Traumatic brain injury (TBI) Causes, Symptoms, Diagnosis and Treatment

Overview

Traumatic brain injury (TBI) results from an aggressive blow to the head or body. Anything that travels through the brain tissue, such as a bullet or shattered piece of the skull, can cause traumatic brain injury. A mild injury may affect the brain cells for some time, but a severe traumatic brain injury can result in serious injuries like bruising, ripped tissues, bleeding, and multiple physical damages to the brain. These injuries can lead to long-term adverse effects or even death.

Types

Traumatic brain injuries can be classified into the following types;

· Concussions

· Contusions

· Penetrating injuries

· Anoxic brain injuries

1. Concussions:

A concussion is a small brain injury that occurs due to shaking, an impact on the head, or a sudden drastic change in movement. Usually, concussions cannot be seen through an imaging test, but they should still be considered under emergency and should be treated accordingly. Concussions symptoms could be headaches, poor concentration, memory loss, and disorientation. Concussions are particularly considered dangerous if more than one stays over time, or if a second one appears before the first one heals. This is called “Second Impact Syndrome.”

2. Brain Contusions:

A brain contusion is primarily a bruise of the brain tissue, and like any other bruises in the body, they are formed by the breaking and leaking of small blood vessels. On the cutaneous level, leaking blood under the skin appears as blue-colored skin, whereas, in the brain, the leaking causes many ailments due to the pressure building on brain mass. Any blow to the head can cause brain contusions. The brain can be damaged directly under the site of impact, or on the opposite side from the point of impact as the brain is slammed into the opposite side of the skull, or both. These differences at the site of injury are classified under coup and contrecoup injuries. Contusions, like concussions, can result in minor to extremely severe injuries. Severe contusions may result in loss of consciousness, confusion, tiredness, emotional distress, or agitation. Swelling and brain herniation can occur with severe contusions, preventing proper oxygenation and causing other serious consequences.

3. Penetrating Brain Injuries:

Penetrating brain injuries may cause the object, hair, skin, or fragments of the skull to come in contact with the brain resulting in laceration, cavitation, bleeding, and crushing of the brain tissue.

4. Anoxic Brain Injuries:

An anoxic brain injury occurs when the brain does not receive the proper amount of oxygen to function. Within a few minutes, the brain cells will start to die, and an irreversible brain injury can occur. Since oxygen is carried to the brain through the bloodstream, anoxic brain damage usually occurs because of a blockage of this blood flow. Blockage can occur due to blood clots, stroke, heart attack, or serious trauma. It may also be possible that the blood supply to the brain, in quantity, is normal but that the blood itself does not carry enough oxygen. This can also occur due to poisoning, drowning, carbon monoxide poisoning, choking, suffocation, or anything that is not letting the lungs from taking in a normal amount of oxygen.

Traumatic brain injuries can be classified into the following types;

· Concussions

· Contusions

· Penetrating injuries

· Anoxic brain injuries

1. Concussions:

A concussion is a small brain injury that occurs due to shaking, an impact on the head, or a sudden drastic change in movement. Usually, concussions cannot be seen through an imaging test, but they should still be considered under emergency and should be treated accordingly. Concussions symptoms could be headaches, poor concentration, memory loss, and disorientation. Concussions are particularly considered dangerous if more than one stays over time, or if a second one appears before the first one heals. This is called “Second Impact Syndrome.”

2. Brain Contusions:

A brain contusion is primarily a bruise of the brain tissue, and like any other bruises in the body, they are formed by the breaking and leaking of small blood vessels. On the cutaneous level, leaking blood under the skin appears as blue-colored skin, whereas, in the brain, the leaking causes many ailments due to the pressure building on brain mass. Any blow to the head can cause brain contusions. The brain can be damaged directly under the site of impact, or on the opposite side from the point of impact as the brain is slammed into the opposite side of the skull, or both. These differences at the site of injury are classified under coup and contrecoup injuries. Contusions, like concussions, can result in minor to extremely severe injuries. Severe contusions may result in loss of consciousness, confusion, tiredness, emotional distress, or agitation. Swelling and brain herniation can occur with severe contusions, preventing proper oxygenation and causing other serious consequences.

