Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. We hear of horrific consequences of “king hits” or “coward punches” for victims and their families in the news. There are also safety campaigns in Australia and New Zealand to tackle this very issue. But what is a TBI, how do they happen, and how are they treated? Read on to learn more.
What is a TBI?
A TBI is an injury to a person’s brain that may be caused by a blow, jolt or bump to the head, an object that goes through the skull, or the body being shaken or hit hard enough to cause the brain to hit against the skull. Keep in mind that not all blows and jolts to the head will cause TBI.
The severity of a TBI may range from mild to severe. A mild TBI may result in a short change in mental status or consciousness, while a severe TBI may cause a longer period of unconsciousness or memory loss. Most TBIs are mild, commonly called “concussion.”
What are the different types of TBIs?
There are a number of different types of TBIs. They are:
- A concussion, which can be a result of a hard fall or hit to the head. The fall or hit shakes the brain. After a concussion, some people lose consciousness for a short time, but most who have a concussion do not. They may feel confused or off balance. They may also lose their memory or have trouble with their vision for a short time.
- A brain contusion, which is a bruise of the brain that makes the brain bleed and swell. The bruise may not be visible on the skin.
- A skull fracture, which is when the skull cracks. Sometimes pieces of the skull cut into the brain, causing bleeding or other damage.
- An intracranial haematoma, which is bleeding inside the skull that leads to clotted blood forming between the brain and skull. It can sometimes be days or even weeks after the TBI for this to happen.
- A facial (or scalp) haematoma, which is bleeding outside the skull that collects and clots. This can look like a lump on a person’s forehead or scalp or a black eye. These haematomas can look bad, but they usually heal and don’t cause permanent damage.
What are common causes of TBIs?
Overall, falls are the leading cause of TBI-related hospitalisations. Motor vehicle crashes, and being hit by or hitting against an object are also among the top causes of TBI.
Among young people, sports and recreational activities such as bicycling, football, soccer, basketball, and playground activities are also a major cause of TBI.
What are the signs and symptoms of a TBI?
There are a number of signs and symptoms of a TBI. While some of them are the same regardless of the severity of the TBI, people who have a moderate to severe TBI have one or more additional symptoms. Not all of the symptoms of a TBI happen right away. In fact, some of them may not appear until days or even months after the injury.
People with a mild TBI may feel dizzy, have a headache, or feel sick to their stomach. Other symptoms of a mild TBI include:
- Ringing in the ears.
- Neck pain.
- Trouble with their vision.
- Changes in behaviour or mood
- Sleep disturbances
- Problems with memory
- Slower reflexes than usual.
- Losing consciousness.
Moderate to severe TBIs
People with moderate to severe TBI may have some of the same signs and symptoms as with a mild TBI, along with one or more of the following:
- Nausea or vomiting that lasts.
- Headache that lasts a long time.
- Pupils that are larger than normal.
- Trouble waking up, walking, or speaking.
- Slurred speech.
- Weakness or numbness in the arms or legs.
- Drainage of bloody or clear fluids from the ears or nose.
Mild symptoms usually go away after a few days or weeks. Moderate to severe TBIs can have long-lasting effects. For example, a person’s mood can change, making him or her feel angry, anxious, or sensitive. In addition, short-term memory and the ability to think clearly or focus on a task may be affected. Some people have a loss of their sense of taste and smell.
When to get medical attention
Any type of TBI should be taken seriously—even if it doesn’t appear to be. If there is any loss of consciousness, no matter how short, it is important to go to a doctor as soon as possible. Even if there is no loss of consciousness, the first few hours after the injury are critical. During this time, it’s important to look for any of the following symptoms:
- Slurred speech
- Increased sleepiness
- Change in pupils
- Confusion about the time or date
- Memory loss
Any of these symptoms could be a sign that the brain is bleeding or swelling. It is important to seek medical attention immediately.
How are TBIs treated?
The type of treatment a person with TBI receives is based on the severity of the injury and where the injury is in the brain.
For mild TBIs, which may include a concussion, sometimes the only treatment required is rest. This could include a period of complete rest followed by a slow return to normal activities. It’s important to follow the doctor’s instructions regarding rest and resuming activities. Some activities, like working on a computer and concentrating hard, can tire the brain even though they are not physically demanding.
For more serious TBIs, emergency treatment may be needed. This can include supplying oxygen flow to the brain, managing blood pressure, and taking steps to stabilise the head and neck. In some cases, surgery may be needed to reduce damage to the brain. Surgery could include removing any clotted blood in the brain or between the brain and skull, repairing skull fractures, or relieving the increased pressure inside the skull, resulting from the trauma. Many people with moderate to severe TBI will also need rehabilitation to help them with physical, emotional, or thinking issues.
For some people with a TBI, medicines may also be used to treat symptoms and lower the risks associated with TBI.
Lowering the risk for TBIs
While not all TBIs can be avoided, there are things people can do to help avoid some of them. These include:
- Always wearing a seat belt.
- Putting children in approved car seats.
- Never driving while under the influence of drugs or alcohol.
- Wearing a helmet when doing activities such as skateboarding and bike riding, and when playing certain sports.
- Making living areas safer by removing tripping hazards such as area rugs, keeping inside areas well-lit, and installing window guards and safety gates if there are children in the home.
Medically reviewed by George H. Sands, MD, FAAN, Senior Medical Director at Pfizer Inc.
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