Traumatic brain injury (TBI) is a major cause of morbidity and mortality throughout the world. Trauma is a leading cause of morbidity and mortality among older patients. Regardless of the type, TBIs need to be taken seriously. Symptoms of traumatic brain injury (TBI). It usually requires immediate treatment. Accessed Nov. 22, 2019. Current Sports Medicine Reports. Policy. Masks are required inside all of our care facilities. Head trauma, caused by a fall, car accident, sports accident or other type of blow to the head. Request PDF | On Feb 28, 2023, Ilaria Alice Crippa and others published Cerebral Autoregulation is Influenced by Carbon Dioxide Levels in Anoxic Brain Injury | Find, read and cite all the research . A single copy of these materials may be reprinted for noncommercial personal use only. Of note, there was an increase in ductular reaction with PMNs in the DBD group (52.9%, p-value = 0.041). Contrecoup brain injury involves a contusion remote from, and classically opposite to, the actual site of impact to the head. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. This causes pressure inside the skull to increase, which can lead to brain damage. Focal and diffuse brain injury are ways to classify brain injury: focal injury occurs in a specific location, while diffuse injury occurs over a more widespread area.It is common for both focal and diffuse damage to occur as a result of the same event; many traumatic brain injuries have aspects of both focal and diffuse injury. In this type of fracture, the normal suture lines are widened. Primary injuries can involve a specific lobe of the brain or can involve the entire brain. These bleeds can "squish the brain," Graffagnino said, and cause injury at a slower rate. Last reviewed by a Cleveland Clinic medical professional on 05/04/2020. Positive reinforcement will encourage the patient to strengthen his/her self-esteem and promote independence. Persons who suffer a severe brain injury may lose muscle strength, fine motor skills, speech, vision, hearing, or taste function, depending on the brain region involved and the severityof brain damage. A bruise directly related to trauma, at the site of impact, is called a coup(pronounced COO) lesion. Some tips that may help you to prevent or minimize your risk of head injury include: Wearing protective gear during sports and other recreational activities. These affects can include: However, over time and with a lot of effort and determination in rehabilitation (physical, occupational and speech therapy), you can regain some of these lost functions. Crossed cerebellar diaschisis (CCD) has been widely investigated in patients with supratentorial stroke. For example, if someone seems fine after a head injury and can talk but later becomes unconscious, seek immediate medical care. Most people usually recover fully after a concussion. Such bleeding in your brain can be fatal. Schultz BA (expert opinion). A hard blow to the head can shake your brain inside the skull. A traumatic brain injury (TBI) can be caused by a forceful bump, blow, or jolt to the head or body, or from an object that pierces the skull and enters the brain. But concussions can be difficult to recognize in infants and toddlers because they can't describe how they feel. Drowsiness and progressive loss of consciousness, Loss of movement (paralysis) on the opposite side of the body from the head injury, Experience vomiting, weakness, blurred vision, unsteadiness, Take aspirin or other blood-thinning medication daily. During the examination, the doctor obtains a complete medical history of the patient and family and asks how the injury occurred. information is beneficial, we may combine your email and website usage information with An acquired brain injury (ABI) is an injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma. Your healthcare providers will monitor you closely after surgery. This content does not have an Arabic version. These persons require long-term medical and rehabilitative (physical, occupational, or speech therapy) management. American Association of Neurological Surgeons. This type of brain injury may lead to bleeding in or around your brain, causing symptoms . Children and adolescents should be evaluated by a health care professional trained in evaluating and managing pediatric concussions. It can cause bleeding, swelling and increased pressure in the . Findings In this cohort study, subarachnoid hemorrhage, subdural hematoma, and contusion often co-occurred and were associated with both incomplete recovery and more severe impairment out to 12 months after injury, while intraventricular and/or petechial hemorrhage co-occurred and were associated with more severe impairment up to 12 months . Accessed Jan. 9, 2020. This space is called the subdural space because it is below the dura. How common is a headache from a chronic subdual hematoma? McBride W. Subdural hematoma in adults: Etiology, clinical features and diagnosis. Electroencephalogram (EEG). Prediction of Chronic Subdural Hematoma: Symptoms After Fall? Chronic subdural hematoma in patients under 40, 3 chronic SDH questions answered by neurosurgeon. Make a donation. [1][2] Sometimes . Epidural hematomas occur when a blood clot forms underneath the skull, but on top of the dura, the tough covering that surrounds the brain. There are many causes of head injury in children and adults. Violently shaking of the head and upper body also can cause concussions. They're caused by a weakened vessel that ruptures and bleeds into the surrounding brain. An acute subdural hematoma is an emergency situation and has an 80 percent mortality rate. Specific treatment of a head injury will be determined by yourdoctor based on: Your age, overall health, and medical history, Your tolerance for specific medications, procedures, or therapies, Expectations for the course of the head injury. The Journal of Family Practice. Centers for Disease Control and Prevention. 