3. Penetrating Brain Injuries:

Penetrating brain injuries may cause the object, hair, skin, or fragments of the skull to come in contact with the brain resulting in laceration, cavitation, bleeding, and crushing of the brain tissue.

4. Anoxic Brain Injuries:

An anoxic brain injury occurs when the brain does not receive the proper amount of oxygen to function. Within a few minutes, the brain cells will start to die, and an irreversible brain injury can occur. Since oxygen is carried to the brain through the bloodstream, anoxic brain damage usually occurs because of a blockage of this blood flow. Blockage can occur due to blood clots, stroke, heart attack, or serious trauma. It may also be possible that the blood supply to the brain, in quantity, is normal but that the blood itself does not carry enough oxygen. This can also occur due to poisoning, drowning, carbon monoxide poisoning, choking, suffocation, or anything that is not letting the lungs from taking in a normal amount of oxygen.

Traumatic brain injuries can be classified into the following types;

· Concussions

· Contusions

· Penetrating injuries

· Anoxic brain injuries

1. Concussions:

A concussion is a small brain injury that occurs due to shaking, an impact on the head, or a sudden drastic change in movement. Usually, concussions cannot be seen through an imaging test, but they should still be considered under emergency and should be treated accordingly. Concussions symptoms could be headaches, poor concentration, memory loss, and disorientation. Concussions are particularly considered dangerous if more than one stays over time, or if a second one appears before the first one heals. This is called “Second Impact Syndrome.”

2. Brain Contusions:

A brain contusion is primarily a bruise of the brain tissue, and like any other bruises in the body, they are formed by the breaking and leaking of small blood vessels. On the cutaneous level, leaking blood under the skin appears as blue-colored skin, whereas, in the brain, the leaking causes many ailments due to the pressure building on brain mass. Any blow to the head can cause brain contusions. The brain can be damaged directly under the site of impact, or on the opposite side from the point of impact as the brain is slammed into the opposite side of the skull, or both. These differences at the site of injury are classified under coup and contrecoup injuries. Contusions, like concussions, can result in minor to extremely severe injuries. Severe contusions may result in loss of consciousness, confusion, tiredness, emotional distress, or agitation. Swelling and brain herniation can occur with severe contusions, preventing proper oxygenation and causing other serious consequences.

3. Penetrating Brain Injuries:

Penetrating brain injuries may cause the object, hair, skin, or fragments of the skull to come in contact with the brain resulting in laceration, cavitation, bleeding, and crushing of the brain tissue.

4. Anoxic Brain Injuries:

An anoxic brain injury occurs when the brain does not receive the proper amount of oxygen to function. Within a few minutes, the brain cells will start to die, and an irreversible brain injury can occur. Since oxygen is carried to the brain through the bloodstream, anoxic brain damage usually occurs because of a blockage of this blood flow. Blockage can occur due to blood clots, stroke, heart attack, or serious trauma. It may also be possible that the blood supply to the brain, in quantity, is normal but that the blood itself does not carry enough oxygen. This can also occur due to poisoning, drowning, carbon monoxide poisoning, choking, suffocation, or anything that is not letting the lungs from taking in a normal amount of oxygen.

Traumatic brain injuries can be classified into the following types;

· Concussions

· Contusions

· Penetrating injuries

· Anoxic brain injuries

1. Concussions:

A concussion is a small brain injury that occurs due to shaking, an impact on the head, or a sudden drastic change in movement. Usually, concussions cannot be seen through an imaging test, but they should still be considered under emergency and should be treated accordingly. Concussions symptoms could be headaches, poor concentration, memory loss, and disorientation. Concussions are particularly considered dangerous if more than one stays over time, or if a second one appears before the first one heals. This is called “Second Impact Syndrome.”

2. Brain Contusions:

A brain contusion is primarily a bruise of the brain tissue, and like any other bruises in the body, they are formed by the breaking and leaking of small blood vessels. On the cutaneous level, leaking blood under the skin appears as blue-colored skin, whereas, in the brain, the leaking causes many ailments due to the pressure building on brain mass. Any blow to the head can cause brain contusions. The brain can be damaged directly under the site of impact, or on the opposite side from the point of impact as the brain is slammed into the opposite side of the skull, or both. These differences at the site of injury are classified under coup and contrecoup injuries. Contusions, like concussions, can result in minor to extremely severe injuries. Severe contusions may result in loss of consciousness, confusion, tiredness, emotional distress, or agitation. Swelling and brain herniation can occur with severe contusions, preventing proper oxygenation and causing other serious consequences.

