Traumatic brain injury

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 8, 2016
StartDiseasesTraumatic brain injury

Traumatic brain injury (TBI) can be caused by a specific trauma or accident, and it is a complex injury as the brain is so intricately connected to mobility, cognition, memory, and personality. TBI has the power to disrupt a number of body systems at the same time, whereas other injuries may affect the functioning of just one part of the body.

Contents

Definition & Facts

Traumatic brain injury is defined as brain dysfunction caused by external forces, such as a strong blow or impact to the head or body. A forceful jolt to the body that violently shakes the head or a foreign object that penetrates the skull may also result in TBI in an individual.

While symptoms and complications differ greatly from injury to injury, the primary result of TBI is the loss of brain functioning. TBI often results in death, but other brain injuries cause widespread brain damage, often leaving the victim impaired in a number of faculties.

The incidence of traumatic brain injury has been increasing in recent years and TBI affects men at a higher rate than women. Rates of death from traumatic brain injuries are highest in those over the age of 65 and have a fairly even distribution among those aged 15 to 64. Nine out of 10 instances of TBI resulting from a gunshot wound result in the death of the victim.

Symptoms & Complaints

The extent of the symptoms ranges from mild to severe depending on the trauma which caused the brain injury. Symptoms of mild trauma may appear as a loss of consciousness, a sensation of being confused or disoriented. A patient may feel dizzy, have a headache, fatigue or nausea.

Complaints that may signal mild brain trauma may also be cognitive or involve sensory perception, such as having difficulties remembering things, dramatic mood or temperament changes, sensitivity to light or noise, blurred vision or experiencing a ringing in the ears.

If the traumatic brain injury is more severe, the individual may experience seizures, dilation of one or both of their pupils, profound confusion, slurred speech or coma. A child who has experienced a brain trauma may show a dramatic change in eating habits, cry inconsolably, show a loss of interest in toys or playing, or may exhibit a change in mood.

Causes

Injuries which often cause traumatic brain injuries can be classified as a closed head injury or a open head injury. The type of injury may also be classified as either focal or diffuse as well as primary or secondary. Each classification of brain injury often has a different cause. For example, in a closed head injury, a strong force to the body or head leaves the skull intact, but severely shakes the brain causing damage, whereas an open head injury occurs when the skull is damaged and a foreign object penetrates the brain tissue. Some of the primary causes of traumatic brain injury include the following:

  • Falls - such as common slip and fall accidents or falls off of roofs
  • Car accidents - including collisions with cars, bikes or pedestrians
  • Violent acts - such as bullet wounds from firearms, abuse or battery
  • Combat-related injuries or blasts - seen in a number of military personnel that have sustained injury as a result of explosions or shrapnel
  • Sports injuries - most often involving athletes in high-impact sports like football, hockey or boxing. Chronic traumatic encephalopathy is a recently discovered and highly publicized disease caused by multiple concussions typically experienced during sports.

Diagnosis & Tests

As often seen with moderate to severe traumatic brain injuries, evidence of the event is quite clear, for instance in the case of a fall, car accident or bomb explosion. If other injuries are present, the focus is first on lifesaving measures, and afterward, patients are often sedated and put on life support or ventilation to allow for brain swelling or bleeding to subside.

After the patient is stabilized, a detailed neurological examination must be taken to see the areas of the brain that have been damaged and the extent of the damage. Medical practitioners may use the Rancho Los Amigos Scale or Glasgow Coma Scale to get some insight into the patient’s level of awareness, cognition and interaction with the environment.

A cognitive exam by a neuropsychologist and a series of brain scans, including CT scan, MRI, and PET scan are performed to assess brain damage and help make a diagnosis. Follow-up testing and evaluation performed by specialists in speech therapy, physical therapy, or occupational therapy can help provide an understanding of the likely deficits the individual may face and can help to outline the best course of treatment and therapy to benefit the individual patient.

Treatment & Therapy

As the scope, scale, cause and symptoms differ among traumatic brain injury patients, so does the necessary treatment and therapy. Mild traumatic brain injuries, like concussions, should show a reduction of symptoms with rest or over-the-counter pain treatment.

Treatment of more severe TBI is often initially dependent on the steps needed to save the life of the individual, so the patient may need to undergo surgery to remove brain clots, repair skull fractures or decrease brain pressure and swelling to prevent death or further brain damage.

Therapy is also largely dependent on the area or areas of the brain that were damaged, so that patients who experienced damage to the frontal lobe will likely require therapy to regain lost cognitive function or learn to manage cognitive impairments, while patients with a damaged cerebellum will require more physical therapy that focuses on regaining balance and body coordination. Still, other patients may also have other body injuries or damage to the spinal column, which may permanently restrict future mobility and thus require physical rehabilitation.

Prevention & Prophylaxis

While accidents cannot always be avoided and mild to severe traumatic brain injuries will continue to occur, prevention is the best tool to minimize the risks. Proper use of vehicle safety belts and airbags help to protect the body in the event of a car accident. It is important to always securely fasten children into the backseat of vehicles, as airbags themselves can cause injury to children in the front seat.

Drivers should never drive a vehicle under the influence of alcohol, drugs, medication or while feeling tired. Use of helmets when playing high-impact sports or while biking may also prevent TBI, and take proper safety precautions to prevent falls, such as the use of handrails, non-slip mats and ensuring proper lighting. Vigilance is a simple, yet under-rated and necessary measure to protect people from accidents that may cause traumatic brain injuries and subsequent life-altering consequences.