Overview of Traumatic Brain Injury | Neurology

Traumatic brain injury (TBI)

What is a traumatic brain injury?

Traumatic brain injury (TBI) may be a disruption within the normal functioning of the brain which will be caused by a blow, bump, or jolt to the top, the top striking an object suddenly and violently, or when an object pierces the skull and enters the brain tissue. The observation of the subsequent clinical signs constitutes an alteration of the traditional functioning of the brain:

  • Loss or decrease of consciousness
  • Focal neurological deficits like muscle weakness, vision loss, speech changes
  • Altered mental statuses like disorientation, slow thinking, or difficulty concentrating

Symptoms of a traumatic brain injury are often mild, moderate, or severe, counting on the extent of the brain damage. Mild cases can cause a quick change in the psychological state of consciousness. Severe cases can cause prolonged periods of unconsciousness, coma, or maybe death.

Types of traumatic brain injury

Concussion may be a mild head injury that will cause a quick loss of consciousness and typically doesn’t cause permanent traumatic brain injury.

An injury may be a bruise during a specific area of the brain caused by an impression to the head; Also called hit or kickback injuries. In injuries, the brain is injured directly below the impact area, while in kickback injuries the brain is injured on the side opposite the impact.

Diffuse axonal injury (DAI) may be shearing and stretching of nerve cells at the cellular level. It occurs when the brain moves rapidly back and forth within the skull, tearing and damaging the nerve axons. Axons connect one neuron to a different throughout the brain, like telephone wires. Generalized axonal injury interrupts the brain’s normal transmission of data and may cause large changes during a person’s wakefulness.

Traumatic subarachnoid hemorrhage involves bleeding into space around the brain. This space is generally crammed with spinal fluid (CSF), which acts as a floating cushion to guard the brain. Traumatic SAH occurs when the tiny arteries are torn during the initial injury. Blood spreads over the surface of the brain causing widespread effects.

A hematoma may be a form when a vessel breaks. Blood that escapes from the traditional bloodstream begins to thicken and clot. Clotting is the body’s natural way of stopping bleeding. A hematoma is often small or it can grow and compress the brain. Symptoms vary counting on the situation of the clot. A clot that forms between the skull and therefore the lining of the brain’s dura is named an epidural hematoma. A clot that forms between the brain and therefore the dura is named a subdural hematoma. A clot that forms deep in brain tissue is named an intracerebral hematoma. Over time, the body reabsorbs the clot. Sometimes surgery is completed to get rid of large clots.

Causes of traumatic brain injury

Traumatic brain injury is typically caused by a blow or other traumatic injury to the top or body. The degree of injury can depend upon several factors, including the character of the injury and therefore the force of the impact.

Common events that cause traumatic brain injury include the following:

  • Falls from a bed or a ladder, downstairs, within the bathroom, and other falls are the foremost common explanation for TBI generally, especially in older adults and young children.
  • Vehicle-related collisions. Collisions involving cars, motorcycles, or bicycles, and pedestrians involved in such accidents, are a standard explanation for traumatic brain injury.
  • Violence. Gunshot wounds, violence, maltreatment, and other assaults are common causes. The shaken baby syndrome may be a traumatic brain injury in babies caused by violent tremors.
  • Sports injuries. Traumatic brain injuries are often caused by injuries from various sports, including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other extreme or high-impact sports. These are particularly common in youth.
  • Explosive blasts and other combat injuries. Explosive blasts are a standard explanation for traumatic brain injury in active-duty military personnel. Although how damage occurs remains not well understood, many researchers believe that the pressure wave passing through the brain significantly alters brain function.

Traumatic brain injuries also are the result of penetrating wounds, severe blows to the top with shrapnel or debris, and falls or collisions with objects after an explosion.

Symptoms of traumatic brain injury

Symptoms of the traumatic brain injury vary greatly counting on the severity of the top injury. they will include any of the following:

  • Vomiting
  • Lethargy
  • Headache
  • Confusion
  • Paralysis
  • Loss of consciousness
  • Dilated pupils
  • Vision changes (blurred or diplopia, inability to tolerate bright light, loss of eye movement, blindness)
  • Spinal fluid (CSF) (clear or tinged with blood) appears within the ears or nose
  • Balance problems and dizziness
  • Respiratory problems
  • Slow pulse
  • A slow rate of respiration with increased vital sign
  • Ringing within the ears or changes in hearing
  • Cognitive difficulties
  • Inappropriate emotional responses
  • Speech difficulties (difficulty speaking, inability to know and/or articulate words)
  • Difficulty to swallow
  • Body numbness or tingling
  • Droopy eyelids or facial weakness
  • Loss of bowel or bladder control

Diagnosis of traumatic brain injury

Anyone with signs of moderate or severe TBI should get medical attention as soon as possible. Because there’s not much we will do to reverse the initial brain damage caused by trauma, medical providers attempt to stabilize an individual with TBI and specialize in preventing further injury.

