Traumatic brain injury (TBI)
Make an Appointment
Talk to DoctorOverview
Traumatic brain injury (TBI) is a critical health condition that impacts brain function. It can occur when an object, like a bullet or a fragment of skull, penetrates the brain tissue. A mild TBI might temporarily disrupt brain cells, while a more severe TBI can cause bruising, tissue tears, bleeding, and other physical damage to the brain. Such injuries can lead to long–term issues or even be fatal.
Traumatic brain injuries (TBIs) are categorized into two main types: penetrating and non–penetrating (blunt).
- Penetrating TBI: This type occurs when an object pierces the skull and damages brain tissue. Commonly referred to as open TBI, it can result from injuries caused by sharp objects such as shrapnel, bullets, or knives.
- Blunt TBI: Also known as non–penetrating or closed head TBI, this occurs when an impact to the head causes the brain to move or twist within the skull. Common causes include vehicle accidents, falls, sports injuries, or being struck on the head.
Healthcare providers further classify TBIs into three severity levels: mild, moderate, and severe.
- Mild TBI: Accounting for over 75% of all TBIs, mild TBIs can still lead to significant and long–term difficulties. A concussion is a common term used for mild TBIs. Individuals may experience challenges in resuming their daily activities, including work.
- Moderate and severe TBI: Individuals with moderate to severe TBIs often face substantial and long–lasting health complications.
However, there are treatments available for TBI, and importantly, there are preventive measures to reduce the risk of occurrence.
Symptoms
Traumatic brain injury happens when the brain experiences a forceful impact, causing it to twist or bounce within the skull. This can lead to the risk of brain damage and injury to cerebral blood vessels. Additionally, the brain’s chemistry undergoes changes following a traumatic brain injury, disrupting the normal functioning of brain cells.
A traumatic brain injury can result in a wide range of psychological and physical effects. Following the traumatic occurrence, certain signs or symptoms could show up right away, while others might take days or weeks to show up.
- Mild traumatic brain injury: The following are potential signs and symptoms of mild traumatic brain injury:
-
- Physical symptoms
- Dizziness or loss of balance
- Drowsiness
- Fatigue
- Headache
- Nausea or vomiting
- Speech problem
-
- Sensory symptoms
- Blurred vision.
- Changes in smell
- Ringing in the ears.
- Sensitivity to light or sound
- Unpleasant taste in the mouth.
-
- Cognitive, behavioral, or mental symptoms
- Depression or anxiety.
- Difficulty to sleep.
- Getting more sleep than normal
- Mood swings.
- Problem of concentration or memory.
- State of being dazed, confused, or disoriented instead of a loss of consciousness.
- Temporary loss of consciousness.
- Moderate to severe traumatic brain injuries: Any of the signs and symptoms of a mild injury, as well as the following indications that could manifest in the initial hours or days following a head accident, can indicate a moderate to severe traumatic brain damage:
-
- Physical symptoms
- Clear liquids dripping from the ears or nose
- Convulsions or seizures.
- Frequent vomiting or nausea.
- Having trouble waking up from sleep
- Headache that never goes away or becomes worse.
- Inability to coordinate.
- Loss of consciousness for several minutes to hours.
- One or both of the eyes’ pupil’s dilation
- Weakness or numbness in the toes and fingers
-
- Cognitive or mental symptoms
- Agitation, aggressiveness, or other unusual conduct
- Coma and other disorders of consciousness
- Profound confusion
- Slurred speech
- Children’s symptoms: Headaches, sensory issues, disorientation, and other related symptoms may not be communicated by infants and young children who have brain damage. When a child has a traumatic brain injury, you could notice:
-
- Change in eating or nursing habits.
- Irritable.
- Constant crying and an not able to be comforted.
- Unable to pay attention.
- Change in sleep pattern.
- Seizures.
- Sad, depressed, or drowsy.
- Loss of interest in playing games or toys.
Always consult a doctor if you or your child experiences a significant impact to the head or body that causes concern or behavioral changes. Seek immediate medical attention for any signs of TBI, which can occur when the head is struck forcefully enough to cause the brain to move within the skull, potentially damaging brain cells and blood vessels. This can lead to chemical changes that impair brain function. Symptoms of TBI vary in severity but generally include physical difficulties, cognitive impairments, and emotional or social issues. In infants, symptoms may manifest as persistent crying and feeding problems. Prompt medical evaluation is crucial, regardless of the injury being classified as mild, moderate, or severe.
Causes
The most common cause of traumatic brain injury is a blow to the head or other severe body injury. A number of factors, such as the type of injury and the impact force, can affect how much damage is done.
Traumatic brain injury is commonly caused by the following incidents:
- Falls: The most common cause of traumatic brain injury overall is falls—especially from beds or ladders, down stairs, in the bath, and other falls—especially in elderly persons and small children.
- Vehicular accident: Traumatic brain injury can often be caused by accidents involving automobiles, motorcycles, bicycles, and pedestrians involved in these types of incidents.
- Violence : Common causes include gunshot wounds, domestic violence, child abuse, and other attacks. Babies that experience severe shaking may suffer from traumatic brain injury, or “shaken baby syndrome.”