3. Penetrating Brain Injuries:

Penetrating brain injuries may cause the object, hair, skin, or fragments of the skull to come in contact with the brain resulting in laceration, cavitation, bleeding, and crushing of the brain tissue.

4. Anoxic Brain Injuries:

An anoxic brain injury occurs when the brain does not receive the proper amount of oxygen to function. Within a few minutes, the brain cells will start to die, and an irreversible brain injury can occur. Since oxygen is carried to the brain through the bloodstream, anoxic brain damage usually occurs because of a blockage of this blood flow. Blockage can occur due to blood clots, stroke, heart attack, or serious trauma. It may also be possible that the blood supply to the brain, in quantity, is normal but that the blood itself does not carry enough oxygen. This can also occur due to poisoning, drowning, carbon monoxide poisoning, choking, suffocation, or anything that is not letting the lungs from taking in a normal amount of oxygen.

Risk Factors And Epidemiology

In the United States, Traumatic brain injury is a major cause of disability and death among children and young adults. Around 1.5 million people sustain a traumatic brain injury every year in the US.

The people at highest risk of traumatic brain injury include:

· Male gender

· Young adults as they are prone to accidents and fights

· Children

· Older adults, due to their risk of falls

In the United States, Traumatic brain injury is a major cause of disability and death among children and young adults. Around 1.5 million people sustain a traumatic brain injury every year in the US.

The people at highest risk of traumatic brain injury include:

· Male gender

· Young adults as they are prone to accidents and fights

· Children

· Older adults, due to their risk of falls

In the United States, Traumatic brain injury is a major cause of disability and death among children and young adults. Around 1.5 million people sustain a traumatic brain injury every year in the US.

The people at highest risk of traumatic brain injury include:

· Male gender

· Young adults as they are prone to accidents and fights

· Children

· Older adults, due to their risk of falls

In the United States, Traumatic brain injury is a major cause of disability and death among children and young adults. Around 1.5 million people sustain a traumatic brain injury every year in the US.

The people at highest risk of traumatic brain injury include:

· Male gender

· Young adults as they are prone to accidents and fights

· Children

· Older adults, due to their risk of falls

Signs And Symptoms

Some common signs and symptoms according to the severity of trauma include;

Mild to moderate head injury;

· Headache

· Nausea or vomiting

· Fatigue, drowsiness, or Dizziness

· Speech problems

· Loss of balance

· Sensory problems- difficulties with vision, taste, and smell

· Loss of consciousness for a short time (a few seconds to a few minutes)

· confusion or disorientation

· Memory or concentration problems

· Mood changes - feeling depressed or anxious

· Decreased or increased sleep

Moderate to severe traumatic brain injuries

· Loss of consciousness which can be longer (several minutes to hours)

· Severe headache that may be persistent or worsening

· recurrent vomiting or nausea

· Seizures

· Dilation of one or both pupils of the eyes

· Fluids from the nose or ears

· Weakness or numbness in fingers and toes

· Loss of coordination

· Extreme confusion

· Agitation

· Slurred speech

· Coma and other disorders of consciousness

Some common signs and symptoms according to the severity of trauma include;

Mild to moderate head injury;

· Headache

· Nausea or vomiting

· Fatigue, drowsiness, or Dizziness

· Speech problems

· Loss of balance

· Sensory problems- difficulties with vision, taste, and smell

· Loss of consciousness for a short time (a few seconds to a few minutes)

· confusion or disorientation

· Memory or concentration problems

· Mood changes - feeling depressed or anxious

· Decreased or increased sleep

Moderate to severe traumatic brain injuries

· Loss of consciousness which can be longer (several minutes to hours)

· Severe headache that may be persistent or worsening

· recurrent vomiting or nausea

· Seizures

· Dilation of one or both pupils of the eyes

· Fluids from the nose or ears

· Weakness or numbness in fingers and toes

· Loss of coordination

· Extreme confusion

· Agitation

· Slurred speech

· Coma and other disorders of consciousness

Some common signs and symptoms according to the severity of trauma include;

