Traumatic brain injury

Description

Traumatic brain injury usually results from a violent blow or jolt to the head or body. An object that passes through the brain tissue, such as a bullet or shattered piece of skull, also can cause traumatic brain injury.

The mild traumatic brain injury may affect your brain cells temporarily. More serious traumatic brain injury can result in bruising, torn tissues, bleeding and other physical damage to the brain. These injuries can result in long-term complications or death.

Symptoms

Traumatic brain injury can have a wide range of physical and psychological effects. Some of the signs or symptoms may appear immediately after the traumatic event, while others may appear days or weeks after.

The mild traumatic brain injury

The signs and symptoms of mild traumatic brain injury may include:

  • Headache
  • Nausea or vomiting
  • Fatigue or drowsiness.
  • Problems with speech
  • Dizziness or loss of balance
  • Sensory problems, such as blurred vision, ringing in the ears, bad taste in the mouth, or changes in the ability to smell
  • The sensitivity to light or sound
  • Loss of consciousness for a few seconds to a few minutes
  • There is No loss of consciousness, but a state of being dazed, confused or disoriented
  • Memory or concentration problems
  • Mood changes or mood swings
  • Feeling depressed or anxious
  • Difficulty sleeping
  • Sleeping more than usual

Moderate-to-severe traumatic brain injury

Moderate-to-severe traumatic brain injury can include any of the signs and symptoms of mild injuries, as well as these symptoms can appear within the first hours or days after a head injury:

  • The loss of consciousness from several minutes to hours
  • Persistent headache or a headache that gets worse
  • Repeated vomiting or nausea
  • Convulsions or seizures
  • Dilation of one or both pupils of the eyes
  • Clear fluids draining from the nose or ears.
  • Inability to awaken from sleep
  • Weakness or numbness in the fingers and toes
  • Loss of coordination
  • A deep confusion
  • Agitation, aggression or behavior out of the ordinary
  • Speech difficulty
  • Coma and other disorders of consciousness

Children's symptoms

Infants and children with brain injuries may not be able to communicate headaches, sensory problems, confusion, and similar symptoms. In a child with traumatic brain injury, you may notice:

  • The change in diet or habits of nursing
  • Unusual or irritability
  • Persistent crying and inability to be consoled
  • Change in the ability to pay attention
  • Change in sleep habits
  • Seizures
  • Sad or depressed mood
  • Drowsiness
  • Loss of interest in favorite toys or activities

When to see a doctor

Always consult your doctor if you or your child has received a blow to the head or body that concerns you or to cause changes in behavior. Seek emergency medical attention if signs or symptoms of traumatic brain injury after a recent stroke or other traumatic injury to the head.

The terms "mild," "moderate" and "severe" is used to describe the effect of the injury on brain function. A mild brain injury is still a serious injury that requires immediate attention, and an accurate diagnosis.

Causes

Traumatic brain injury is usually caused by a blow or other traumatic injury to the head or body. The degree of damage can depend on several factors, including the nature of the injury and the force of the impact.

The most common events causing traumatic brain injury include the following:

  • Falls. Falling out of bed or of a ladder, go down the stairs, in the bathroom, and other falls are the most common cause of traumatic brain injury in general, in particular in older adults and young children.
  • Vehicle-related collisions. Collisions of cars, motorcycles or bicycles and pedestrians involved in these accidents are a common cause of traumatic brain injury.
  • Violence. Gunshot wounds, domestic violence, child abuse and other attacks are common causes. Shaken baby syndrome is a traumatic brain injury in infants, caused by a violent shaking.
  • Sports injuries. Traumatic brain injuries can be caused by injuries to a number of sports, such as football, boxing, soccer, baseball, lacrosse, skating, hockey, and other high-impact or extreme sports. These are particularly common in young people.
  • Explosive blasts and other combat injuries.Explosive blasts are a common cause of traumatic brain injury in military personnel in active service. Regardless of how the damage occurs is not yet well understood, many researchers believe that the pressure wave passes through the brain significantly disrupts the function of the brain. Traumatic brain injury also results from penetrating wounds, severe blows to the head with shrapnel or debris, and falls or bodily collisions with objects in the wake of a terrorist attack.

