Falling, being hit by an object, and motor vehicle collisions were the most common causes of TBI that led to emergency room visits. Traumatic brain damage can also be caused by indirect forces that severely jolt the brain inside the skull, like shock waves from wartime explosions. Gunshot wounds or other traumas that pierce the brain and skull can also cause traumatic brain damage.
Depending on whether the damage induces unconsciousness, how long the unconsciousness lasts, and the severity of the symptoms, doctors describe traumatic brain injury as mild, moderate, or severe. Even if most traumatic head injuries are categorized as mild because they aren’t life-threatening, sometimes a minor traumatic brain injury can still have substantial and long-term consequences.
Concussions are a form of TBI that is generally mild. Traumatic brain injuries, on the other hand, send approximately 3 million Americans to the emergency department each year.
Traumatic brain injuries affect about 800,000 children in the United States annually.
TBIs that are severe enough can result in death or irreversible brain damage.
Traumatic Brain Injury
A traumatic brain injury (TBI) is a physical damage to the brain tissue that causes temporary or permanent impairment of brain function. Then, clinical suspicion is raised, and imaging confirms the diagnosis. The first line of defense is to maintain a stable airway and appropriate breathing, ventilation, and blood pressure.
Patients with more serious injuries may require surgery to implant intracranial pressure monitors, decompression of the brain if the intracranial pressure is elevated, or removal of intracranial hematomas. In addition, maintaining appropriate brain perfusion and oxygenation and avoiding problems from an altered sensorium are critical in the initial few days after an injury. As a result, many patients need rehabilitation.
Traumatic brain injury, which occurs when the head is struck, and normal brain function is disrupted, poses a hazard to brain health in two ways:
- Loss of consciousness, inability to remember the traumatic incident, disorientation, difficulty learning and retaining new knowledge, difficulty speaking clearly, instability, lack of coordination, and visual or hearing difficulties are some of the immediate repercussions of a traumatic brain injury.
- Years after a traumatic brain injury, some forms of traumatic brain injury may raise the chance of getting Alzheimer’s disease or another type of dementia.
Symptoms of Traumatic Brain Injury
The symptoms caused by a moderate concussion or a less serious TBI may be transitory. Even a moderate TBI requires immediate medical attention. The symptoms of more serious injuries may be lifelong, and the consequences may be deadly. Some symptoms develop right away or shortly after the accident, while others appear long later.
Symptoms of Mild TBI
Mild TBI can cause the following symptoms:
- A brief period of unconsciousness
- Disorientation, dizziness, and/or confusion
- Headache
- Vomiting and/or nausea
- Vision blur, buzzing in the ears, and other sensory issues
- Light sensitivity
- Lethargy, sleepiness, or weariness
- Speech impediments
- Sleeping habits change
- Memory problems
- Having trouble concentrating or focusing
- Changes in mood or behavior
- Depression or anxiety
Symptoms of Severe TBI
Moderately severe TBI symptoms may resemble mild TBI symptoms. However, additional symptoms may appear. These signs and symptoms include:
- Long periods of unconsciousness
- Severe headache that persists or worsens over time
- Long-term dizziness, balance issues, or coordination issues
- Serious, long-term disorientation or perplexity
- In the extremities, numbing, tingling, or weakening
- Convulsions or seizures
- Uneven pupil responses or dilated pupils
- Speech problems that persist
- Not able to stay awake
- Agitation, anxiety, or aggressive rage
- Extreme mood or behavior changes.
- Drainage of clear fluid from the ears or noses
Causes of Traumatic Brain Injury
Accidental injuries and purposely inflicted violence are both common causes of TBI. Certain demographic groups are more susceptible to certain causes than others.
The following are the most prevalent causes of TBI:
1. Falls
Unexpected falls are the most prevalent cause of TBI, accounting for around 50 percent of all TBI cases. The elderly and children are the most prone to falls. Falls cause over half of all TBIs in kids under the age of 18 and far more than 80% of TBIs in persons over 64.
2. Injuries Caused by Gunshots
In the United States in 2014, self-inflicted gunshot wounds were responsible for 33% of all TBI-related deaths.
3. Vehicle Accidents
Car accidents and other motor vehicle-related occurrences account for almost one out of every five TBI hospitalizations.
4. Injuries Sustained in Sports
TBI in children and young people is frequently caused by injuries sustained while playing sports.
5. Violence
TBIs are commonly caused by domestic violence and child abuse.
6. Injuries Suffered in Combat
Active-duty military soldiers are susceptible to TBIs caused by explosives.
Types of Injury in Traumatic Brain Injury
TBIs can cause “mass lesions,” which are regions of localized injury in the brain such as hematomas and contusions that elevate the pressure. The following is a list of the several forms of TBI sequelae:
1. Hematomas
They are blood clots that form inside or on the surface of the brain. Hematomas can develop in any part of the brain. A blood clot develops between the dura mater (the brain’s layered membrane) and the interior of the skull, causing an epidural hematoma.
A subdural hematoma is a blood clot that occurs between the dura mater and the arachnoid layer, which is located immediately on the brain’s surface.
2. Contusions
A cerebral contusion is brain tissue that has been bruised. Cerebral contusions mimic bruises in other sections of the body when studied under a microscope. They’re made up of blood from arteries, capillaries, and veins mixed with injured or enlarged brain tissue.
Contusions are more prevalent in the brain’s lower front areas, but they can happen everywhere.
3. Intracerebral Hemorrhage
Intracerebral hemorrhage (ICH) is a kind of brain bleeding produced by a variety of brain injuries, including contusions. Whether a hemorrhage can be surgically removed depends on its size and location.
