoms)

• Definition: Traumatic brain injury (TBI, commonly concussion) is a condition in which brain function is temporarily impaired by external force, and includes cases in which structural damage is not clearly evident. Typically, loss or alteration of consciousness may occur.
• Main causes: Traumatic impacts such as traffic accidents, exercise- or sports-related injuries, occupational accidents, and falls.
• Pathophysiology: Acute brain dysfunction caused by impact (focal or diffuse); mild cases may have no structural damage, while severe cases may progress to contusions, hemorrhage (subdural, epidural, or intracerebral), or diffuse axonal injury.
• Typical symptoms: Loss or alteration of consciousness, headache, dizziness, nausea and vomiting, memory impairment (short-term memory loss), reduced concentration, fatigue, sensory hypersensitivity, convulsions (seizures), and neurological deficits (in severe cases).

Treatment Methods (Standard Treatment · Medication · Procedures/Surgery · Lifestyle Management · Precautions)

• Initial response
  • Mild symptoms: Observation and rest (at a hospital or at home under the observation of a caregiver); acetaminophen is recommended as an analgesic (appropriate evaluation is needed for severe headache, convulsions, and other symptoms).
  • Convulsions, neurological abnormalities, decreased consciousness, or high-risk groups (older adults, use of anticoagulants, bleeding disorders, heavy alcohol use, etc.): Visit the emergency department immediately and undergo neuroimaging (CT is generally prioritized).
• Imaging and surgical treatment
  • If there are emergency signs such as cerebral hemorrhage (subdural, epidural, or intracerebral), a large contusion, or increased intracranial pressure (cerebral edema), surgery (decompression and hematoma removal) and intensive care may be required according to neurosurgical assessment.
• Medication treatment
  • Pain: Acetaminophen is preferred.
  • Anticonvulsants: Short-term anticonvulsant therapy may be considered for severe TBI requiring seizure prevention during the initial period (e.g., within 7 days after the injury). Long-term prevention is generally not recommended (requires a physician’s judgment).
  • Treatment for cerebral edema (in severe cases): Follow intensive care unit guidelines, including hyperosmotic agents (mannitol) and hyperthermia treatment.
• Rehabilitation and follow-up care
  • Multidisciplinary rehabilitation, including cognitive rehabilitation, physical therapy, occupational therapy, and speech therapy, is important for improving prognosis.
  • Gradual return to activities (exercise, driving, and returning to work) should follow a symptom-based, stepwise protocol (medical approval is required when the patient is symptom-free).
• Precautions and self-care
  • Avoid alcohol and medication use (they may delay recovery and increase the risk of bleeding).
  • People taking anticoagulants have a higher risk of complications and should consult a medical institution immediately.
  • Observation by a caregiver is recommended for 24–48 hours after returning home (check for emergency signs such as vomiting, altered consciousness, severe headache, seizures, hemiplegia, and dilated pupils).
  • Since headaches, dizziness, and reduced concentration may persist over the long term, specialized rehabilitation or neurology care is recommended when necessary.
• Risk of complications
  • Early: Cerebral hemorrhage, cerebral edema, seizures (early seizures), and infection (in cases of open injury).
  • Chronic: Post-traumatic headache, cognitive impairment, depression and anxiety, sleep disorders, sequelae (such as hemiplegia), and an increased risk related to chronic traumatic encephalopathy (CTE) in rare cases.

Checklist Before an Outpatient Visit (Including Items to Bring · Test Records · Example Questions)

• Items to bring
  • A list of all medications currently being taken (especially anticoagulants, antiplatelet agents, and anticonvulsants) or the medication packages.
  • A record of the circumstances and time of the accident and changes in symptoms (duration of loss of consciousness, whether vomiting or seizures occurred, etc.).
  • Copies of previous test results (imaging and blood tests), if available.
  • A caregiver is recommended to accompany the patient (to explain symptoms and communicate observations).
• Information to record during the medical visit
  • Time of onset (injury), type of accident (traffic accident, fall, etc.), whether loss of consciousness occurred and its duration, and the subsequent course of symptoms (improvement or worsening).
  • Sleep and sleep disorders, the nature and frequency of headaches, whether vomiting occurred, and specific memory loss (before and after the event), etc.
• Self-observation points before the outpatient visit
  • If emergency symptoms (severe headache, repeated vomiting, persistent dizziness, decreased consciousness, seizures, hemiplegia, difficulty speaking, etc.) occur, visit the emergency department immediately.
• Example questions (questions that can be used before scheduling an appointment or at the initial visit)
  • "How have my symptoms changed since immediately after the accident?"
  • "How do the medications I am currently taking, especially anticoagulants, affect the treatment plan?"

Examples of General Questions to Ask the Doctor

• Do I need additional imaging tests such as CT or MRI for this accident? If so, when should I have them?
• How long are my headaches (or memory problems) expected to last? What is the prognosis?
• If I am currently taking medications such as aspirin or warfarin, what should I do? Do I need to stop taking them?
• Should I take anticonvulsants to prevent seizures? What are the side effects?
• When can I resume daily activities (driving, exercise, and work)? What criteria should I follow?

Examples of Disease-Specific Questions

• I am taking an anticoagulant (or antiplatelet agent). Because of this injury, do I need additional observation in the emergency department or hospitalization even if the imaging tests show no abnormalities?
• I have had reduced memory and concentration since the accident. Do I need cognitive rehabilitation? What rehabilitation programs do you recommend, and what is the expected treatment duration?