Authored by MCN Neurologists
(See also Traumatic Brain Injury in Children)
Traumatic brain injury (TBI), or simply head injury, takes place when a trauma causes injury to the brain. This can happen when the head hits an object or when an object pierces the skull and damages brain tissue. Frequently a less apparent form of injury also takes place, which is called shearing (or diffuse axonal injury), that damages membranes and proteins of individual neurons breaking connections within neural networks and the communication between different parts of the brain.
Causes of Traumatic Brain Injury
Examples of causes include falls (28%), motor vehicle accidents (20%) or having been struck by or against something, for example when playing sports (19%) and assaults (11%).
Symptoms of Traumatic Brain Injury
Symptoms of TBI can be mild, moderate or severe depending on the extent of the damage to the brain.
A mild injury, referred to as a concussion, can result in brief loss of consciousness for a few seconds or minutes, or a person may remain conscious the entire time. Other symptoms of mild TBI may include:
• change in sleep pattern
• balance issues
• trouble with memory
• difficulty with attention
• impaired concentration
• problems with thinking.
• blurred vision
• ringing in the ears
• bad taste in the mouth
• mood or behavioral changes
Moderate and severe head injury may cause the same symptoms, but also
• a prolonged headache, which may worsen with time
• recurrent nausea and vomiting
• an inability to wake from sleep
• change in pupil size
• slurred speech
• weakness or numbness of limbs
• lack of insight
• denial of disability
• increased aggressiveness
What to Expect at the Doctor’s Visit
Depending on the severity of a TBI, treatment, rehabilitation and medications may be started prior to an office appointment with a neurologist.
A neurologist will take a thorough history to identify the severity of the head injury and determine the symptoms developed as a consequence. S/he will also want to learn what therapy, if any, has been received so far for your injury. The neurologist will focus on the problems that are most important to the patient.
A detailed neurological examination will be directed at functions that are often affected by head injury. Special attention will be devoted to systems that may have been affected in such a way as to produce particular symptoms. Cranial nerves, including those that control vision, speech and swallowing will be checked. Sensation, strength and reflexes in the limbs will also be tested.
Evaluation of cognitive performance will be part of the examination, but some patients may be referred to a neuropsychologist for an even more extensive testing of cognition.
As certain complications can evolve over time the neurologist may order a brain scan, such as an MRI or CT to assess the extent of the damage, ascertain that the situation is stable and verify that no additional complications have evolved. Blood tests and an EMG may also be recommended to see if other organs and nerves in the limbs have been affected along with the brain injury.
Treatment of Traumatic Brain Injury
Initial damage is by and large irreversible. Preventing further injury is a focus of early care. This begins with the paramedics, when they arrive at the scene of accident, or when a patient comes to an emergency department of a hospital. Proper oxygen supply to the brain and other organs, sufficient blood flow and maintaining blood pressure are the primary concerns. The patient’s level of consciousness and neurological functioning are assessed using the Glasgow Coma Scale. It ranges between three and fifteen points and allows rapid determination of a mild, moderate or severe injury.
Most people with a concussion completely recover fairly quickly with rest and gradual return to activity. If symptoms do not resolve within 2-4 weeks, this may indicate that a person is experiencing post-concussive syndrome and a referral to physical and occupational therapy for concussion rehabilitation may be appropriate in order to assist in a full and timely recovery.
For moderate to severe cases, computerized tomography, which creates images of brain, bone and the surrounding tissue, is ordered. This test can detect bleeding, brain swelling, contusions and tumors. Close to one-half of patients with severe head injury will need surgery to treat hematomas or contusions. Depending on the severity of the initial injury and other complications, the patient may receive a variety of appropriate treatments in an intensive care unit.
Once stable, and when able to participate for hours in therapy, the patient may be transferred to a sub-acute unit of a hospital or to an independent rehabilitation hospital. Rehabilitation is an important part of the recovery process for a TBI patient. TBI patients receive an individualized rehabilitation program based upon the patient’s strengths and capacities, and rehabilitation services should be modified over time to adapt to the patient’s changing needs. This involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, psychology/psychiatry and social support. The overall goal of rehabilitation after a TBI is to improve the patient’s ability to function at home and in society. Speech, occupational and physical therapies may be needed for a long time after the injury.
Many TBI patients who show psychiatric or behavioral problems can be helped with medication and psychotherapy. Some patients may need medication for physical problems and pain resulting from the TBI. Great care must be taken in prescribing medications because TBI patients are more susceptible to side effects and may react adversely to some pharmacological agents.
Prevention of Traumatic Brain Injury
There are many ways to reduce the chances of a TBI, including:
1. Wear a seat belt every time you drive or ride in a motor vehicle.
2. Buckle your child in the car using a child safety seat, booster seat or seat belt (according to the child’s height, weight, and age). Children should start using a booster seat when they outgrow their child safety seats (usually when they weigh about 40 pounds). They should continue to ride in a booster seat until the lap/shoulder belts in the car fit properly, typically when they are 4’9” tall.
3. Never drive while under the influence of alcohol or drugs.
4. Wear a helmet and make sure your children wear helmets when:
a. Riding a bike, motorcycle, snowmobile, scooter or all-terrain vehicle;
b. Playing a contact sport, such as football, ice hockey or boxing;
c. Using in-line skates or riding a skateboard;
d. Batting and running bases in baseball or softball;
e. Riding a horse; or
f. Skiing or snowboarding.
5. Making living areas safer for seniors, by:
a. Removing tripping hazards such as throw rugs and clutter in walkways;
b. Using non-slip mats in the bathtub and on shower floors;
c. Installing grab bars next to the toilet and in the tub or shower;
d. Installing handrails on both sides of stairways;
e. Improving lighting throughout the home; and
f. Maintaining a regular physical activity program, if your doctor agrees, to improve lower body strength and balance.
6. Making living areas safer for children, by:
a. Installing window guards to keep young children from falling out of open windows;
b. Using safety gates at the top and bottom of stairs when young children are around;
c. Making sure the surface on your child’s playground is made of shock-absorbing material, such as hardwood mulch or sand.
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