Traumatic brain injury Totally Explained

Everything about Traumatic Brain Injury totally explained

Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when physical trauma causes brain damage. TBI can result from a closed head injury or a penetrating head injury and is one of two subsets of acquired brain injury (ABI). The other subset is non-traumatic brain injury, or injuries that don't involve external mechanical force (for example stroke, meningitis, anoxia). Parts of the brain that can be damaged include the cerebral hemispheres, cerebellum, and brain stem.
TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. TBI can cause a host of physical, cognitive, emotional, and social effects. Outcome can be anything from complete recovery to permanent disability or death.

Signs and symptoms

Some symptoms are evident immediately, while others don't surface until several days or weeks after the injury.
With mild TBI, the patient may remain conscious or may lose consciousness for a few seconds or minutes. The person may also feel dazed or not like him- or herself for several days or weeks after the initial injury. Other symptoms include:

headache
mental confusion
lightheadedness
dizziness
double vision, blurred vision, or tired eyes
ringing in the ears
bad taste or metallic in the mouth
fatigue or lethargy
a change in sleep patterns
behavioral, personality or mood changes
trouble with memory, concentration, or calculation
decreased coordination
symptoms may remain the same or get better; worsening symptoms indicate a more severe injury

With moderate or severe TBI, the patient may show these same symptoms, but may also have:

loss of consciousness

personality change

a severe, persistent, or worsening headache

repeated vomiting or nausea

seizures

inability to awaken

dilation (widening) of one or both pupils

slurred speech

weakness or numbness in the extremities

loss of coordination

increased confusion, restlessness, or agitation

abnormal posturing, ie. decorticate or decerebrate posturing

vomiting and neurological deficit (for example weakness in a limb) together are important indicators of prognosis and their presence may warrant early CT scanning and neurosurgical intervention. Small children with moderate to severe TBI may show some of these signs as well as signs specific to young children, including:

persistent crying

inability to be consoled

refusal to nurse or eat Head injured people with signs of moderate or severe TBI should receive immediate emergency medical attention.

Causes and risk factors

Transportation accidents involving automobiles, motorcycles, bicycles, and pedestrians cause half of all TBIs and the largest portion of TBI in people under age 75. For those aged 75 and older, falls cause the majority of TBIs. Outcome for patients with head injury depends heavily on the cause. For example, in the US, patients with TBIs from falls have an 89% survival rate, while only 9% of patients with firearm-related TBIs survive.

Classification and subtypes

Focal vs. diffuse

The damage from TBI can be focal, confined to one area of the brain, or diffuse, involving more than one area. Diffuse trauma to the brain is frequently associated with concussion (a shaking of the brain in response to sudden motion of the head), diffuse axonal injury, or coma. Localized injuries may be associated with neurobehavioral manifestations, hemiparesis or other focal neurologic deficits. Types of focal brain injury include bruising of brain tissue called a contusion and intracranial hemorrhage or hematoma, heavy bleeding in the skull. Hemorrhage, due to rupture of a blood vessel in the head, can be extra-axial, meaning it occurs within the skull but outside of the brain, or intra-axial, occurring within the brain. Extra-axial hemorrhages can be further divided into subdural hematoma, epidural hematoma, and subarachnoid hemorrhage. An epidural hematoma involves bleeding into the area between the skull and the dura. With a subdural hematoma, bleeding is confined to the area between the dura and the arachnoid membrane. A subarachnoid hemorrhage involves bleeding into the space between the surface of the brain and the arachnoid membrane that lies just above the surface of the brain, usually resulting from a tear in a blood vessel on the surface of the brain. Bleeding within the brain itself is called an intracerebral hematoma. Intra-axial bleeds are further divided into intraparenchymal hemorrhage which occurs within the brain tissue itself and intraventricular hemorrhage which occurs into the ventricular system.

Open vs. closed

TBI can result from a closed or penetrating head injury. A closed injury occurs when the skull isn't breached, while a penetrating injury occurs when an object pierces the skull and enters brain tissue.
As the first line of defense, the skull is particularly vulnerable to injury. Skull fractures occur when a bone in the skull cracks or breaks. A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain. A penetrating skull fracture occurs when something pierces the skull, such as a bullet, leaving a distinct and localized traumatic injury to brain tissue. Skull fractures can cause cerebral contusion.

Severity

Further Information

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