Explosive blasts and other combat injuries. Explosive blasts are a common cause of traumatic brain injury in military personnel in active service. Regardless of how the damage occurs is not yet well understood, many researchers believe that the pressure wave passes through the brain significantly disrupts the function of the brain.

Traumatic brain injury also results from penetrating wounds, severe blows to the head with shrapnel or debris, and falls or bodily collisions with objects in the wake of a terrorist attack.

Risk factors

The majority of people at risk of traumatic brain injury include:

  • Children, especially newborns to children of 4 years
  • Young adults, especially those between the ages of 15 and 24
  • Adults of 60 years and more
  • The men in any age group

Complications

Several complications may occur immediately or shortly after a traumatic brain injury. Serious injury and increase the risk of a greater number of more serious complications.

Altered consciousness

Moderate-to-severe traumatic brain injury can result in prolonged or permanent changes in a person's state of consciousness, the consciousness or responsiveness. Different states of consciousness are:

  • State of Coma. A person in a coma is unconscious, there is no consciousness of anything, and able to respond to any stimulus. This is the result of widespread damage to all parts of the brain. After a few days to a few weeks, a person can emerge from a state of coma or enter into a vegetative state.
  • Vegetative state.Substantial damage in the brain may be in a vegetative state. Although the person is not aware of the surroundings, he or she can open her eyes, making sounds, respond to the reflections, or move. It is possible that a vegetative state can become permanent, but often, people progress to a minimally conscious state.
  • Minimally conscious state. A minimally conscious state is a condition of altered consciousness, but with some signs of self-awareness or awareness of the environment. Sometimes it is a state of transition from a state of coma or in a vegetative state to a greater recovery.
  • Brain death. When there is no measurable activity in the brain and the brainstem, it is called brain death. In a person who has been declared brain dead, the removal of the breathing devices will result in an interruption of breathing, and eventual heart failure. Brain death is irreversible.

Vegetative state. Substantial damage in the brain may be in a vegetative state. Although the person is not aware of the surroundings, he or she can open her eyes, making sounds, respond to the reflections, or move.

It is possible that a vegetative state can become permanent, but often, people progress to a minimally conscious state.

Physical complications

  • Seizures. Some people with traumatic brain injury will develop seizures. The seizures may occur only in the early stages, or years after the injury. Recurrent seizures is called post-traumatic epilepsy.
  • The accumulation of fluid in the brain (hydrocephalus). The cerebrospinal fluid can build up in the spaces in the brain (cerebral ventricles) of some people who have had traumatic injuries to the brain, causing increased pressure and swelling in the brain.
  • Infections. Skull fractures or penetrating wounds can break down the layers of protective tissues (meninges) that surround the brain. This can allow bacteria to enter the brain and cause infections. An infection of the meninges (meningitis) could be extended to the rest of the nervous system if not treated.
  • Damage to the blood vessels. Several large or small blood vessels in the brain can be damaged in a traumatic brain injury. This damage can lead to stroke, blood clots or other problems.
  • Headaches. Frequent headaches are very common after a traumatic brain injury. May begin within a week after the injury and may persist for several months.
  • Vertigo. Many people experience vertigo, a condition that is characterized by dizziness, after a traumatic brain injury.

Sometimes, one or several of these symptoms may persist for a couple of weeks to a couple of months after a traumatic brain injury. When a combination of these symptoms last for a long period of time, this is generally referred to as the persistence of post-concussive symptoms.

