Traumatic Brain Injury (TBI)

Definition

Brain injury due to trauma is known as traumatic brain injury (TBI) and commonly occurs due to falls, road traffic accidents and abuse. This type of injury can occur immediately after the trauma (impact) or delayed (within minutes to days after initial trauma). Basically the brain becomes injured and inflamed due to the injury, with some severe cases leading to tissue death or even hemorrhage. The outcome of traumatic brain injury ranges from complete recovery to paralysis, coma or death. Depending upon the extent of injury traumatic brain injury patients may require no treatment, drugs, surgery or both. Rehabilitation therapy may at times be required for long periods following TBI.

Symptoms

The symptoms of traumatic brain injury depend upon the location and extent of damage to the brain. Injury can occur at different parts of the brain like :

  • Area immediately at the point of the impact (“coup” injury).
  • At the opposite point of the impact (“contrecoup” injury) where he head stops abruptly immediately after the impact but the brain moves due to inertia striking the inner side of the opposite skull.

Mild Brain Injury

  • Loss of consciousness lasting for seconds to minutes (blackout).
  • No loss of consciousness but confused, disoriented state (to time, place and person).
  • Headaches.
  • Nausea.
  • Loss of memory of the incident (anterograde and retrograde amnesia).
  • Poor concentration.
  • Change in sleeping pattern (sleeping longer).
  • Unsteady movements.
  • Sensory disturbance – altered taste, smelling sensation, ringing in ear (tinnitus).
  • Intolerance to light (photophobia) or sound.

Moderate to Severe Brain Injury

  • Loss of consciousness lasting for minutes to hours, rarely even for days.
  • Poor alertness.
  • Weakness of limbs.
  • Inability to control bowel or bladder movements.
  • Repeated vomiting.
  • Excruciating headache.
  • Blurring of vision, double vision, unequal pupil size.
  • Convulsion (seizures / fits).
  • Bleeding from the nose and/or ear.
  • Clear fluid leakage from the nose.
  • Personality change.
  • Slurring of speech, inability to find words, poor speech due to weakness of facial muscles.
  • Abnormal gait, loss of balance

Symptoms in Children

  • Inability to suckle or eat.
  • Change of sleeping pattern.
  • Excessive crying.
  • Loss of interest in the surrounding.
  • Lethargy.
  • Irritability.
  • Vomiting.

Causes

Most common causes of traumatic brain injury include :

  • Fall from a height.
  • Road traffic accident.
  • Abuse or assault like in shaken baby syndrome where there is intentional shaking of the child leading to bleeding in the brain, eye and accumulation of fluid in brain.
  • Sports injury – boxing, wrestling and other contact sports.
  • Explosive blast injury.
  • Industrial accidents.
  • Penetrating head injury.
  • Rotational injury leading to tearing of brain tissue.

Bleeding from ruptured blood vessels causing irritation of the brain tissue and accumulation of fluid (cerebral edema). Thus pressure within the brain increases (as brain is covered by hard bony structure, the skull) which further compromises blood flow in the brain

Risk factors

  • Children, young very active adults and the elderly who may have neuromuscular disorders that make them prone to falls.
  • Driving without helmets or a seat belt.
  • Boxing, wrestling, adventure sports.
  • Heavy industrial workers.

Treatment

Mild injury requires no intervention and just a wait-and-watch approach is necessary to monitor for worsening or persistence of symptoms. In moderate to severe injury, the following measures may be necessary :

  • Emergency care: ensuring clear airway, breathing, circulation.
  • Drugs:
    – Diuretics (water pills): to reduce cerebral edema.
    – Antiseizure drugs.
  • Surgery: to remove blood clot, relieve pressure or repair a skull fracture.

Survivors of TBI may require rehabilitative therapy such as :

  • Speech therapy.
  • Physical therapy.
  • Occupational therapy.
  • Psychotherapy.

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