Traumatic Brain Injury - Causes, Symptoms, and Treatments

09 April, 2021
Traumatic brain injury refers to a brain dysfunction. An outside force, usually a violent blow to the head, causes this brain dysfunction. Read on to learn much more about this scary condition.

Traumatic brain injury, also called craniocerebral trauma, is a brain dysfunction. An outside force, usually a violent blow to the head, causes it. In fact, traumatic brain injury often occurs as a result of a severe sports injury or car accident.

Did you know that, in 2014, there were 8.87 million cases of TBIs in the United States, of which 837,000 were among children? According to research, 1.2 million people die each year from traumatic brain injury around the world. Likewise, between 20-50 million suffer non-fatal trauma. TBI refers to any damage to the brain from an applied force. 

In addition, these forces can be from direct contact, as in a blunt or penetrating head injury from a gravitational source. This gravitational source can be fierce shaking. Traumatic brain injury also results from rotational energy force. This force produces shear stress between the brain and the skull. Certainly, TBI often comes from a combination of forces. 

For instance, a motor vehicle collision causes both direct blunt trauma and injury from rotational and rapid velocity changes. Sadly, those events cause a deformation of the brain tissue that results in several types of conditions. In addition to the main injury, a series of events are set in motion.  Meanwhile, these events keep causing cellular damage over the next days to weeks. 

Those secondary injury events include biochemical reactions and molecular changes extending cellular damage and brain edema. Likewise, they also include inflammation in a self-perpetuating cycle, rapidly increasing the extent of the brain damage.

So who exactly is at risk of this medical condition? Unfortunately, certain groups are at higher risk of TBI. Men are more likely to get a TBI than women. Adults age 65 and older are at the highest risk for dying from a traumatic brain injury.

Severity categories

Did you know that approximately 13.5 million individuals live with a disability due to traumatic brain injury in America alone? TBI is broadly defined in terms of three categories of severity. Most importantly, these categories are based on the Glasgow Coma Scale (GCS):

  • Mild.
  • Moderate.
  • Severe.

The GCS is a 15-point scale that accurately measures the patient’s ability to respond to visual, verbal, and motor stimuli after a TBI. Moreover, the degree of impairment depends on the extent of damage to critical brain areas. As a result, most traumatic brain injuries are mild. 

Nonetheless, traumatic brain injuries are a significant cause of death. In the United States, for example, 40 percent of deaths from acute injuries are due to TBI. Subsequently, this condition is also a major source of disability that could result in permanent impairment of physical and cognitive function.

Types of injuries

Traumatic brain injuries cause a myriad of injuries. These include mass lesions with an area of localized injury like hematomas that increase brain pressure. Check out the different types of injuries in detail below: 

Hematoma

A hematoma is a blood clot within the brain or on its surface. It occurs anywhere within the brain. An epidural hematoma is a collection of blood between the dura mater and the inside of the skull. A subdural hematoma is a collection of blood between the dura mater and the arachnoid layer. 

Concussion

A concussion is a type of mild brain injury, involving a short loss of normal brain function. It happens when a blow to the head causes your head and brain to move rapidly back and forth. This movement causes the brain to bounce around or twist in the skull, creating chemical changes in your brain. 

Hemorrhage 

An intracerebral hemorrhage describes bleeding within the brain tissue. It’s related to other brain injuries, especially concussions. The size and location of the hemorrhage help determine whether it can be removed surgically. Bleeding into the subarachnoid space causes subarachnoid hemorrhage. In consequence, most cases of SAH associated with head trauma are mild.

Diffuse axonal injury

This refers to an impaired function and gradual loss of axons. Certainly, these long extensions of nerve cells enable them to communicate with each other. If it harms enough axons, the nerve cell’s ability to communicate and to integrate, their function is lost. In short, that will leave a patient with severe disabilities.

Skull fractures

Firstly, linear skull fractures or simple cracks in the skull accompany traumatic brain injury. Possible forces, strong enough to cause a skull fracture, may damage the underlying brain. Therefore, fractures at the base of the skull are problematic, since they cause nerve and artery injury.

Symptoms

To clarify, traumatic brain injury requires a medical diagnosis. If you have a head injury or other trauma that may have caused a TBI, you need to get medical care as soon as possible. To make a diagnosis, your healthcare provider will ask about your symptoms. Additionally, they’ll ask about the details of your injury and do a neurologic exam.

After that, they’ll do imaging tests like a CT scan or MRI, and use the Glasgow Coma Scale to determine severity. This scale measures your ability to open your eyes, speak, and move. Lastly, the provider will do neuropsychological tests to check how your brain is functioning.

Immediate or delayed symptoms may include confusion, blurry vision, and difficulty concentrating. Infants may cry persistently or be irritable. People may experience the following symptoms:

  • Cognitive. Amnesia, inability to speak or understand language, mental confusion, difficulty concentrating, difficulty thinking and understanding, inability to create new memories, or inability to recognize common things.
  • Behavioral. Abnormal laughing and crying, aggression, impulsivity, irritability, lack of restraint, insomnia, or persistent repetition of words and actions.
  • Mood. Anger, blackout, dizziness, fainting, or fatigue.
  • Eyes. Dilated pupils, raccoon eyes, or unequal pupils.
  • Muscular. Instability or stiff muscles.
  • Gastrointestinal. Nausea or vomiting.
  • Speech. Difficulty speaking or slurred speech.
  • Visual. Blurred vision or sensitivity to light.
  • Other common symptoms. Persistent headache, a temporary moment of clarity, bleeding, bone fracture, bruising, depression, loss of smell, nerve injury, post-traumatic seizure, ringing in the ears, or sensitivity to sound.

What are the treatments for traumatic brain injury?

The treatments for TBI depend on many factors, including the size, severity, and location of the brain injury. For example, for mild traumatic brain injury, the main treatment is rest. If you have a headache, take over-the-counter painkillers. It’s vital to follow your healthcare provider’s instructions for complete rest and a gradual return to your normal activities. 

Moreover, if you start too soon, you’ll take longer to recover. Contact your doctor if your symptoms aren’t improving. For moderate to severe TBIs, your doctor will first stabilize you, preventing further injury. They’ll manage your blood pressure, ensuring there’s enough blood and oxygen getting to your brain. Once you’re stable, the treatments include:

  • Surgery to get rid of damaged or dead brain tissue.
  • Surgery to repair skull fractures.
  • Anti-anxiety medication to lessen nervousness and fear.
  • Anticoagulants to prevent blood clots.
  • Medicines to treat TBI symptoms.
  • Anticonvulsants to prevent seizures.
  • Muscle relaxants to reduce muscle spasms.
  • Stimulants to increase alertness and attention.
  • Rehabilitation therapies, including physical, emotional, cognitive.
  • Physical therapy builds physical strength, coordination, and flexibility.
  • Occupational therapy helps you relearn performing tasks, like cooking and bathing.
  • Speech therapy improves your speech and treats swallowing disorders.
  • Psychological counseling helps you learn coping skills, improving emotional well-being.
  • Vocational counseling helps you return to work, dealing with workplace challenges.
  • Cognitive therapy improves your memory, attention, perception, and judgment.

In short, some people with traumatic brain injuries have permanent disabilities. A TBI also puts you at risk for other health problems, such as anxiety, depression, and post-traumatic stress disorder. You must treat these problems, improving your quality of life.

  • Pereira Riverón R. Traumatismos craneoencefálicos. Revisiones de conjunto. La Habana: MINSAP; 1987. p. 61-121.