Traumatic brain injuries in the base of the skull can cause damage to the nerves that emerge directly from the brain (cranial nerves). Cranial nerve damage may result in:

  • The paralysis of the facial muscles, or loss of feeling in the face
  • Loss or alteration of the sense of smell or taste
  • The loss of vision or double vision
  • Swallowing problems
  • Dizziness
  • Ringing in the ear
  • Hearing loss

Intellectual problems

Many people who have had a significant brain injury will experience changes in their thinking (cognitive) skills. It may be more difficult to focus and take more time to process their thoughts. Traumatic brain injury can result in problems with many skills, including:

  • Memory
  • Learning
  • Reasoning
  • Judgment
  • Attention or concentration
  • Troubleshooting
  • Multitasking
  • Organization
  • The planning of the
  • Decision-making
  • Beginning or in the accomplishment of tasks

Communication problems

Language and communication problems are common following traumatic brain injury. These problems can cause frustration, conflict and misunderstanding for people with a traumatic brain injury, as well as members of the family, friends and care providers.

The problems of communication may include:

  • The difficulty to understand speech or writing
  • Difficulty speaking or writing
  • Inability to organize their thoughts and ideas
  • Difficulty to follow and participate in conversations

The communication problems that affect the social skills may include:

  • Problems with shifts, or the selection of topics in the talks
  • Problems with changes in pitch, tone, or emphasis, to express emotions, attitudes, or subtle differences in the meaning
  • The difficulty to understand the non-verbal signals
  • Problems to read the signs of the listeners
  • Problems to start or stop the talks
  • Inability to use the muscles that are needed for forming words (dysarthria)

Behavior changes

The people who have suffered brain injury may experience changes in behavior. These may include:

  • Difficulty with self-control
  • The lack of awareness of the skills
  • Risk behaviors
  • Difficulty in social situations
  • Verbal or physical outbursts

Emotional changes

Emotional changes may include:

  • Depression
  • Anxiety
  • Mood swings
  • Irritability
  • The lack of empathy for others
  • The anger
  • Insomnia

Sensory problems

Problems that involve the senses can include:

  • Persistent ringing in the ears
  • The inability to recognize objects
  • Deterioration of hand-eye coordination
  • The blind spots, or double vision
  • A bitter taste, odor, or difficulty smelling
  • Skin tingling, pain, or itching
  • Balance problems or dizziness

Degenerative diseases of the brain

The relationship between degenerative brain diseases and injuries in the brain is still unclear. But some research suggests that repeated or severe traumatic brain injury may increase the risk of degenerative diseases of the brain. But this risk can not be predicted for a person, and the researchers are still investigating whether, why, and how traumatic brain injuries could be related to degenerative brain diseases.

A degenerative brain disorder can lead to gradual loss of brain functions, including:

  • Alzheimer's disease, which is mainly devoted to the cause of progressive loss of memory and other thinking skills
  • Parkinson's disease, a progressive disease that causes problems with movement, such as tremors, rigidity and slowness of movements
  • Dementia pugilistica — most often associated with repetitive blows to the head in the career of boxing — that causes the symptoms of dementia and movement problems

Prevention

Follow these tips to reduce the risk of brain injury:

  • Seat belts and air bags. Always wear a seat belt in a motor vehicle. A small child should always sit in the back seat of a car secured in a child safety seat or booster seat appropriate for their size and weight.
  • Use of Alcohol and drugs. Do not drive under the influence of alcohol or drugs, including prescription medications that can affect the ability to drive.
  • Helmets. Wear a helmet when riding a bicycle, skateboard, motorcycles, snowmobiles and all-terrain vehicles. Also wear protective gear for the head when playing baseball or contact sports, skiing, skating, snowboarding or riding a horse.
  • Pay attention to your surroundings. Do not drive, walk or cross the street while using your phone, tablet or any smart device. These distractions can lead to accidents or falls.

The prevention of falls

The following tips can help older adults avoid falls around the house:

  • Install handrails in the bathroom
  • Put a non-slip mat in the bathtub or in the shower
  • Remove carpets
  • Install handrails on both sides of the stairs
  • Improve the lighting in the home, especially around the stairs
  • Keep stairs and floors free of obstacles
  • Get regular vision checkups
  • Get regular exercise

Prevention of head injuries in children

The following tips can help children to avoid head injuries:

  • Install safety gates at the top of a ladder
  • Keep stairs free of obstacles
  • Install window guards to prevent falls
  • Put a non-slip mat in the bathtub or in the shower
  • The use of playgrounds with shock-absorbing materials in the soil
  • Make sure that the carpets are safe
  • Do not allow children to play on the stairs of a fire or balconies

Traumatic brain injury

Diagnosis

Traumatic brain injuries can be emergency situations. In the case of the most severe traumatic brain injury (Tbi), the consequences can quickly get worse without treatment. Doctors or first responders of the need to assess the situation quickly.

