If your client recently sustained injury to head, neck, face, or body, or has been strangled, and is experiencing any of the red flag symptoms listed below, get medical help immediately - call 911 or get them to the nearest emergency department.

Photo: Signs and Symptoms

Signs and Symptoms

After a moderate or severe traumatic brain injury, a person can experience some of the same symptoms as experienced after a mild injury, in addition to the following:3

  • Headache that gets worse/won't go away
  • Persistent nausea/repeated vomiting
  • Slurred speech
  • Convulsions/seizures
  • Inability to wake from sleep
  • Enlargement of pupils (dark centre) in one or both eyes
  • Numbness/tingling of the limbs
  • Loss of coordination
  • Increased confusion/restlessness/agitation
  • Emotional changes (e.g., depression, anxiety, aggression, impulsivity)
  • Personality changes

Red flag symptoms:1

  • Neck pain
  • Loss of consciousness, in and out of consciousness
  • Confusion or irritability
  • Severe or worsening headache
  • Repeated vomiting
  • Unusual changes in behaviour
  • Seizures or convulsions
  • Double vision
  • Weakness/tingling/burning in limbs

Mild Traumatic Brain Injury/Concussion Signs and Symptoms:2


  • Headache
  • Dizziness
  • Nausea
  • Vomiting
  • Poor coordination
  • Vision problems
  • Fatigue
  • Light sensitivity
  • Noise sensitivity


  • Difficulty organizing thoughts
  • Feeling slowed down
  • Difficulty concentrating
  • Difficulty remembering new information


  • Irritability
  • Sadness
  • Heightened emotions
  • Nervousness
  • Anxiety


  • Sleeping more/less than usual
  • Trouble falling asleep

Strangulation Signs and Symptoms:4


  • Voice changes (e.g., hoarse, raspy voice, loss of voice)
  • Pain when swallowing
  • Bleeding from mouth/coughing up blood
  • Abrasions, swelling, redness or bruises on the neck
  • Ligature marks from rope, cord, fabric
  • Swollen tongue
  • Difficulty with concentration/attention/coordination/memory
  • Difficulty using words, processing meaning of words
  • Headache
  • Light-headedness
  • Dizziness
  • Ear ringing
  • Facial/eyelid drooping
  • Breathing changes (e.g., hyperventilating)
  • Sweating
  • Visual disturbances
  • Numbness/tingling
  • Confusion
  • Mental status changes (e.g., combativeness, agitation)
  • Drowsiness
  • Cyanosis (blue tint to skin due to low oxygen)
  • Petechiae (small red spots) under the eyelids, around eyes/face/neck/scalp
  • Bloody red eyes
  • Limb jerking
  • Seizures
  • Loss of consciousness
  • Coma
  • Miscarriage if pregnant
  • Involuntary urination/defecation
  • Hormonal problems (e.g., neurogenic diabetes insipidus causing excessive thirst and urine production)


  • Limb weakness
  • Disturbed movement/balance/coordination (e.g., tremor, involuntary writhing, jerking)
  • Spasticity/rigidity
  • Cortical blindness (loss of vision in otherwise healthy eyes due to brain damage)
  • Memory problems
  • Disturbed speech and language functions
  • Disturbed executive function (e.g., thinking, reasoning, making judgments, planning)
  • Personality changes (e.g., irritability, impulsiveness, social conduct)
  • Hormonal problems (e.g., muscle weakness, low blood pressure, inability to regulate body temperature)


1Parachute Canada, “Concussion: The Basics,” Parachute Concussion Series, 2018. [Online]. Available: http://www.parachutecanada.org/downloads/resources/Concussion_Basics.pdf

2Centers for Disease Control and Prevention, “Traumatic Brain Injury & Concussion Signs and Symptoms,” Centers for Disease Control and Prevention, 2017. [Online]. Available: https://www.cdc.gov/traumaticbraininjury/symptoms.html.

3Eunice Kennedy Shriver National Institute of Child Health and Human Development, “What are common TBI symptoms?,” 2016. [Online]. Available: https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/symptoms.

4A. Foley, Federal Way, D. Gurney (ed.), “Strangulation: Know the symptoms, save a life,” J. Emerg. Nurs., vol. 41, no. 1, pp. 89-90, 2015.