08/13/2026
During a traumatic brain injury (TBI), the brain can be injured not only at the moment of impact, but also through a cascade of changes that occur afterward. The severity can range from a mild concussion to extensive structural brain damage. Here’s what can happen: The brain moves inside the skull. A sudden impact, acceleration, deceleration, or rotation can cause the brain to shift, stretch, twist, or strike the inside of the skull. Importantly, a TBI can occur without the head directly hitting anything.
Brain cells and their connections can be stretched or damaged. Rapid rotational forces are particularly capable of stretching axons—the long fibers that allow different areas of the brain to communicate. Normal brain chemistry is disrupted. Injured neurons can release neurotransmitters and experience abnormal movement of ions across their membranes. The brain then needs additional energy to restore its normal chemical balance.
The brain can develop an energy crisis. At the same time that injured cells require more energy, cerebral blood flow and the brain's ability to use glucose efficiently may be altered. This mismatch is one reason a person can experience significant symptoms even when conventional imaging looks normal. Inflammation and swelling may occur. The body's response to injury can produce additional cellular changes. In more serious TBIs, swelling or bleeding can increase pressure inside the skull and become life-threatening.
Brain networks may stop communicating normally. Depending on the areas affected, a patient may develop headaches, dizziness, balance problems, visual disturbances, memory difficulties, slowed thinking, fatigue, sleep problems, emotional changes, or sensitivity to light and noise.
One of the most important things to understand about a mild TBI or concussion is that the injury can involve functional and microscopic changes rather than a large structural abnormality. Therefore, a normal CT or conventional MRI does not automatically mean that the brain was unaffected. This is also why TBI evaluation often considers the patient's neurological examination, symptoms, cognitive function, balance, vision/eye movements, and other objective findings—not imaging alone.
When you need expert care: for your patient, for your case, or for your sanity - Trust TBI Associates. (405)400-0771