1). American Association of Neurological Surgeons. The findings of a SDH can occur immediately [acute], between three days and three weeks [sub-acute] or greater than three weeks [chronic], says Dr. Carpenter. Subdural hematomas occur in up to 25% of people with head injuries. Brain bleeds can occur in the meninges layers outside the brain tissue or inside the brain tissue itself. Intracranial hematoma (ICH). Accessed Nov. 22, 2019. To better understand brain bleeds, its important to have a basic understanding of the different types. CT scans are more detailed than general X-rays. (https://www.cdc.gov/mmwr/volumes/65/wr/mm6552a2.htm), (https://familydoctor.org/condition/head-injuries/), Visitation, mask requirements and COVID-19 information, Headache that doesnt go away. Get useful, helpful and relevant health + wellness information. Accessed Nov. 22, 2019. Jackson WT, et al. Hemorrhagic strokes make up about 13 % of stroke cases. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, Brain Bleed, Hemorrhage (Intracranial Hemorrhage), (https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cerebrovascular-Disease), (https://www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds), (https://bafound.org/about-brain-aneurysms/brain-aneurysm-basics/brain-aneurysm-statistics-and-facts/), (https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/stroke-cva/intracerebral-hemorrhage), (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443867/), (https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebral-Aneurysms-Information-Page), (https://www.ninds.nih.gov/Disorders/All-Disorders/Stroke-Information-Page), (https://cvsection.org/patients/cerebrovascular-diseases/), Visitation, mask requirements and COVID-19 information, Cerebral hemorrhage accounts for about 13% of all strokes in the United States. The extent of the person's recovery depends on the type of brain injury and other medical problems that may be present. Concussions are also common if you play a contact sport, such as football or soccer. Clinical evidence indicates diabetes as a majorrisk factor for titaniumimplant treatment with high failure rates and poor osteointegration, but the underlying mechanism involved remains elusive.We hypothesize that reactive oxygen species (ROS) overproduction may contribute to the impaired osteogenesis of porous titanium implants (pTi) under diabetic conditions. The following are some of the different types of head injuries: Concussion. Sprouse RA, et al. Remember though, if you suspect a brain bleed, the sooner you can get to the emergency room the better your chance of survival. . Sudden acceleration or deceleration of the head, caused by events such as a car crash or being violently shaken, also can cause brain injury. The first use of the contrecoup was made by Hippocrates to describe a fracture opposite to the point of impact. This is the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Symptoms of a subdural hematoma may appear immediately following trauma to the head, or they may develop over time even weeks to months. A cerebral aneurysm that has not ruptured may require clipping or filling (sealing off) of the aneurysm through a craniotomy surgical procedure, or an angiography-type procedure to prevent a future rupture. A person can often feel normal for several days before feeling any symptoms. A traumatic brain injury (TBI) occurs when a traumatic event causes harm to the brain. The brain has three membrane layers or coverings (called meninges) that lie between the bony skull and your brain tissue. Use of this website and any information contained herein is governed by the Healthgrades User Agreement. All text is copyright property of this site's authors. A single copy of these materials may be reprinted for noncommercial personal use only. OBJECTIVES: To systematically review the effects of UCBCs on brain outcomes in animal models of . This period is called the lucid interval. Inability to move part of the body (paralysis). Inside your skull and over the brain there are 3 layers called the meninges. Ferri FF. You might seem fine after a head injury. The brain can be hurt in many different ways; injuries to the brain are typically classified . Stiffness in the neck. Drowsiness and progressive loss of consciousness. This is the most common type of skull fracture. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Policy. These doctors further describe brain bleeds by their exact location. As we noted earlier, the change in altitude, or atmospheric pressure, could worsen symptoms. Speech therapy or alternative forms of communication. Symptoms include ongoing headache, confusion and drowsiness, nausea and vomiting, slurred speech and changes in vision. Blood clot that formed in the brain or traveled to the brain from another part of the body, which damaged the artery and caused it to leak. Traumatic impact injuries can be defined as closed (or non-penetrating) or open (penetrating). This type of fracture may be seen with or without a cut in the scalp. The purpose of the meninges is to cover and protect the brain. [1] When compared to younger patients, elderly patients with traumatic head . problems with walking, balance, understanding, speaking or writing. The blood may collect in the brain tissue or underneath the skull, pressing on the brain. May 18, 2022. Healthcare providers treat larger hematomas with decompression surgery. