Traumatic Brain Injury
Any force directed to the head can produce a traumatic brain injury (TBI). In a baby, the applied force may be from a rapid or hard shake. Often, TBI results from a blow to the head, a hard impact from a fall or car accident, or a penetrating injury such as a gunshot wound.
TBI can range from mild (with only a brief alteration in brain function) to severe. Severe TBI can produce bleeding (subdural, epidural or intracerebral hematomas), brain bruising (contusion), torn brain tissue (diffuse axonal injury) and brain swelling (cerebral edema).
A mild head injury, such as a concussion, produces temporary symptoms. These symptoms may be very brief or take some time to resolve. Repetitive mild TBI is now raising concern over the possibility of developing a condition involving permanent and progressive brain injury called chronic traumatic encephalopathy.
Severe TBI can be fatal or result in permanently altered brain function or coma.
Signs and Symptoms
TBI symptoms can vary greatly depending on the severity of the injury. Symptoms may range from a very mild, temporary alteration in thinking or behavior to deep coma. The severity of the brain injury does not always correlate with the findings on imaging studies.
Symptoms of mild TBI include the following:
- Dizziness or loss of consciousness
- Difficulty with vision, such as blurry vision or fatigued eyes
- Difficulty with hearing, such as ringing in the ears
- Bad taste in mouth
- Changes in sleep patterns
- Changes in behavior or mood
- Difficulty with cognitive functions, such as memory, concentration, attention or thinking
Symptoms of moderate to severe TBI include the following:
- Persistent or worsening headache
- Nausea or vomiting
- Unable to be woken up from sleep
- Dilation of one of both pupils
- Difficulty with speech
- Weakness or numbness in the arms or legs
- Difficulty with coordination
- Worsening confusion or agitation
Traumatic brain injuries are diagnosed through a general neurological exam, the Glasgow Coma Scale (GCS), and a pupil exam . These exams, in combination, make the best rapid assessment tool for head injury patients.
Severe TBI often requires treatment in an intensive care unit setting. Although the primary brain injury has already occurred, treatment is geared at providing basic life support measures and decreasing further injury from increased pressure within or on the brain. Depending on the circumstances, procedures such as an ICP monitor, ventriculostomy , craniotomy or decompressive craniectomy may be considered.
Survivors of severe TBI often need considerable rehabilitative therapies (including physical, occupational and speech/language therapy. The road to recovery can be difficult, lengthy and incomplete.
Some forms of TBI do not require any specific treatment. However, return to activities such as work, school, driving or sports should be guided by a medical provider.
General treatment options are outlined below based on the severity of brain injury:
- Mild TBI
- Over the counter pain medication
- Moderate to severe TBI
- Medication to manage the pressure in the brain.
- Surgery to address the possible injuries sustained.
- Thrombectomy is an emergency, minimally invasive (non-surgical) treatment to remove a blood clot from inside a brain artery.
- Shunting is a way to direct the fluid away from the brain and relieve the pressure it causes. A shunt is a surgically implanted device used to drain the extra cerebrospinal fluid (CSF) from the ventricles in the brain into the abdominal area or right atrium of the heart in order to relieve pressure on the brain.
- Ventriculostomy is a procedure that helps drain the cerebrospinal fluid out of the brain. This can relieve pressure in your brain after a TBI. It allows CSF to bypass the obstruction causing the hydrocephalus and circulate from the ventricles to the space surrounding the brain so that it can be reabsorbed back into the vascular system.
- Rehabilitation to regain any lost functions due to a TBI.