Glasgow Coma Scale

This 15-point test of the help of a medical or other emergency medical personnel to assess the initial severity of a brain injury, by testing the ability of a person to follow the instructions and move the eyes, and limbs. The coherence of the discourse also provides important clues.

The skills are scored from three to 15 on the Glasgow Coma Scale. Higher scores mean less serious injuries.

Information about the injury and symptoms

If you saw someone suffer an injury or arrived immediately after an injury, you may be able to provide medical staff with information that is useful in the evaluation of the injured person's condition.

Answers to the following questions may be useful for judging the severity of the injury:

  • How did the injury occur?
  • Does the person loses consciousness?
  • How long was the person unconscious?
  • Observed other changes in the state of alert, talking, co-ordination or other signs of injury?
  • Where was the head or other parts of the body hit?
  • You can provide any type of information about the force of the injury? For example, what struck the head of the person, to what extent he or she, or the person was thrown from a vehicle?
  • It was the body of the person whipped around, or severely damaged?

Imaging tests

  • Computed tomography (CT scan). Usually this test is conducted for the first time in an emergency room for a suspected traumatic brain injury. A computed tomography (CT) scan uses a series of X-rays to create a detailed view of the brain. A ct scan can visualize fractures and discover evidence of bleeding in the brain (hemorrhage), blood clots (hematomas), hematoma of brain tissue (contusions), and brain tissue swelling.
  • Magnetic resonance imaging (MRI). A Magnetic resonance imaging (MRI) uses powerful radio waves and magnets to create a detailed view of the brain. This test can be used after the person's condition is stabilized, or if symptoms do not improve soon after the injury.

Monitor intracranial pressure

Swelling in the tissue of a traumatic brain injury can increase the pressure inside the skull and cause additional damage to the brain. Doctors can insert a probe through the skull to control this pressure.

Treatment

The treatment is based on the severity of the injury.

Minor injury

Mild traumatic brain injuries usually require no treatment other than rest and over-the-counter pain relievers to treat headache pain. However, a person with a mild traumatic brain injury usually needs to be monitored closely at home for any persistent, worsening or new symptoms. He or she can also have follow-up doctor appointments.

The doctor will tell you when to return to work, school or recreational activities is appropriate. Relative rest — which means that the physical limitation or thinking (cognition) activities that make things worse — it is generally recommended for the first few days or until your doctor tells you it is ok to return to regular activities. It is not recommended that you rest for full physical and mental activity. Most of the people go back to the normal routine a little bit.

Immediate emergency care

Emergency care of moderate-to-severe traumatic brain injury is focused on ensuring that the person has enough oxygen and an adequate supply of blood, the maintenance of the blood pressure and prevent more injuries to the head or neck.

People with severe injuries may also have other injuries that need to be addressed. Additional treatments in the emergency room or intensive care unit of a hospital, they focus on minimizing the damage side, due to inflammation, bleeding, and / or the reduction of the oxygen supply to the brain.

Drugs

Medications to limit secondary damage to the brain immediately after an injury may include:

  • Anti-seizure drugs.People who have had a moderate to severe traumatic brain injury are at risk of having a seizure during the first week after their injury. An anti-seizure drug may be administered during the first week to prevent any further brain damage that may be caused by a seizure. Continued against the attacks of the treatments are only used if convulsions occur.
  • Coma-inducing drugs. Sometimes, doctors use drugs to put people in temporary comas due to a state of coma brain needs less oxygen to function. This is especially useful if the blood vessels, compressed by the increased pressure in the brain, are unable to provide the brain cells with normal amounts of nutrients and oxygen.
  • Diuretics. These drugs reduce the amount of fluid in the tissues and increase the production of urine. Diuretics given intravenously to people with traumatic brain injury, helping to reduce pressure within the brain.