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. Magnetic resonance imaging (MRI). Please note that reading information about concussion, including this web page or others, is not a substitute for appropriate care. Since the brain cannot store oxygen, it relies upon a series of blood vessels to supply oxygen and nutrients. Cerebral contusions are scattered areas of bleeding on the surface of the brain, most commonly along the undersurface and poles of the frontal and temporal lobes. Diffuse Axonal Injury (DAI) Diffuse axonal injuries are one of the most severe types of traumatic brain injury. (See next question.). 2016; https://www.mdedge.com/familymedicine/article/110762/neurology/sport-related-concussion-how-best-help-young-athletes. Mayo Clinic. However, efficacy of UCBCs may be influenced by different patient population and intervention characteristics. The content on this site is meant for information and guidance only, not for diagnosing or treating medical conditions. In this fracture, part of the skull is actually sunken in from the trauma. This type of brain injury may lead to bleeding in or around your brain, causing symptoms such as prolonged drowsiness and confusion. Dec. 17, 2019. INTRODUCTION: We have previously described preclinical literature which supports umbilical cord blood-derived cell (UCBC) therapy as an efficacious treatment for perinatal brain injury. Your doctor may perform a physical and neurologic exam along . While the ICP device is in place the patient will be given medication to stay comfortable. Unfortunately, some patients who remain in a coma, or have been severely paralyzed after an intracranial or cerebral hemorrhage may need permanent, long-term care typically provided in a nursing home. Surgery may be needed in the following situations: The goals of long-term treatment are to help you regain the functions needed for daily living, as much and as soon as possible, and to prevent future brain hemorrhages. Doctors usually run tests to rule out worst cases like a brain bleed or skull fracture. Seek immediate medical attention after a blow to the head if you: If you don't notice signs and symptoms right after you've been hit in the head, watch for physical, mental and emotional changes. A head injury may result from motor vehicle or bicycle accidents, falls, assaults, and sports injuries. https://www.uptodate.com/contents/search. Diseases can cause spontaneous leakage of blood into the brain. Some symptoms include headache; nausea and vomiting; or sudden tingling, weakness, numbness or paralysis of face, arm or leg. The injury can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone(s), or from internal bleeding and damage to the brain. a mild and long-lasting . After impact, the brain may undergo a delayed trauma - it swells - pushing itself against the skull and reducing the blood flow. A scan of your brain (such as a CT scan) is not needed to spot a mild TBI or concussion, but may sometimes be used for patients at risk for bleeding on the brain after a head or brain injury. Inability to read, write, speak, or effectively communicate. Stovitz SD, et al. bleeding from their ears or bruising behind their ears. This site complies with the HONcode standard for trustworthy health information: verify here. Let a healthcare professional determine if you have a brain emergency. The decision depends on the size, cause and location of the bleed and other factors. However, the role of CCD in lower limb recovery after stroke is still unknown. During the first 24 hours you should avoid medications that can increase risk of bleeding. These can range from mild head injuries to quite serious and potentially life-threatening injuries. If you have a subdural hematoma, blood is leaking out of a torn vessel into a space below the dura mater, a membrane between the brain and the skull. numbness or weakness in part of their body. Various types of intracranial hemorrhages strike people of all ages. Brain swelling after a concussion has the potential to amplify the severity of the injury. We are vaccinating all eligible patients. Computed tomography scan (also called a CT or CAT scan). Complete vascular study, complete blood count (CBC), and/or blood studies. Additional surgery may be needed to remove large or thick blood clots if present. Chick embryos received 25% ethanol (75 L) and TSE (250, 500, 750 &mu . Traumatic vs. non-traumatic brain injury Brain injury can be called by different names, like concussion, shaken baby syndrome, and head injury. If you have a subdural hematoma, blood is leaking out of a torn vessel into a space below the dura mater, a membrane between the brain and the skull. At >6 months, pericholangitis (19% vs 4.5%, p = 0.13) persisted in the DCD group. Head injury may cause the brain to swell. British Journal of Sports Medicine. The blood builds up in a space between the protective layers that surround your brain. A stroke can occur. Treatment is individualized, depending on the extent of the condition and the presence of other injuries. Concussion evaluation and management. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. In patients with anaplastic oligodendroglial tumors with 1p/19q codeletion, probable 20-year overall survival following radiotherapy without vs with the combination of procarbazine, lomustine, and vincristine was 13.6% vs 37.1% (80 patients; HR, 0.60 [95% CI, 0.35-1.03]; P = .06) in the EORTC 26951 trial and 14.9% vs 37% in the RTOG 9402 trial . Traumatic brain injury: Hope through research. Sudden acceleration or deceleration of the head, caused by events such as a car crash or being violently shaken, also can cause brain injury. First, your healthcare provider will do a thorough physical and neurological exam. Always consult yourdoctor for a diagnosis. Concussion (child). The older person may not remember hitting their head. Conditions related to abnormal collagen formation in the blood vessel walls that can cause to walls to be weak, resulting in a rupture of the vessel wall. Accessed Nov. 24, 2019. Some TBIs are mild, producing headaches or dizziness that improve on their own within a few days. Anti-epileptic drugs for seizure management. A surgeon drills one or more holes in the skull to drain the blood. Photophobia (sensitivity to light) One side of the face or body becoming weaker than the other. (Headache is usually severe in the case of acute subdural hematoma.). It may also be caused by trauma such as a car accident or fall. Bed rest, medications and observation may be all that is needed. Lempke L, et al. A concussion is a traumatic brain injury that affects your brain function. Symptoms of concussion include brief: loss of consciousness after the head injury; periods of memory . Scary Symptoms does not make any representation regarding the accuracy of any information contained in those advertisements or sites, and does not accept any responsibility or liability for the content of those advertisements and sites and the offerings made by the third parties. Trauma to the head can cause neurological problems and may require further medical follow up. A subdural hematoma is a buildup of blood on the surface of the brain. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. . Symptoms can last for days, weeks or longer. This content does not have an Arabic version. These people include: Subdural hematomas can be life-threatening. Neurology. Centers for Disease Control and Prevention. Silverberg ND, et al. other information we have about you. Conditions related to pregnancy or childbirth, including. (However, some for example, subdural hematomas can take days to weeks before symptoms develop.) One of the main concerns with a concussion is the development of a brain hemorrhage. These pathophysiological changes following ICH . 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). In this study, we used chick embryos to establish ALD model to study the hepatoprotective effects of tamarind shell exttract (TSE). Acute mild traumatic brain injury (concussion) in adults. Mayo Clinic is a not-for-profit organization. National Institute of Neurological Disorders and Stroke. When trauma is not the cause, the most common causes are long-standing, high blood pressure in older adults, bleeding disorders in either children or adults, or the use of medications that cause blood thinning or certain illicit drugs. The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. 2019; doi:10.1016/j.apmr.2019.10.179. Percent of People with Normal Head CT Who Develop Brain Bleed. Clinical Journal of Sports Medicine. Concussion vs brain bleed. Traumatic Brain Injury (TBI) Pre-Class Notes TBI: external force causing damage to the brain o Mechanical (physical), thermal, chemical, electrical, and radiation Major cause of preventable death and disability in the US Force= Mass x Acceleration o Force- depends on object size and the speed o Impact is dependent on the amount of force, direction, duration, rate, and more Mechanisms of Injury . Usually, healthcare providers leave a drain in place for several days following surgery to allow the blood to continue draining. "Traumatic brain injury (TBI) can produce hemorrhages (including subdural, epidural and subarachnoid) from the focal trauma to a particular area of the brain," says D'Wan Carpenter, DO, a board certified physical medicine and rehabilitation physician with SIMEDHealth . Nausea and vomiting. This video explains the difference between concussions and brain bleeds. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain. Giza CC, et al. After suffering a concussion, many people experience headache and confusion. Collins MW, et al. These fractures are more often seen in newborns and older infants. In fact diagnosis of concussion includes no evidence of bleed. Yes, a subdural hematoma can be a serious event. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. Concussion in children: Management. Get useful, helpful and relevant health + wellness information. Weakness or numbness in any part of the body. About 50% of people with large acute hematomas survive, though permanent brain damage often occurs as a result of the injury. Essentially, this type of brain injury is one that has occurred after birth. If you or your loved one take a blow to the head or have symptoms, call 911. A traumatic brain injury (TBI) is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force. Some types of TBI can cause temporary or short-term problems with normal brain function, including problems with how the person . A violent blow to your head and neck or upper body can cause your brain to slide back and forth forcefully against the inner walls of your skull. A hematoma that gets bigger can cause gradual loss of consciousness and possibly death. [1] From the 16th to the 19th centuries, it has been occasionally referenced in the literature. Symptoms generally improve over time, and most people with a mild TBI or concussion feel better within a couple of weeks. Bleeding disorders or treatment with anticoagulant therapy (blood thinners). Occasionally, the bleed is slow and the body is able to absorb the pooled blood. If the