Occurs when normal brain functioning is perturbed by an external mechanical force – a violent blow, jolt, objects that could penetrate the skull. Mild injuries can cause temporary brain cell dysfunction. Serious traumas can cause bleeding, bruising, damaged tissues, which can lead to life-threatening complications. Types of injuries: open head injuries, closed head injuries, deceleration injury (the brain is slammed back and forth in the skull), chemical/toxic (poisoning, attacks the neurons), hypoxia (lack of oxygen), tumors (direct damage/pressure, spread over the brain’s surface), infections (encephalitis, meningitis), stroke.

Causes

Accidents, falls, firearms, violence, sports injuries

 

Open head injuries – bullet wounds, sharp objects

 

Closed head injuries – falls/slips; no skull penetration

 

Deceleration injuries – the soft tissue of the brain is slammed against the skull; axons (part of the neuron) can be torn leading to brain cell death

 

Chemical/ toxic – poisoning by pesticides, insecticides, solvents, carbon monoxide, lead, etc

 

Hypoxia – resulting from a heart attack, respiratory failure, a low-oxygen environment

 

Tumors – spread over the brain’s surface, pressure, direct damage; trying to surgically remove a tumor may also result in brain injury

 

Infections – the brain and surrounding membranes are affected

 

Stroke – brain damage caused by bleeding (hemorrhage or hematoma) or blocked blood flow (cellular death occurs in the area that is deprived)

Symptoms and signs

Symptoms and signs can occur immediately or day/weeks after the trauma

 

Mild traumatic brain injuries may include:

Loss of consciousness for brief periods (seconds or minutes)

Confusion, disorientation

Headaches

Nausea

Dizziness

Sleeping difficulties/excessive sleeping

Fatigue

Ringing sound in ears

Blurred vision

Altered taste, smell

Light sensitivity

Memory problems

Mood swings

Depression or anxiety

 

Moderate to severe cases:

Loss of consciousness (minutes to hours)

Loss of coordination

Persistent or progressive headaches

Convulsions, seizures

Vomiting

Pupil dilatation (in only one or both pupils)

Weakness or numbness in fingers/toes

Inability to awaken

Leaking clear fluids from nose/ears

Speaking difficulties

Profound confusion, agitation

Unusual behavior

Coma

 

Symptoms and signs observed in infants or young children:

Changes in eating/nursing habits

Unusually high irritability

Persistent crying

Changes in sleeping habits

Difficulty in paying attention

Depressed state

Advice

 

Traumatic brain injuries are treated as emergencies and doctors should quickly evaluate the patient’s situation in order to determine an appropriate course of action and treatment

Information regarding the context that led to the injury is important in understanding the severity of the case (manner of occurrence, loss of consciousness, length of unconscious state, etc)

CT scans (computerized tomography) and MRIs (magnetic resonance imaging) are used to see fractures, bleeding, blood clots, bruised tissue, swelling

Mild injuries usually do not require other treatment besides rest and medication for headaches, however, follow-up examinations are required especially if a symptom or any other discomfort persists

In moderate to severe cases the patient needs to be hospitalized and kept under surveillance – oxygen levels, blood supply and blood pressure must be kept under control, swelling must be reduced to prevent secondary damage to the brain

Medication: diuretics (to reduce pressure inside the brain by reducing the amount of fluids in tissues), anti-seizure drugs (to prevent possible seizures), coma-inducing drugs (in some cases, gives the brain a better chance of healing)

Surgery may be performed to minimize additional damage: to remove blood clots, to repair skull fractures or remove parts of the skull that may penetrate the brain, to relieve pressure (drilling a hole to drain accumulated spinal fluid)

Rehabilitation from severe traumatic brain injury can be challenging at times, but not impossible – basic skills such as walking or talking may need to be relearned

A series of specialists are part of rehabilitation teams that are there to offer the best of care and solutions: physiatrist (physical medicine and rehabilitation expert that oversees the whole process), occupational therapist (helps in learning/relearning skills for daily activities), physical therapist (helps with movement skills), speech-language pathologist, neuropsychologist (evaluates cognitive impairment and patient performance, teaches coping strategies and helps in behavioral management), rehabilitation nurse, recreational therapist, vocational counselor (evaluates the possibility of going back to work, opportunities and gives advice regarding challenges that may occur in the workplace)

MISCONCEPTIONS
  • If there is no bleeding or a cracked skull you shouldn’t see a doctor

     

    Mild traumatic brain injuries are nothing to worry about

     

    Recovery is a quick process that only depends on how much effort you put into it

     

    People that suffer a traumatic brain injury can no longer work

     

    Traumatic brain injury symptoms appear immediately

Statistics

 

Each year, approximately 1.5 million people in the US suffer a traumatic brain injury

 

50,000 people/year die from this kind of injury

 

85,000 people suffer complications and life-long disabilities

 

3 million people in the US live with disabilities that are generated by traumatic brain injury

Did you know?

 

The Glasgow Coma Scale (a 15 points test) is used to assess the initial severity of a traumatic brain injury. The patient’s ability to move their eyes, limbs and follow directions is checked, as well as their speech coherence.

The age categories that are most at risk are: children (up until 4 years old), young people (15-24 years old) and adults over 75.

Men are 1.5 times more prone to traumatic brain injuries than women.

Loss of consciousness occurs in less than 10% of concussions. So it’s not like in the movies.

Abraham Lincoln suffered a traumatic brain injury (a mule kicked him in the back of his head). This incident left him with a lazy eye and possibly depression.

NASCAR racer Ernie Irvan suffered not one, but two traumatic brain injuries on the same race track, exactly five years apart from one another. He opened the Race2Safety Foundation to educate people regarding TBI prevention and develop head-safety equipment for children.