Traumatic Brain Injury

Traumatic brain injury occurs when external mechanical force causes brain dysfunction. It usually results from a violent blow or jolt to the head or the body.

Mild traumatic injury may cause temporary dysfunction of brain cells but more serious injuries may result in long-term complications or death.

Signs and symptoms of traumatic brain injury vary depending on its type.

Mild traumatic brain injury

The signs and symptoms of mild traumatic brain injury may include:

Physical symptoms:

• Loss of consciousness for a few seconds to a few minutes
• No loss of consciousness, but a state of being dazed, confused or disoriented
• Headache
• Nausea or vomiting
• Fatigue or drowsiness
• Difficulty sleeping
• Sleeping more than usual
• Dizziness or loss of balance

Sensory symptoms include:

• Blurred vision.
• Ringing in the ears.
• Bad taste in mouth.
• Changes in ability to smell and sensitivity to light and sound.

Cognitive or mental symptoms:

• Memory and concentration problems.
• Mood swings.
• Depression and anxiousness.

Moderate to severe traumatic brain injuries

The signs and symptoms of moderate to severe traumatic brain injuries include:

• Physical Symptoms- loss of consciousness from minutes to hours, persistent headache, repeated vomiting, seizures, convulsions, dilation of pupils, clear fluids draining from nose or ears, inability to awaken from sleep, weakness or numbness in fingers or toes and loss of coordination.
• Coordinative or Mental Symptoms- profound confusion, agitation, slurred speech and coma.

If this injury occurs in children then the following signs and symptoms may occur:

• Change in eating or nursing habits
• Persistent crying.
• Unusual or easily irritated.
• Change in ability to pay attention.
• Change in sleep habits.
• Depressed mood and loss of interest.

Traumatic brain injury is caused by blow or other traumatic injuries to the head or body the flowing factors play an important role in traumatic brain injury:

• Damage to brain to the area directly below the point of impact.
• Severe blow or jolt that can cause multiple points of damage.
• Severe rotational or spinning jolt that can cause tearing of cellular structures.
• A blast that can cause wide spread damage an object penetrating the skull can cause severe.
• Irreparable damage to brain cells and bleeding in or around the brain which can disrupt oxygen supply.

Frequently the following events lead to brain injury:

• False- falling from bed, slipping in the bath.
• Falling from steps and Falling from heights are the most common cause of traumatic brain injury overall.

Vehicle related collision- accidents involving cars, motorcycles, bicycles and pedestrians may lead to traumatic brain injury.

Violence- gunshot wounds, domestic violence or child abuse make about 20% of such injuries.

Sports Injuries- a number of sports including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey and other extreme sports.

Commonly lead to traumas particularly in youth. Explosive blasts and other combat injuries. Such events are common cause for an active-duty military personal.

It is believed that the pressure wave passing through the brain significantly disrupts brain function.

Diagnosis of traumatic brain injury should be done rapidly because it can lead to worsening situation.

The following methods can be used:

• Glasgow come scale- It is a 15-point test which allows the doctor to assess the severity of brain damage by checking a person’s ability to follow directions and move their eyes and limbs.
• Information about injury and symptoms- thorough information must be provided to the medical personnel about the injury which can help improve the diagnosis.
• Imaging tests- CT and MRI are used to picturized the brain and locate the damage such as hemorrhage, hematoma and contusions. The electrical activity can also be measured.
• Intracranial pressure monitoring- swelling from injury causes increased pressure inside the skull and cause further damage. A probe is inserted into the skull to monitor the pressure.

Immediate medical treatment must be provided to people with traumatic brain injury. If treatment is delayed the injury might cause permanent damage to brain and will cause in diminishing of brain’s activity.

Medications:

• Diuretics- these drugs reduce the amount of fluid in the tissues. Reliving the pressure in the brain.
• Anti-seizure drugs- to avoid additional brain damage ant seizure drugs are given.
• Coma-inducing drugs- doctors sometimes recommend drugs to induce comma for short-time because a comatose brain consumes less oxygen.

Surgery:

• Removing blood clots- removal of hematomas to reduce the pressure in skull is done.
• Repairing skull fractures- pieces of skull from the brain are removed in this type of procedure.
• Opening a window in the skull- surgery is used to relieve pressure by draining accumulated fluid in the skull.