pressure goes up, it can be treated right away. Accessed May 13, 2022. If worrisome signs develop later, seek emergency care. You might develop signs and symptoms of an intracranial hematoma right after a head injury, or they may take weeks or longer to appear. This is especially true if you're taking a blood-thinning medication or an anti-platelet drug, such as aspirin. Remember to always visit an emergency care center immediately after any major head injury, and tell them if you're experiencing any of the following: Headache. information highlighted below and resubmit the form. Mayo Clinic does not endorse companies or products. If the patient has a severe head injury, he or she may require monitoring for increased intracranial pressure (pressure inside the skull). Many traumatic brain injuries cause immediate brain trauma and swelling, meaning TBI symptoms and brain bleeding often overlap. Subdural hematomas can be serious. Time between the start of symptoms and start of a bleed and between start of a bleed and confirmation of a bleed are critical time points. You may opt-out of email communications at any time by clicking on These injuries are fairly common and are usually caused by shaking of the brain back and forth, which can happen in car accidents, from falls or shaken baby syndrome. A diagnostic imaging procedure that uses a combination of X-rays and computer technology to producehorizontal, or axial,images (often called slices)of the body. Accessed Nov. 25, 2019. Accessed Nov. 22, 2019. Someone who suffers trauma to the side of their skull can cause blood to leak out from the middle meningeal artery. First, there are two main areas where bleeding can occur bleeding can occur either within the skull but outside of the brain tissue, or inside the brain tissue. Yes. https://www.uptodate.com/contents/search. Two types of brain bleeds can occur inside the brain tissue itself intracerebral hemorrhage (also called cerebral hemorrhage and hemorrhagic stroke) and intraventicular hemorrhage. What is a concussion? Accessed May 18, 2022. When the swelling has gone down and there is little chance of more swelling, the device will be removed. The following are the most common symptoms of a head injury. A subdural hematoma is always a risk after a head injury. Olympia RB, et al. In DAI, the patient is usually in a coma for a prolonged period of time, with injury to many different parts of the brain. At my follow up appointment the possibility of a small bleed was mentioned again if I didn't get better , CT scan was done a day after initial injury , I don't feel necessarily bad , kinda tired , full head pains , Bright lights do bother me and loud noises , I am sleeping better at night and I do feel better , I . Although they do not appear that often, an expanding bleed in the brain can be life threatening. A head injury occurs as a result of trauma to the scalp, skull or brain and may be classified as closed (no cut to the skin) or penetrating (skin and/or bone of the skull is broken). Concussion symptoms usually are temporary and include a brief change in mental status. Neurologia Medico-Chirurgica. Other complications include: Although it may not be possible to prevent a hematoma as a result of an accident, you can reduce your risk by: If you have a subdural hematoma, your prognosis depends on your age, the severity of your head injury and how quickly you received treatment. All Rights Reserved. However, an intracranial hematoma is potentially life-threatening. Buildup of amyloid protein within the artery walls of the brain (cerebral amyloid angiopathy). Concussions are usually caused by a blow to the head. Symptoms of a brain hemorrhage depend on the area of the brain involved. Concussion is treatable: Statements of agreement from the targeted evaluation and active management (TEAM) approaches to treating concussion meeting held in Pittsburgh, October 15-16, 2015. Concussion. TBI can also cause serious long term effects (like physical . Good to know if you hit your head or have balance issues. Grade 2: When the brain malfunctions and the person is confused for more than 15 . The injury results in a change to the brain's neuronal activity, which affects the physical integrity, metabolic activity, or . Jensen NA. Traumatic brain injury (TBI) can range from mild concussions to severe brain damage. All rights reserved. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Guide to Raising a Healthy Child. The different types are classified by their location in the brain. T. Depending on the severity of the injury, treatment may include: Topical antibiotic ointment and adhesive bandage, Moderate sedation or assistance with breathing that would require being placed on a breathing machine, or mechanical ventilator or respirator. Activities and factors that may increase your risk of a concussion include: Potential complications of concussion include: Second impact syndrome. https://www.uptodate.com/contents/search. Can Chronic Subdural Hematoma with Symptoms Go Away on Its Own? This is called a lucid interval. Mayo Clinic. The risk is also greater for people who: Also called an extradural hematoma, this type occurs when a blood vessel bursts between the outer surface of the dura mater and the skull. Grade 1: The least severe form of concussion, when the individual's brain functions return to normalcy after 15 minutes. Centers for Disease Control and Prevention. The Joint Cerebrovascular Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. A concussion is an injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event.
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