Mild to moderate head injury;

· Headache

· Nausea or vomiting

· Fatigue, drowsiness, or Dizziness

· Speech problems

· Loss of balance

· Sensory problems- difficulties with vision, taste, and smell

· Loss of consciousness for a short time (a few seconds to a few minutes)

· confusion or disorientation

· Memory or concentration problems

· Mood changes - feeling depressed or anxious

· Decreased or increased sleep

Moderate to severe traumatic brain injuries

· Loss of consciousness which can be longer (several minutes to hours)

· Severe headache that may be persistent or worsening

· recurrent vomiting or nausea

· Seizures

· Dilation of one or both pupils of the eyes

· Fluids from the nose or ears

· Weakness or numbness in fingers and toes

· Loss of coordination

· Extreme confusion

· Agitation

· Slurred speech

· Coma and other disorders of consciousness

Some common signs and symptoms according to the severity of trauma include;

Mild to moderate head injury;

· Headache

· Nausea or vomiting

· Fatigue, drowsiness, or Dizziness

· Speech problems

· Loss of balance

· Sensory problems- difficulties with vision, taste, and smell

· Loss of consciousness for a short time (a few seconds to a few minutes)

· confusion or disorientation

· Memory or concentration problems

· Mood changes - feeling depressed or anxious

· Decreased or increased sleep

Moderate to severe traumatic brain injuries

· Loss of consciousness which can be longer (several minutes to hours)

· Severe headache that may be persistent or worsening

· recurrent vomiting or nausea

· Seizures

· Dilation of one or both pupils of the eyes

· Fluids from the nose or ears

· Weakness or numbness in fingers and toes

· Loss of coordination

· Extreme confusion

· Agitation

· Slurred speech

· Coma and other disorders of consciousness

Diagnosis

With a traumatic brain injury, you or your loved one may have to go to the emergency department as serious brain injuries can be lethal. You will be handled vigilantly by the healthcare providers, who will take a quick necessary history, perform some clinical examinations and order some necessary and urgent investigations.

Glasgow coma scale: One important parameter for assessing the consciousness levels in cases of an acute brain injury is the Glasgow Coma Scale. The GCS evaluates a person’s ability to perform eye movements, speak, and move their body. The scale findings help the doctor make a decision and monitor the response to ongoing treatments so that a new plan can be made if required.

Imaging Tests

CT scan of the head: It is the best initial investigation as it is readily available in hospitals and can show hemorrhages, bone fractures, and brain injuries. It uses X-ray beams from multiple axes and gives a whole scan of the brain tissues and arteries.

Magnetic resonance imaging (MRI scan) of the brain: This procedure uses a strong magnetic field to generate images and evaluate the condition of the tissues. It has a high sensitivity than a CT scan, but it takes a longer time and cost, so CTscan is preferred as a first choice in emergency situations.

With a traumatic brain injury, you or your loved one may have to go to the emergency department as serious brain injuries can be lethal. You will be handled vigilantly by the healthcare providers, who will take a quick necessary history, perform some clinical examinations and order some necessary and urgent investigations.

Glasgow coma scale: One important parameter for assessing the consciousness levels in cases of an acute brain injury is the Glasgow Coma Scale. The GCS evaluates a person’s ability to perform eye movements, speak, and move their body. The scale findings help the doctor make a decision and monitor the response to ongoing treatments so that a new plan can be made if required.

Imaging Tests

CT scan of the head: It is the best initial investigation as it is readily available in hospitals and can show hemorrhages, bone fractures, and brain injuries. It uses X-ray beams from multiple axes and gives a whole scan of the brain tissues and arteries.

Magnetic resonance imaging (MRI scan) of the brain: This procedure uses a strong magnetic field to generate images and evaluate the condition of the tissues. It has a high sensitivity than a CT scan, but it takes a longer time and cost, so CTscan is preferred as a first choice in emergency situations.

With a traumatic brain injury, you or your loved one may have to go to the emergency department as serious brain injuries can be lethal. You will be handled vigilantly by the healthcare providers, who will take a quick necessary history, perform some clinical examinations and order some necessary and urgent investigations.

