CONDITIONS
Traumatic Brain Injury (TBI)
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In India, 60% of TBI is because of road traffic accidents (RTA), followed by falls and assaults contributing to 25% and 10% of TBI respectively.
Traumatic brain injury occurs due to a violent blow or a sudden shock (jolt) to the head or body. It may also happen if an object such as a bullet or shattered piece of skull goes through brain tissue.
What are the different types of TBI?
Brain injury may happen in one of two ways:
Closed brain injury: A nonpenetrating injury to the brain with no break in the skull.
May be caused by car accidents, falls, and increasingly, in sports. Shaking a baby can also result in this type of injury (called shaken baby syndrome).
Penetrating brain injury: These are open head injuries and occur when there is a break in the skull, such as a bullet piercing the brain.
TBI may also be classified as mild, moderate and severe using the term concussion while mentioning mild TB. A concussion is a type of TBI, caused by a bump, blow, or jolt to the head and may change the way the brain normally works.
What are the symptoms of Traumatic Brain Injury?
Symptoms of TBI may appear immediately after the traumatic event or appear days or weeks later.
Mild traumatic brain injury
Physical symptoms
- Headache
- Nausea or vomiting
- Fatigue or drowsiness
- Problems with speech
- Dizziness or loss of balance
Sensory symptoms
- Sensory problems, such as not seeing clearly (blurred vision), ringing in the ears,etc.
- Sensitivity to light or sound
- Cognitive, behavioral or mental symptoms
- Loss of consciousness for few seconds to minutes
- A state of being dazed, confused
- Memory or concentration problems
- Mood changes or mood swings
- Feeling depressed or anxious
- Difficulty sleeping
- Sleeping more than usual
Moderate to severe traumatic brain injuries
Physical symptoms
- Loss of consciousness from several minutes to hours
- Persistent headache or headache that keeps getting worse
- Vomiting or nausea that keeps re-occuring
- Convulsions or seizures
- Dilation of one or both pupils of the eyes
- Clear fluids draining from the nose or ears
- Inability to awaken from sleep
- Weakness or numbness in fingers and toes
- Loss of coordination
Cognitive or mental symptoms
- Profound confusion
- Agitation, or other unusual behaviour
- Slurred speech
- Coma and other disorders of consciousness
Children’s symptoms
- Change in eating or nursing habits
- Unusual or easy irritability
- Persistent crying and inability to be consoled
- Short attention span
- Change in sleep habits
- Seizures
- Sad or depressed mood
- Drowsiness
- Loss of interest in favourite toys or activities
What are the causes and risk factors of Traumatic Brain Injury?
Common events causing TBI include the following:
- Falls from bed or a ladder, down the stairs, in the bath, that could particularly happen in older adults and young children.
- Vehicle-related collisions which includes cars, or even people walking on the road
- Violent experiences or incidences such as gunshot wounds, domestic violence, child abuse and other assaults. Shaken baby syndrome is a TBI in infants caused by violent shaking.
- Sports injuries are injuries caused from a number of sports, including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other high-impact or extreme sports.
- Explosive blasts and other combat injuries that are prominent feature in the life of an active-duty military personnel.
Risk factors for TBI:
The people most at risk of traumatic brain injury include:
- Children, especially newborns to 4-year-olds
- Young adults, especially those between ages 15 and 24
- Adults age 60 and older
Males in any age group
How is Traumatic Brain Injury diagnosed?
In case of mild TBI, the healthcare provider examines and asks about the symptoms and also enquire about the cause of injury. They may suggest the following tests:
- Neurological evaluation.
- Imaging tests. A CT scan or MRI checks for brain bleeding and swelling.
- Blood tests.
Cases of moderate or severe TBI may be an emergency and in more-severe TBIs consequences can worsen rapidly without treatment. Doctors or first responders would likely will do blood tests and a CT scan so they can decide on immediate medical treatment.
Glasgow Coma Scale – A 15-point test helps doctor or other emergency medical personnel to assess the initial severity of a brain injury by checking a person’s ability to follow directions and move their eyes and limbs and also the presence of a coherent speech could provide important clues. Abilities are scored from three to 15 and higher scores mean less severe injuries.
Apart from imagining tests such as Computerized tomography (CT) or Magnetic resonance imaging (MRI) scans, in cases where tissue swelling from a TBI can increase pressure inside the skull and cause additional damage to the brain, the intracranial pressure may be monitored by insert a probe through the skull
What are the treatment options for Traumatic Brain Injury?
Treatments depend on the type of TBI like mild and moderate/severe TBI.
Treatment for mild TBI
- Rest.
- Over-the-counter nonNSAID pain relievers.
- Regular checkups over the next few weeks to watch for new symptoms or worsening symptoms.
Treatment for a moderate or severe TBI
A moderate or severe traumatic brain injury is a medical emergency and emergency care focuses that the person has enough oxygen and an adequate blood supply, maintaining blood pressure, and preventing any further injury to the head or neck.
Medications:
- Prescription pain medicines.
- Antiseizure medications.
- Medication to prevent venous thromboembolism.
- Coma-inducing drugs – to put people into temporary comas since that would need less less oxygen to function
Surgery may be conducted to:
- Relieve pressure inside the skull.
- Remove any debris inside the skull from a penetrating TBI
- Remove blood clots.
- Repair fractures in the skull.
- Place monitors in brain to measure pressure and oxygenation.
Rehabilitation:
Post surgery may require rehabilitation treatment. The goal of rehabilitation is improvement in the ability to handle daily activities. The type and duration of rehabilitation is different for everyone, depending on the TBI and accordingly rehabilitation specialists such as the following may be suggested:
- Physical therapist.
- Occupational therapist.
- Speech therapist.
- Respiratory therapist.
- Psychological therapist.
- Traumatic brain injury nurse specialist
- Recreational therapist
Can Traumatic Brain Injury be prevented?
Tips to reduce the risk of brain injury are as follows:
- Always wear seat belts and check I airbags are functioning in the car.
- Don’t drink and drive or drive under the influence of drugs, or prescription medications that affect the ability to drive.
- Wearing a helmet should be a must while riding a bicycle, skateboarding, motorcycling
- Proper head protection when playing baseball or contact sports, skiing, skating, snowboarding or riding a horse should be worn at all times.
- Stay alert and pay attention to the surroundings. It is unadvisable to drive, walk or cross the street while using the phone, tablet or any smart device.
Preventing head injuries in children
- Install safety gates at the top of a stairway in case of multi-storeyed home or in bungalows
- Do not block stairs
- Install window guards to prevent falls
- Put a nonslip mat in the bathtub or shower
- Visit playgrounds that have proper safety and shock-absorbing materials on the ground
- Don’t let children play on fire escapes, refugee areas or balconies without protection
References
- Agrawal A, Munivenkatappa A, Shukla DP, Menon GR, Alogolu R, Galwankar S, Kumar SS, Momhan PR, Pal R, Rustagi N. Traumatic brain injury related research in India: An overview of published literature. Int J Crit Illn Inj Sci. 2016 Apr-Jun;6(2):65-9.
- Traumatic Brain Injury. Mayo Clinic. May 2024. https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/diagnosis-treatment/drc-20378561
- Traumatic Brain Injury. Cleveland Clinic. May 2024. https://my.clevelandclinic.org/health/diseases/8874-traumatic-brain-injury
