Traumatic brain injuries happen when a bump, blow or head injury causes damage to the brain. There are approximately 200,000 traumatic brain injuries a year, with car accidents accounting for half of these injuries. Falls are also a common cause of traumatic brain injury. Other causes of traumatic brain injury include military duty in combat zones, sports injury, violence, trauma to the head, and child abuse. Symptoms may be mild, moderate or severe.
The people most at risk for traumatic brain injury include children, especially newborns to 4 years old, young adults between the ages of 15-24, and adults age 60 and over. Males in any age group are also more susceptible to these injuries.
Half of all traumatic brain injuries require hospital treatment. Once at the hospital, the person will be evaluated by a neurological exam and imaging test to assess the severity of the injury.
Symptoms include a headache that gets worse or does not go away; repeated nausea and vomiting, convulsions or seizure; vertigo or dizziness; inability to awaken from sleep; slurred speech; weakness or numbness in arm and legs; dilated pupils; mild fatigue; and problems with memory, concentration, attention, and thinking. Symptoms may not appear for days or weeks after the injury.
These symptoms may last for a few weeks or months or may be permanent. When the symptoms last from a few weeks to a few months it is known as post-concussive symptoms. Post-concussion syndrome occurs when the symptoms last for an extended period of time.
Traumatic brain injury at the base of the skull can cause nerve damage to the cranial nerves. Cranial nerve damage may cause paralysis of facial muscles or loss of sensation in the face; loss or alteration of sense of smell; loss or alteration of sense of taste; loss of vision or double vision; swallowing problems; dizziness; and ringing in the ears or hearing loss.
Significant Brain Injury
People with significant brain injury will experience changes in their cognitive skills. They take longer to process their thoughts and have more difficulty focusing. Other changes may occur in their executive functioning. For example, they may have trouble with problem-solving, organization, planning, decision-making, and beginning or completing tasks.
Communication problems are common following traumatic brain injury. These problems cause frustration, conflict and misunderstanding for the person with the traumatic brain injury and the family members, friends and care providers.
Traumatic brain injuries are usually emergencies and symptoms can worsen rapidly. It is important that assessment of the situation happen quickly. Three methods are used:
- Glasgow Coma Scale or GCS rates the ability for the injured party to follow directions, move eyes and limbs, and the coherence of speech on a 15-point scale. The higher the score, the less severe the injuries.
- Computerized tomography or CT scan can be performed in the emergency department. The CT scan creates a detailed view of the brain that uncovers fractures, bleeding, blood clots, bruised brain tissue and brain tissue swelling.
- Magnetic resonance imaging or MRI uses radio waves and magnets to create a detailed image of the brain. This test may be used after the person is stable or if their symptoms don’t improve soon after the injury.
Tissue swelling from the traumatic brain injury causes tissue swelling in the skull. Intracranial pressure monitoring is used to monitor pressure inside the skull. This is done by placing a probe inside the skull.
Treatment of traumatic brain injury depends on the severity of the injury. Mild traumatic brain injury usually requires no treatment other than rest and over the counter pain relievers for the headache. Mild traumatic brain injury requires close, at home monitoring to see if the condition persists or worsens, or if new symptoms develop. Follow-up doctor’s appointments may be needed. The doctor will decide when the patient is able to return to work, school or recreational activities. Limiting physical activities or cognitive activities is best until cleared by the doctor.
Each Case Is Unique
For moderate or severe traumatic brain injury, oxygenation, adequate blood supply, maintaining blood pressure and preventing any further injury to the head or neck is important. There may also be other injuries that may be addressed. Additional treatment may take place in the emergency department or in the appropriate intensive care unit. Medications to limit secondary damages to the brain may include diuretics, anti-seizure drugs or coma-inducing drugs. Surgery to the skull and/or brain may be required to stop bleeding or remove clotted blood, repair skull fractures, or to open a section of the skull to help relieve pressure in the brain.
People with a significant traumatic brain injury will probably need rehabilitation. How much rehabilitation and where will depend on the abilities that the person is left with. Most rehabilitation starts in the hospital and continues in some facility. Janet Bailey Parker