First, heart and lung function is evaluated. this is often followed by a fast full-body exam, followed by an entire neurological exam. The neurological examination includes an assessment using the Glasgow Coma Scale (GCS). In addition to GCS, the power of the pupils to become smaller in bright light is additionally assessed. In patients with large masses of lesions or with high intracranial pressure (ICP), one or both pupils could also be very dilated or “swollen.” The presence of a good or dilated pupil on just one side suggests that there could also be an outsized mass of lesion. Brainstem reflexes, including those for nausea and cornea (blinking), also can be evaluated.

Radiological tests

A computerized tomography (CT) scan is the gold standard for radiological evaluation of a patient with TBI. A CT scan is straightforward to perform and a superb test to detect the presence of blood and fractures, the foremost crucial injuries to spot in cases of medical trauma. Some recommend plain radiographs of the skull as to how to usage patients with mild neurological dysfunction. However, most centers are having CT scans, a more accurate test, reducing the routine use of skull X-rays for TBI patients.

Resonance imaging (MRI) isn’t commonly used for acute head injuries, because it takes longer to perform an MRI than a CT scan. Because it’s difficult to move an acutely injured patient from the ER to an MRI scanner, the utilization of MRI isn’t practical. However, once the patient is stabilized, the MRI can demonstrate the existence of lesions that weren’t detected on the CT scan. This information is usually more helpful in determining prognosis than in influencing treatment. 

Treatment for traumatic brain injury

Surgery

Many patients with moderate or severe head injuries go straight from the ER to the OR. In many cases, surgery is completed to get rid of an outsized bruise or contusion that significantly compresses the brain or increases pressure within the skull. After surgery, these patients are under observation within the medical care unit (ICU).

Other head injury patients might not attend the OR directly, but instead could also be taken from the ER to the ICU. Since bruises or bruises may become larger during the primary hours or days after the top injury, immediate surgery isn’t recommended in these patients until several days after the injury. Delayed bruising is often discovered when a patient’s neurological examination worsens or when her ICP increases. At other times, a routine follow-up CT scan to work out whether a little lesion has changed in size indicates that the hematoma or contusion has become significantly enlarged. In these cases, the safest method is to get rid of the lesion before it enlarges and causes neurological damage.

During surgery, the hair on the affected part of the top is typically shaved. After the scalp incision, the removed bone is removed in one piece or flap, then replaced after surgery unless contaminated. The dura is carefully moved to reveal the underlying brain. After removing any bruises or contusions, the neurosurgeon makes sure the world isn’t bleeding. Then close the dura, replace the bone, and shut the scalp. If the brain is extremely swollen, some neurosurgeons may decide to not replace the bone until the swelling subsides, which may take several weeks. The neurosurgeon may prefer to fit an ICP monitor or other sorts of monitors if these aren’t already in situ. The patient returns to the ICU for observation and extra care.

Non-surgical treatments

Currently, there are not any medications given to stop nerve damage or promote nerve healing after TBI. The most goal within the ICU is to stop any secondary injury to the brain. “Primary insult” refers to the initial trauma to the brain, while “secondary insult” is any later development that will contribute to neurological injury. for instance, an injured brain is particularly sensitive and susceptible to drops in vital signs that might rather be well tolerated. a method to avoid secondary insults is to undertake normal or slightly elevated vital sign levels. Also, increases in ICP decreased oxygenation of the blood, increased blood heat, increased blood sugar, and lots of other changes can potentially worsen neurological damage. the most role of ICU management is the prevention of secondary injuries in patients with head injuries.

Prevention of traumatic brain injury

Follow the following pointers to scale back your risk of traumatic brain injury:

  • Seat belts and airbags. Always wear a safety belt during a motor vehicle. A young child should sit within the back seat of a car secured during a child safety seat or booster seat that’s appropriate for his or her size and weight.
  • Consumption of alcohol and medicines. Don’t drive under the influence of alcohol or drugs, including prescribed drugs which will affect the power to drive.
  • Helmets. Wear a helmet when riding a bicycle, skateboard, motorcycle, snowmobile, or ATV. Also wear proper head protection when playing baseball or contact sports, skiing, skating, snowboarding, or horseback riding.

Complications of traumatic brain injury

  • Physical complications
  • Altered consciousness
  • Intellectual problems
  • Communication problems
  • Behavior changes
  • Emotional changes
  • Sensory problems
  • Degenerative diseases of the brain

Departments to consult for this condition

  • Department of Neurology

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