Rehabilitation:

Rehabilitation specialists may include:

• Psychiatrist- doctor trained in physical medicine and rehabilitation prescribes medicines as needed.
• Occupational therapists- they help person to learn and improve skills to perform everyday activities.
• Speech and language pathologist- helps the person to improve speech and language skills,
• Neuropsychologists- accesses and improves cognitive function of the patient.
• Social worker- who facilitates access to service agencies, assists with care decisions and planning.
• Rehabilitation nurse- who provides ongoing rehabilitation care of services and helps in discharge planning from the hospital.
• Traumatic brain injury nurse specialist- who helps coordinate care and educated family about the injury and recovery process.
• Recreational therapist- assists with time management and leisure activities. Vocational counselor- who accesses the ability to return to the work.

Following steps must be taken to prevent traumatic brain injury:

• Seat belts and airbags- always wear a seat belt and use cars equipped with airbags.
• Alcohol and drug use- never drink and drive.
• Helmets- wear helmet while riding a motorcycle.

Prevent falls:

• Install handrails in bathrooms.
• Put a nonslip mat in the bathtub.
• Install handrails in steps.
• Improve lighting in home.
• Keep stairs and floors clear and clutter.
• Get regular vision checkups and get regular exercise.

Preventing head injuries in children:

• Install safety gates in top of the stairway.
• Keep stairs clear of clutter.
• Install window guards.

Make sure rugs are secure and don’t let children play near fire escapes or balconies.

No alternatives or homeopathic remedies can treat traumatic brain injury. Immediate medical care is advised.

Lifestyle modifications are necessary in order to cope with traumatic brain injury, which include:

• Join a support group- talk to doctor ask for any support groups nearby.
• Learn new coping strategies and get emotional support.
• Write things down- keep a record of important events and things that are difficult to remember.
• Follow a routine- keep things in designated places and avoid confusion.
• Take breaks- make arrangements at work or school to take breaks as needed.
• After work expectations or tasks- breaking down tasks into smaller steps.
• Avoid distractions- avoid distractions such as loud background noise.
• Stay focused- work on one task at one time.

There are several risks and complications associated with traumatic brain injury.

Following are common risk factors of traumatic brain injury:

• Children, especially newborns till 4 years of age.
• Young adults between ages of 15- 24 and adults aged 75 and older.

Several complications can occur after traumatic brain injury. Complications depend on the severity of the injury and include the following:

Altered consciousness:

Alterations in consciousness as a result of traumatic brain injury include:

• Coma- a person in coma is unconscious, unaware of environment and cannot respond to any stimulus. After a few days - weeks a person enters vegetative state.
• Vegetative state- Wide damage can occur to brain in vegetative state. The person may open eyes, make sounds and respond to reflexes or move. Sometimes vegetative states may become permanent.
• Minimally conscious state- In this state, consciousness is severely altered but with some evidence of self-awareness.
• Logged-in syndrome- person is aware of surroundings and is awake but cannot speak and move. Damage to the lower brain and brainstem mat cause this condition.
• Brain-death- When there is no measurable activity in brain and brain stem, this state is called brain death. Such state is irreversible.
• Seizures- serious injuries may result in recurring seizures called posttraumatic epilepsy.
• Fluid build-up- Fluid build-up may occur in ventricles of brain causing increase pressure and swelling of brain.
• Infections- penetrating wounds can cause damage to the meninges. This allows bacteria to enter the brain and cause damage.
• Blood vessel damage- traumatic brain injury can damage several small or large blood vessels.
• Nerve damage- damage to nerve causes the following manifestations; paralysis of facial muscles, loss of vision, loss of sensation on face, swallowing problems, loss of smell and damage to the nerves responsible for eye movements.

Intellectual problems:

• Cognitive problems such as memory, learning, reasoning, judgment, speed of mental processing and attention or concentration disorders.
• Communication problems- problems with language can be as a result of traumatic brain injury.
• Social problems- Trouble in talking, problems with changes in tone and pitch, difficulty deciphering non-verbal signals, trouble reading ques from listeners, trouble in starting or stopping, inability to use muscle required to form words.
• Behavioral changes such as risky behavior, difficulty with self-control and lack of awareness. Emotional changes such as depression, anxiety and mood swings can occur.
• Sensory problems- some problems like difficulty in recognizing objects, skin tingling, pain or itching.