- Sports injuries: Sports injuries from a number of sports, such as hockey, skateboarding, football, baseball, lacrosse, boxing, soccer, and other high–impact or extreme sports, can result in traumatic brain injury. Among young people, these are very common.
- Explosive blasts and other combat injuries: Traumatic brain injuries among active–duty military soldiers are frequently caused by explosive blasts. Many researchers think that the pressure pulse traveling through the brain seriously impairs brain function, even though it is yet unclear how the harm is caused.
Penetrating wounds, severe strikes to the head with shrapnel or debris, falls, or physical impacts with objects after a blast can also cause traumatic brain damage.
Risk factors
The following people are most susceptible to traumatic brain injury:
- Children, especially from birth to the age of 4.
- Young adults, in particular those in the 15–24 age range
- Adults who are at the age 60 and older
- It is common among men.
Diagnosis
When more serious traumatic brain injuries (TBIs) left untreated, the effects can quickly worsen. Emergency personnel, such as healthcare providers, must act swiftly to examine the situation.
- Physical examination: You might be able to give healthcare providers information that will help them determine the injured person’s condition if you witnessed someone getting injured or if you arrived right away.
- Glasgow Coma Scale: The Glasgow Coma Scale assigns scores for abilities between three and fifteen. Less severe injuries correspond to higher ratings.
A person’s capacity to follow instructions and move their eyes and extremities is tested with this 15–point test that helps healthcare providers in determining the initial severity of a brain injury. Another important indicator is the coherence of speech.
- Imaging tests
- Computerized tomography (CT) scan: In an emergency room, this test is typically the first one carried out when a traumatic brain injury is suspected. A sequence of X–rays is used in a CT scan to produce a detailed image of the brain. In addition to rapidly revealing fractures, a CT scan can detect blood clots (hematomas), brain tissue edema, contusions, and bleeding in the brain.
- Magnetic resonance imaging (MRI): A MRI creates a detailed image of the brain by using magnets and strong radio waves. If the patient’s symptoms fail to get better right away following the accident, this test could be used once their condition has stabilized.
- Intracranial pressure monitor: Increased pressure within the skull because of tissue swelling following a traumatic brain injury can lead to further brain damage. To track this pressure, healthcare providers may place a probe into the skull.
Treatment
Treatment options vary for mild and moderate/severe traumatic brain injuries, with recommendations adapting to individual circumstances.
- Mild injury: For treating mild traumatic brain injuries, rest and over–the–counter pain relievers are typically sufficient for managing headaches. However, individuals with mild traumatic brain injuries should have their symptoms monitored at home for any worsening or new indications. Follow–up medical appointments with a healthcare provider may be necessary to assess the progress. The healthcare provider will offer guidance on when it’s safe to return to work, school, or leisure activities. It’s generally recommended to avoid activities that exacerbate symptoms for the first few days or until cleared by the healthcare provider. Complete abstention from all mental and physical exercise is not advised; instead, gradually reintroducing regular routines is typical.
- Immediate emergency care: When a person has moderate to severe traumatic brain damage, emergency care focuses on keeping blood pressure stable, ensuring they have enough oxygen and blood flow, and preventing more head or neck injuries.
It’s possible for people with severe injuries to also have untreated additional injuries. In the hospital’s emergency room or intensive care unit, more treatments will be directed toward reducing secondary brain damage brought on by bleeding, inflammation, or low oxygen delivery.
- Medications: Following an injury, medications to prevent further brain damage may include:
-
- Anti–seizure drugs: During the first week following their brain injury, those with moderate to severe traumatic brain injuries are susceptible to seizures.
During the first week, a medication that prevents seizures may be administered in order to prevent further brain damage from seizures. Only in cases of seizures are ongoing anti–seizure medications administered.
-
- Coma–inducing drugs: Due to the reduced oxygen requirement of a comatose brain, healthcare providers occasionally use medications to place patients into temporary comas. This is particularly beneficial if blood arteries are unable to provide appropriate levels of nutrients and oxygen to brain cells due to compression caused by elevated head pressure.
- Diuretics: These medications cause tissues to retain less fluid and produce more urine. Intravenous diuretics are used to lower intracranial pressure in patients suffering from traumatic brain injury.
- Surgery: It could be necessary to do emergency surgery to prevent more brain tissue injury. The following issues can be resolved by surgery:
-
- Blood clot removal (hematomas): Bleeding from the outside or inside the brain can cause a hematoma, or accumulation of clotted blood, which puts pressure on the brain and harms its tissue.
- Repairing skull fractures: Severe skull fractures or the removal of skull fragments from the brain may require surgery.
- Bleeding in the brain: Surgery may be necessary to stop brain hemorrhage resulting from head injuries.
- Opening a window in the skull: Draining collected cerebrospinal fluid or creating a window in the skull to allow greater space for swelling tissues are two surgical methods for reducing pressure inside the skull.
- Rehabilitation: Rehabilitation is usually necessary for those who have suffered a major brain damage. Basic abilities like walking and speech might need to be learned again by the patients. The intention is to increase their capacity to carry out daily routine tasks.
Typically, therapy starts in the hospital and continues at a residential treatment center, an inpatient rehabilitation unit, or through outpatient treatments. Each person’s rehabilitation program and length vary based on the extent of their brain injury and the specific area of the brain that was damaged.