4. Subarachnoid Hemorrhage
Bleeding into the subarachnoid space causes subarachnoid hemorrhage (SAH). After a TBI, diffuse blood seems to be dispersed randomly throughout the brain surface. The majority of SAH cases linked to head trauma are minor. However, severe traumatic SAH can lead to hydrocephalus.
5. Diffuse Injury
Diffuse injury TBIs can induce minute changes in the brain that are not visible on CT scans, and most are scattered throughout it. A diffuse brain injury is a form of damage that can occur even without a lesion.
6. Diffuse Axonal Injury
Axonal damage is characterized as a progressive loss of axon function. These long extensions allow nerve cells to communicate with one another. The capacity of nerve cells to communicate and integrate tasks may be lost or greatly impeded if enough axons are damaged, leaving a person handicapped.
7. Ischemia
Ischemia, or a decrease in blood flow to particular areas of the brain, is another kind of diffuse damage. Blood flow may be reduced to extremely low levels in a significant number of TBI patients.
Since a brain that has recently undergone a catastrophic injury is extremely sensitive to minor variations in blood flow, this is crucial.
8. Skull Fractures
Pressures strong enough to break the skull might harm the underlying brain. If skull fractures are discovered during a patient examination, they might be concerning. Nerves, arteries, and other structures can be damaged by fractures around the base of the skull.
Cerebrospinal fluid (CSF) may leak out the nose or ears if the fracture spreads into the sinuses. Depressed cranial fractures, in which a bone fragment presses on or into the brain, are also a possibility.
Diagnosis in TBI
In order to diagnose a TBI, doctors will take numerous measures. When it comes to a mild TBI, the diagnosis process usually starts with testing to check whether any symptoms are present. Further testing may be needed if all these tests are positive or the indications are severe.
1. Neurological Exam
An in-office exam will be performed by a doctor to check the patient’s neurological function. Reflexes, balancing, agility, coordination, sight, and hearing will all be tested during this examination. In addition, memory, focus, and cognitive tasks may be included in the exam.
2. Imaging Tests
When symptoms worsen, a doctor may order imaging necessary to rule out a serious brain injury that has resulted in brain hemorrhage or swelling. Magnetic resonance imaging (MRI) and computed tomography (CT) scans are examples of these tests.
3. Hospitalization And Management
After a moderate TBI, a doctor may urge hospitalization or in-home surveillance, usually for 24 hours, to ensure that symptoms do not change or worsen.
4. Monitoring of Intracranial Pressure
In the event of moderate or severe TBIs, swelling and fluid accumulation can put a harmful strain on brain tissue. To detect this life-threatening condition, doctors may use a technique to check the pressure inside the skull.
Treatment of Traumatic Brain Injury
Traumatic brain injuries that are severe require specialist medical treatment and months of physical rehabilitation. However, the majority of traumatic brain injuries are minor and can be treated with a brief stay in the hospital for monitoring or at-home observation, followed by outpatient rehab if necessary.
Treatment options include:
1. Surgery
Several patients with moderate and severe head injuries go straight to the operating room from the emergency room. Surgery is sometimes done to remove a big hematoma or contusion, which is pressing the brain or elevating the pressure inside the skull. These patients are monitored in a critical care unit after surgery (ICU).
Other patients who have suffered a brain injury are sent from the emergency department to the intensive care unit (ICU). Because contusions or hematomas might increase in the hours or days following a head injury, surgery is not suggested for these individuals until several days later. Delayed hematomas may be identified if a patient’s neurological evaluation worsens or their ICP rises.
In certain cases, a simple follow-up CT scan to see if a minor lesion has altered size that reveals if the hematoma or contusion has dramatically grown. In these circumstances, removing the lesion before it expands and induces neurological damage is the safest option.
2. Non-Surgical Options
Currently, no medicine is available to stop nerve damage or enhance nerve recovery after a TBI. Therefore, the fundamental purpose of the ICU would be to avoid any further brain harm. The original brain injury is the “primary insult,” whereas any formation that could contribute to cognitive dysfunction is the “secondary insult”.
A wounded brain, for example, is more susceptible to blood pressure drops that are generally well tolerated. Attempting normal or slightly higher blood pressure levels is one approach to avoid subsequent insults.
Increases in ICP, decreased blood oxygenation, increased body temperature, increased blood glucose, and a variety of other factors can all exacerbate brain injury. The primary goal of ICU treatment in head-injured patients is to prevent further injuries.
Various monitoring gadgets may aid healthcare workers in their patient care. For example, an ICP monitor implanted in the brain can detect severe edema. A ventriculostomy is a tiny, flexible, hollow catheter that is placed into the ventricles, or fluid pockets in the middle of the brain, to measure ICP and drain CSF if the ICP rises.
A tiny fiberoptic catheter is inserted directly into the brain tissue in another form of intracranial pressure monitoring system. Additional catheters for measuring cerebral temperature and brain tissue oxygenation may be added.
The amount of oxygen used by the brain may be measured by inserting an oxygen sensor inside the jugular vein. This might be linked to the severity of the injury to the brain.
Summary
Even if you don’t believe the blow was significant, your healthcare professional should examine for any form of head or brain injury. TBIs can cause immediate complications. However, it is conceivable to have a slight brain damage and be completely unaware of it. Knowing what indications to watch for will help you obtain the medical attention you require.
Severe TBIs can have long-term bodily, cognitive, and psychological health impacts. Your doctor can assist you and your family in locating recovery services. Anxiety and despair are two typical TBI symptoms. Medication and counseling may be beneficial.
References
- https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/traumatic-brain-injury
- https://unitedbrainassociation.org/brain-resources/traumatic-brain-injury/
- https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Traumatic-Brain-Injury
- https://www.msdmanuals.com/en-in/professional/injuries-poisoning/traumatic-brain-injury-tbi/traumatic-brain-injury-tbi
