A Traumatic Brain Injury (or TBI) usually occurs when sudden trauma to the head causes damage to the brain. These injuries can stem from a "closed head injury" where there is a sudden and violent blow to the head, a "penetrating head injury" where an object pierces the skull and enters the brain tissue, or a "diffuse head injury" where the brain is violently shaken.
Signs and Symptoms of Traumatic Brain Injury
The signs and symptoms of a TBI do not necessary occur immediately. With a mild TBI, the patient may remain conscious or loose consciousness for a few seconds. The signs and symptoms of a mild TBI include:
- Mental confusion
- Sensory changes like blurred vision, ringing ears, or a bad taste in the mouth
- Fatigue or lethargy
- Changes in sleep patterns
- Behavioral or mood changes
- Difficulty with memory, concentration, or calculation
If these symptoms worsen, they may indicate a more severe TBI.
With a moderate to severe TBI, the patient may show the same signs and symptoms of a mild TBI, but also exhibit any of the following:
- Loss of consciousness
- Personality change
- A severe, persistent, or worsening headache
- Repeated vomiting or nausea
- Inability to awaken
- Dilation of one or both pupils
- Slurred speech
- Weakness or numbness in the extremities
- Loss of coordination
- Increased confusion, restlessness, or agitation
Children with TBI may lack the communication abilities to report their symptoms. Instead, they may refuse to eat (or nurse), appear listless, and/or cranky.
Common Causes of Traumatic Brain Injuries
About half of all TBIs are due to transportation accidents involving automobiles, motorcycles, bicycles, and pedestrians. For persons 75 and older, falls represent the majority of TBIs. Military men and women serving in war zones are also frequent victims of TBI. Gunshot wounds to the head have the highest rate of death, ninety percent of which are fatal.
Effects of Traumatic Brain Injuries
The effects of TBI vary widely and may involve physical effects, cognitive effects, and emotional effects. Physical effects may include headaches, movement disorders, seizures, difficulty walking, sexual dysfunction, lethargy and/or coma. Cognitive effects may include changes in judgment, ability to reason, memory, and mathematical ability. Emotional effects may include mood swings, poor impulse control, agitation, low frustration threshold, clinical depression, and psychotic symptoms like hallucinations and delusions. Infection is also potentially serious complication from TBI.
Treatment of Traumatic Brain Injuries
Anyone who may have a TBI should receive medical treatment as soon as possible. The first medical treatment for TBI patients often begins when paramedics arrive or when the patient arrives into a hospital emergency room. Normally, there is little that can be done to reverse the initial brain injury. Instead, medical personnel usually focus on preventing any further damage which includes managing proper oxygen supply, blood flow, and blood pressure.
Imaging tests can help doctors reach a TBI diagnosis, treatment plan, and prognosis. Common TBI imaging and diagnostic testing are X-ray, CT, and/or MRI. Other tests include cerebral angiography, electroencephalography (EEG), transcranial Doppler ultrasound, and single photon emission computer tomography (SPECT).
In some instances, TBI patients experiencing brain swelling and fluid accumulation within the brain space. When this occurs, there is no place for swollen tissues to expand and no adjoining tissues to absorb excess fluid. This leads to increased pressure called intracranial pressure (ICP). Depending on the extent of the pressure, severe brain damage can result.
To measure a patient' ICP, doctors insert a probe or catheter into the skull which is connected to a monitor. Depending upon the amount of ICP, doctors may perform a ventriculostomy where cerebral fluid (CSF) is drained from the ventricles to bring down the pressure. Medication may also prove beneficial. In extreme cases, a decompressive craniotomy may be performed where part of the skull is removed to reduce severely high ICP. In patients with severe TBI, nearly half will undergo some form of surgery to remove or repair hematomas (ruptured blood vessels) or contusions (bruised brain tissue).
Rehabilitation and Prognosis for Traumatic Brain Injuries
Rehabilitation for patients with a TBI is a critical part of their recovery process. After the patient is stabilized, they may be transferred for rehabilitation therapy as an inpatient or outpatient depending on their condition and other variables. Patients are usually best managed in a facility that has a specialty focus in Brain Injury Rehabilitation. These patients may often need to relearn basic skills, including walking, talking, and bathing. The overall goal is to improve their ability to function as independently as possible. A TBI patient' prognosis, including the extent of any disabilities, depends largely on the severity of the injury, the location of the injury, and their general health.