Glasgow coma scale: One important parameter for assessing the consciousness levels in cases of an acute brain injury is the Glasgow Coma Scale. The GCS evaluates a person’s ability to perform eye movements, speak, and move their body. The scale findings help the doctor make a decision and monitor the response to ongoing treatments so that a new plan can be made if required.

Imaging Tests

CT scan of the head: It is the best initial investigation as it is readily available in hospitals and can show hemorrhages, bone fractures, and brain injuries. It uses X-ray beams from multiple axes and gives a whole scan of the brain tissues and arteries.

Magnetic resonance imaging (MRI scan) of the brain: This procedure uses a strong magnetic field to generate images and evaluate the condition of the tissues. It has a high sensitivity than a CT scan, but it takes a longer time and cost, so CTscan is preferred as a first choice in emergency situations.

With a traumatic brain injury, you or your loved one may have to go to the emergency department as serious brain injuries can be lethal. You will be handled vigilantly by the healthcare providers, who will take a quick necessary history, perform some clinical examinations and order some necessary and urgent investigations.

Glasgow coma scale: One important parameter for assessing the consciousness levels in cases of an acute brain injury is the Glasgow Coma Scale. The GCS evaluates a person’s ability to perform eye movements, speak, and move their body. The scale findings help the doctor make a decision and monitor the response to ongoing treatments so that a new plan can be made if required.

Imaging Tests

CT scan of the head: It is the best initial investigation as it is readily available in hospitals and can show hemorrhages, bone fractures, and brain injuries. It uses X-ray beams from multiple axes and gives a whole scan of the brain tissues and arteries.

Magnetic resonance imaging (MRI scan) of the brain: This procedure uses a strong magnetic field to generate images and evaluate the condition of the tissues. It has a high sensitivity than a CT scan, but it takes a longer time and cost, so CTscan is preferred as a first choice in emergency situations.

Differential Diagnosis

Some of the conditions overlapping with acute brain injury are;

· Subdural hemorrhage

· Meningitis

· Encephalitis

· Brain tumor

· Hemorrhagic stroke

· Neurosyphilis

· Migraine

· Hypertensive encephalopathy

· Wernicke's encephalopathy

· Brain abscess

· Drug toxicity

· Conversion disorders

· Metabolic disturbance

· Multiple sclerosis

· Seizure

Some of the conditions overlapping with acute brain injury are;

· Subdural hemorrhage

· Meningitis

· Encephalitis

· Brain tumor

· Hemorrhagic stroke

· Neurosyphilis

· Migraine

· Hypertensive encephalopathy

· Wernicke's encephalopathy

· Brain abscess

· Drug toxicity

· Conversion disorders

· Metabolic disturbance

· Multiple sclerosis

· Seizure

Some of the conditions overlapping with acute brain injury are;

· Subdural hemorrhage

· Meningitis

· Encephalitis

· Brain tumor

· Hemorrhagic stroke

· Neurosyphilis

· Migraine

· Hypertensive encephalopathy

· Wernicke's encephalopathy

· Brain abscess

· Drug toxicity

· Conversion disorders

· Metabolic disturbance

· Multiple sclerosis

· Seizure

Some of the conditions overlapping with acute brain injury are;

· Subdural hemorrhage

· Meningitis

· Encephalitis

· Brain tumor

· Hemorrhagic stroke

· Neurosyphilis

· Migraine

· Hypertensive encephalopathy

· Wernicke's encephalopathy

· Brain abscess

· Drug toxicity

· Conversion disorders

· Metabolic disturbance

· Multiple sclerosis

· Seizure

Treatment

Traumatic brain injury can result in serious consequences. The earlier the treatment is started, the better the outcome. For mild traumatic brain injuries, no treatment is required. They are managed conservatively with constant monitoring of the patient by close observation.

Emergency care is required for moderate to severe traumatic brain injuries, starting with maintaining oxygen, adequate blood supply, and blood pressure and preventing further injury to the head or neck by stabilizing the patient.

Later on, treatment is targeted according to the type and extent of brain injury. Surgical procedures may need to be performed after a decision is made by a team of doctors. These procedures may be aimed to relieve intracranial pressure by removing a blood clot or a bony fragment, etc.