Definition & Overview

Traumatic Brain Injury (TBI) is described as a sudden external force to the brain causing a variety of symptoms that can eventually lead to brain dysfunction. Some forms of TBI involve a foreign object piercing the skull or a blunt object striking the skull causing it to shatter and direct bone fragments into the brain.

Depending on the degree of the external force hitting the skull (concussion), TBI may be classified as mild, moderate, or severe. Mild TBI will usually result in headaches, difficulties in thinking clearly, dizziness, and nausea. Patients with moderate to severe TBI normally display the same symptoms, but on a more frequent basis. The symptoms tend to be more severe and get worse over time.

TBI, whether mild, moderate, or severe is a serious condition. Millions of people in the United States and around the world experience TBI. Some are able to make a full recovery, but others aren’t so fortunate. Many TBI cases will result in death or permanent damage to a person’s physical and social functions.

Anybody of any age is at risk of TBI, but according to statistics, the condition mostly occurs between ages 0-4, 15-24, and those above 75 years old.

Cause of Condition

TBI can be caused by a wide variety of factors, such as a simple fall, a sporting event, falling objects, or a vehicular accident. Although it is generally accepted that the stronger the force, the greater the damage, even a mild or moderate force can cause serious damage, especially if a sharp object was able to penetrate the skull.

Damage to the brain may be limited to the impact area or it may be widespread. For instance, a blunt instrument hitting the skull may cause damage directly beneath the point of impact. However, if such instrument were to hit the skull with greater force, the entire head may rock back and forth in a sudden motion causing damage to the entire brain. Another good example would be an explosive device. The force of an explosion alone is enough to rock the entire brain causing widespread damage.

About a fifth of TBI’s were caused by violence. In infants, violence can be as simple as shaking the baby. Other types are domestic violence, street fights, and child abuse.

Key Symptoms

TBI can produce a wide variety of symptoms and they fall in one or more of the four main categories, which are:

  • Mental
  • Physical
  • Emotional
  • Sleep

Mental symptoms include thinking and concentrating difficulties, difficulty in remembering information, and a general feeling of slowness. Physical symptoms are headaches, fuzzy or blurred vision, nausea and vomiting, noise and light sensitivity, fatigue, and balance problems.

Emotional symptoms include depression, nervousness or anxiety, irritability, and a tendency to become more emotional. Sleep symptoms include the need for more or less sleep, or having difficulty falling asleep.

In most cases, the symptoms appear right away after injury. However, there have been cases wherein the symptoms only appeared months or even years after a person was injured.

Displaying symptoms of a TBI are warning signs, especially when they continue to progress. For instance, if the headache keeps getting worse instead of going away, or if the person experiences repeated vomiting or nausea, it’s best to seek medical assistance.

Other signs that immediate medical assistance is required are:

  • Convulsions and seizures
  • Getting more and more confused, agitated, or restless
  • Drowsiness or cannot be awakened
  • If one pupil of the eye is larger than the other
  • Loses consciousness

Who to See & Types of Treatment Available

Mild TBI usually does not require any medical attention, especially if the person is not showing any symptoms. However, this doesn’t mean that the symptoms won’t appear after some time, which is why the person needs to be constantly monitored.

If a person shows any of the above symptoms directly after a head injury, he or she should be brought to a hospital’s emergency department immediately. If the symptoms appear sometime after the injury, the person should consult a doctor to determine the cause of the symptoms.

It’s important to understand that if a person experiences moderate to severe TBI, medical personnel will only be able to prevent the condition from getting worse. The chances of reversing the effects of the initial trauma are slim. Emergency treatment is centered on saving the person’s life.

Almost half of severe TBI cases will require surgery, as it is likely that blood vessels in the brain have ruptured. Surgery is performed to remove the clotting and prevent pressure from building up in the skull. Surgery will also be needed to repair skull fractures or to open a window in the skull to gain access to the brain.

Other than surgery, patients will be given medications to help prevent further damage to the brain. These medications can include, diuretics, anti-seizure drugs, and coma-inducing drugs.

Diuretics help prevent the buildup of fluids in the body. Anti-seizure drugs prevent further brain damage caused by a seizure, and coma-inducing drugs are given to patients who need to be placed into a temporary coma to allow their brains to heal.

The longest part of treatment is rehabilitation. Most people who had severe TBI will normally experience loss of basic movements, such as walking or talking. Undergoing rehabilitation will help them relearn these lost skills and improve them over time.

It will take a team of medical personnel to rehabilitate a single patient. This team can include a psychiatrist, physical therapist, occupational therapist, speech and language pathologist, a social worker or case manager, neuropsychologist, a rehabilitation nurse, TBI nurse specialist, vocational counselor, and a recreational therapist.

Rehabilitation does take time and the results are often not guaranteed. The person’s willpower or determination to live a normal life will play a huge role in the rehabilitation efforts. Without the person’s determination, rehabilitation will have little to no success.

References:

  • American Association of Neuroscience Nurses, Association of Rehabilitation Nurses. Care of the patient with mild traumatic brain injury. Available at: www.aann.org/pubs/content/guidelines.html. Accessed November 5, 2014.
  • Chuang K, Stroud, NL, Zafonte R. Rehabilitation of patients with traumatic brain injury. In: Winn HR, ed. Youman's Neurological Surgery. 6th ed. Phildelphia, PA: Elsevier Saunders; 2011:chap 342.
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