Written By: Dr. Ahmed Diraz
What exactly is traumatic brain injury?
TBI can result from a blow to the head that strikes an object suddenly and violently. A Traumatic Brain Injury (TBI) can also happen secondary to an object penetrating the skull and entering the brain tissue. The scalp, skull, brain, underlying tissue, and blood vessels in the head can all be injured.
What is the prevalence of TBI?
- Nearly 300,000 TBI hospitalizations in the United States each year
- Each year, approximately 100,000 people suffer from long-term disabilities associated with TBI, with an estimated annual TBI cost of $76.5 billion
- TBI affects males more than females; approximately 3:1
- TBI affects more older adults (≥75 years), then the very young (0 to 4 years), and then young adults (15 to 24 years).
- An estimated 50,000 deaths occur in the United States each year, primarily due to motor vehicle accidents, suicide, and falls.
What causes TBI?
TBI is most commonly caused by motor vehicle accidents, violence, falls, sports-related injuries, or child abuse.
Different types of head injuries:
Skull fracture: Because the skull is so strong, it is not easy to break. A fractured skull may also be associated with brain damage. Skull fractures can be linear (fissure), depressed, or basal. The most severe type of skull fracture is a basal skull fracture, which involves a break in the bone at the skull base.
Brain Concussion: It is a mild type of TBI and occurs when a blow to the head is severe enough to cause brain injury. The symptoms that result from a concussion are usually temporary. However, repeated concussions can result in permanent brain damage.
Brain Contusion: Contused brain is slight bleeding and swelling inside the brain near the point where the head was struck.
Intracranial hematomas: Intracranial hematoma means blood collection inside the skull cavity. There are several types of intracranial hematomas based on their location:
- Epidural hematoma. It happens when a blood clot forms beneath the skull but above the dura, the tough covering that surrounds the brain. A tear in the middle meningeal artery, which runs just beneath the skull bone, usually causes it. Typically, epidural hematomas are associated with a skull fracture.
- Subdural hematoma. Blood collects beneath the skull and the dura but outside the brain to form subdural hematomas. A tear in the vein that connects the brain to the dura or a cut in the brain itself can cause it. It is occasionally, but not always, associated with a skull fracture.
- Subarachnoid hemorrhage. It develops beneath the arachnoid layer, which covers the brain beneath the dura. It is most commonly associated with severe head injuries, which are usually fatal.
- Intracerebral hematoma. It happens when blood clots form in the brain and is classified based on where they originate. It is indicative of a severe head injury that could be fatal.
- Diffuse axonal injury: A diffuse axonal injury (sheer injury) is a brain injury that does not cause bleeding but damages brain cells and impairs function. It can also cause swelling, which can exacerbate the damage. Diffuse axonal injury is severe form of head injury. It can lead to either permanent damage or death.
What are the symptoms of TBI?
TBI symptoms vary depending on the severity of the head injury.
The following are common symptoms of a minor head injury:
- Mild confusion
Many of the symptoms of a severe head injury are similar to those of a minor head injury. They may also include the following:
- Loss of consciousness
- Loss of balance
- Severe disorientation
- Abnormal eye movements
- Changes in the pupil size
- Persistent or worsening headache
- Loss of memory
- Mood swings
- Leaking of blood or clear fluid from the ear or nose
How is a head injury diagnosed?
The immediate diagnosis and medical attention are required in the presence of:
- Loss of consciousness
Head injured cases should be moved with caution and without causing further harm.
All of the circumstances surrounding the head injury are important. The doctor can obtain a detailed history from either the patient or the accompanying witnesses.
The patient will be fully assessed in the Emergency Department, including external examination and clinical assessment.
Head injuries are frequently diagnosed using imaging tests. The main diagnostic imaging procedure for determining head injury is a computed tomography (CT) scan. It reveals any fractures, bleeding, brain swelling, or structural damage.
Magnetic resonance imaging (MRI) can provide a more in-depth look at the brain. When a patient’s condition is stable, an MRI scan is usually ordered.
How is a head injury treated?
Treatment for head injuries is determined by the type and severity of the injury.
Minor cases of head injury do not require hospitalization after clinical evaluation. Scalp wounds may require pain relievers, stitches, and antibiotic ointment. This group of patients is given a minor head injury chart, which guides them to return to the hospital for further evaluation.
Hospitalization is required for moderate to severe head injuries. Further treatment may be medical only or surgical and medical to prevent secondary brain insults following the direct damage immediately following the trauma. Patients can be treated in the ward or the intensive care unit (ICU), depending on their condition.
Urgent surgery may be needed to remove intracranial bleeding or repair skull fractures. Intracranial pressure monitoring is also required in severe cases, which involves inserting a sensor into the brain to measure the pressure. The patients can then continue their medical treatment in the ICU and receive medications that protect the brain from secondary damage. Examples of such drugs are anti-seizure medications and diuretics (medicines that increase urine output) to reduce brain swelling. Close observation and follow-up CT brain scans are critical for determining the course following the injury.
Patients with head injuries who do not require surgery are closely monitored until their condition stabilizes. The goal of treatment in this group is to avoid any secondary brain damage that could impair brain function. Follow-up imaging also aids in determining the stability of their condition.
What is the role of rehabilitation?
Patients with severe brain injuries require additional rehabilitation to regain full brain function. Patients may need assistance in regaining mobility and speech.
What is the long-term outcome?
Most people who sustain minor head injuries recover without long-term consequences. On the other hand, patients with severe injuries may experience permanent changes in their personality, physical ability, and ability to understand, concentrate, and think.
- Brain Injury Association of America
- International Brain Injury Association
- Centers for Disease Control and Prevention
- American Association of Neurological Neurosurgeon
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