Traumatic brain injury
Traumatic brain injury (TBI) occurs when there is a blow, jolt or an impact to the head that interferes with the normal functioning of the brain. It can cause changes in the learning, cognitive and thinking ability of the affected person. Most of the cases need hospitalization and in some cases it can lead to permanent brain damage or even death. TBI can be classified into mild, moderate and severe based on the severity of the symptoms and the duration of unconsciousness experienced.
A person with traumatic brain injury may experience the below symptoms usually after few days or weeks:
- Headache or neck pain
- Blurred vision
- Ringing sensation in the ears
- Convulsions or seizures
- Confusion and disorientation
- Difficulty to recall the cause of injury that occurred in the past 24 hours
- Difficulty to speak coherently
- Frequent nausea and vomiting
- Changes in the sleep patterns
- Dilated eye pupils
The state of consciousness in TBI can be categorized as follows:
- Coma is a state in which the person is unconscious and does not respond to external stimulus.
- Vegetative state is when the person is unaware of the surroundings but can move or respond to the reflexes, make sounds and move eyes.
- Minimally conscious state is when the person has severely altered consciousness but is aware of oneself and environment. It is caused due to permanent vegetative state.
- Locked-in syndrome is a condition in which the person is aware of the surroundings but cannot move or talk.
- Brain death is an irreversible loss of activity in the brain and the brainstem.
The main causes of traumatic brain injury are accidental falls and vehicle accidents. The other less common causes are:
- Injury caused due to playing sports, such as boxing, baseball, skating, hockey, soccer, and other such high-impact sports.
- Injuries caused due to violence, such as gunshots, explosive blasts, child abuse or domestic violence.
- Injury caused due to accidental penetration of sharp objects into the skull.
- Shaken baby syndrome, which occurs due to vigorous shaking of infant, can also lead to TBI.
People who are at higher risk of having traumatic brain injury are:
- Children especially aged up to 4 years
- Old people aged above 75 years
- Military personnel in the combat zones
- Sports players
Traumatic brain injury is an emergency condition, which needs to be assessed quickly and treated promptly. The doctor assesses the severity of the injury based on the score of a 15-point test known as ‘Glasgow Coma Scale’. The doctor may check the person’s ability to move the eyes and limbs and also to follow instructions and coherence of the speech. Higher score indicates low severity of the injury.
Additionally, the doctor may order for laboratory tests, such as X-rays, EEG (electroencephalogram), CT scan or MRI to examine the brain in detail for bleeding, blood clots, bruising or swelling of the brain tissue.
The doctor may also monitor the skull pressure (intracranial pressure) using a probe. This diagnostic procedure is performed to minimize any further damage to the skull due to an increase in the intracranial pressure due to swelling.
Treatment aims at preventing the worsening of brain damage. Outcome of the treatment depends on the severity of the injury.
Most cases of mild TBI do not need any extensive treatment other than over-the-counter headache medications and some rest.
Moderate to severe TBI cases need emergency treatment, which includes oxygen, blood supply, blood pressure maintenance and preventing further injuries. In case of severe injury, intensive care and rehabilitation is required.
Medications may be given to prevent secondary damage to the brain. These may include:
- Diuretics to reduce pressure associated with excess fluid in the brain tissue
- Coma-inducing drugs to put the person into a temporary state of coma to reduce the oxygen demands of the brain
- Anti-seizure drugs to prevent additional damage to the brain due to seizures
Surgery may be recommended in some cases to repair a fractured skull, to relieve pressure in the brain or to remove blood clots, which may increase pressure on the brain. It is not advised to involve in physical or cognitive activities for some days as recommended by the doctor.