Anti-seizure drugs. People who have had a moderate to severe traumatic brain injury are at risk of having a seizure during the first week after their injury.

An anti-seizure drug may be administered during the first week to prevent any further brain damage that may be caused by a seizure. Continued against the attacks of the treatments are only used if convulsions occur.

Surgery

Emergency surgery may be needed to minimize the damage to the tissues of the brain. Surgery may be used to treat the following problems:

  • Removal of clotted blood (hematoma). Bleeding within or outside of the brain can result in a collection of blood clots (hematoma) that exerts pressure on the brain and damaged brain tissue.
  • The repair of fractures of the skull. Surgery may be needed to repair severe fractures of the skull, or to remove the pieces of the skull into the brain.
  • Bleeding in the brain. The head injury that causes bleeding in the brain, surgery may be needed to stop the bleeding.
  • The opening of a window in the skull. Surgery may be used to relieve pressure inside the skull by the drainage accumulated cerebrospinal fluid, or the creation of a window in the skull that provides more space for the swelling of the tissues.

Rehabilitation

The majority of people who have had a significant brain injury will require rehabilitation. You can re-learn basic skills, such as walking or talking. The goal is to improve their abilities to perform daily activities.

Therapy usually begins at the hospital and continues in an inpatient rehabilitation unit, a residential treatment facility or through outpatient services. The type and duration of rehabilitation is different for each person depending on the severity of the injury in the brain and in what part of the brain is injured.

Rehabilitation specialists may include:

  • Physiatrist, a doctor trained in physical medicine and rehabilitation, which oversees the entire process of rehabilitation, which manages the medical rehabilitation of the problems and prescribe medications as needed
  • Occupational therapist, that helps a person to learn, re-learn or improve the skills to perform everyday activities
  • Physical therapist, who will help with the mobility and re-learn the patterns of movement, balance, and gait
  • Speech and language therapist, which helps the person to improve the communication skills and the use of assistive communication devices if necessary
  • The clinical neuropsychologist, which assesses the cognitive impairment and the performance, it helps the person to manage behaviors and learn coping strategies, and provides psychotherapy as needed to the emotional and psychological well-being
  • Social worker or case manager, which facilitates the access to the service agencies, assistance with care decisions and planning, and facilitates the communication between the different professionals, health care providers and family members
  • Rehabilitation nurse, that offers continuity of care and rehabilitation services, and help with the planning of the discharge from the hospital or rehabilitation center
  • Traumatic brain injury nurse specialist, who helps coordinate the care and educates the family about the injury and the recovery process
  • Recreational therapist, which helps in the management of the time and leisure activities
  • Vocational counselor, which evaluates the ability to return to work, and appropriate vocational training opportunities and resources are available to address common problems in the workplace

Coping and support

A series of strategies that can help a person with traumatic brain injury cope with complications that affect the activities of daily living, communication, and interpersonal relationships. Depending on the severity of the injury, caregiver, family member or friend who may need to help to implement the following methods:

  • Join a support group. Talk with your doctor or rehabilitation therapist about a support group that can help you to speak on topics related to your injury, learn new coping strategies and emotional support.
  • Write things down. Keep a log of the most important events, names of people, tasks, or other items that are difficult to remember.
  • Follow a routine. Maintain a consistent schedule, keeping things in designated places in order to avoid the confusion and take the same route when going to the visited destinations.
  • Take breaks. To make arrangements at work or school to take breaks when needed.
  • Alter expectations about work or tasks. Appropriate changes in the job or in school, you can include instructions to read to you, which allows for more time to complete tasks or to break down tasks into smaller steps.
  • Avoid distractions. Minimize distractions such as background noise, a television or radio.
  • Stay focused. Work on one task at a time.
Symptoms and treatment of Traumatic brain injury