Old Brain Injuries: Symptoms and When to Seek Help

Old injury to the back of the head?

There is an old scar on the left posterior part of the brain that has been present for about 20 years.
It periodically swells and causes pain, accompanied by dizziness, nausea, and slight visual blurriness.
The pain typically lasts for an entire day, but improves after a night's sleep.
Is this a normal phenomenon, or is medical attention needed? Thank you.

Chily, 20~29 year old female. Ask Date: 2008/07/15

Dr. Lin Zijing reply Neurology

Generally, old scars on the head should not cause symptoms such as swelling, pain, dizziness, nausea, and mild visual disturbances.
These symptoms are more indicative of a migraine.
A migraine is a type of headache of unknown origin that occurs recurrently, lasting between four to seventy-two hours each time.
The characteristics of a migraine include unilateral head pain that feels throbbing or pulsating, often accompanied by nausea and vomiting, as well as sensitivity to light and sound.
Activities such as moving, climbing stairs, or shaking the head can exacerbate the headache.
About ten to twenty percent of patients may experience specific neurological symptoms known as aura before or during the headache.
The most common aura symptoms include visual disturbances such as double vision, overlapping images, hemianopia, or the appearance of blind spots, bright spots, and flickering lines.
Occasionally, hallucinations and distorted visual images, appearing larger or smaller, may occur.
If you experience these symptoms and they recur, it is almost certain that you are experiencing migraines.
However, if your headache is a recent development, it is advisable to seek medical attention at a neurology clinic.

Reply Date: 2008/07/15

More Info

When dealing with old brain injuries, it is crucial to understand that the brain is a complex organ, and symptoms can vary widely depending on the nature and location of the injury. In your case, you mentioned having a scar on the left posterior part of your brain for about 20 years, which periodically swells and causes pain, dizziness, nausea, and slight visual disturbances. These symptoms can be concerning and warrant further investigation.

Firstly, it is important to recognize that old brain injuries can lead to a variety of long-term effects. These can include chronic pain, cognitive difficulties, mood changes, and even physical symptoms like those you are experiencing. The fact that you have a history of a brain injury means that your brain may be more susceptible to changes or stressors that could exacerbate symptoms.

The symptoms you describe—swelling, pain, dizziness, nausea, and visual disturbances—are not typical of a normal healing process for a brain injury that occurred two decades ago. While it is possible for old injuries to cause intermittent symptoms, the combination of dizziness and nausea, especially if they are severe enough to affect your daily life, is concerning. The fact that these symptoms improve after sleep suggests that there may be an underlying issue that needs to be addressed.

Here are a few considerations regarding your symptoms:
1. Post-Traumatic Headaches: Chronic headaches can occur after a brain injury and may be triggered by various factors, including stress, lack of sleep, or even changes in weather. These headaches can sometimes be accompanied by nausea and dizziness.

2. Cerebrospinal Fluid (CSF) Leak: If there is swelling and pain, it could indicate a CSF leak, which can occur after a head injury. This condition can lead to headaches that worsen when standing and improve when lying down.

3. Increased Intracranial Pressure: Swelling in the brain can lead to increased intracranial pressure, which can cause headaches, nausea, and visual disturbances. This is a serious condition that requires immediate medical attention.

4. Neurodegenerative Changes: Over time, brain injuries can lead to neurodegenerative changes that might manifest as cognitive decline, mood changes, or physical symptoms.
5. Need for Imaging: Given the duration and nature of your symptoms, it would be prudent to seek medical evaluation. A healthcare provider may recommend imaging studies, such as an MRI or CT scan, to assess the status of the injury and rule out any complications.

In conclusion, while some symptoms may be manageable, the combination of swelling, pain, dizziness, nausea, and visual disturbances after such a long time since the injury is not typical and should not be ignored. It is advisable to consult a neurologist or a healthcare provider who specializes in brain injuries. They can perform a thorough evaluation, possibly including imaging studies, to determine the cause of your symptoms and recommend appropriate treatment. Early intervention can be crucial in managing symptoms and improving quality of life.

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