Traumatic Brain Injury: Causes, Symptoms and Treatment

What it is

A traumatic brain injury (TBI) is a sudden injury that damages the brain.

• Closed head injury: a blow, bump or jolt to the head.
• Penetrating injury: an object pierces the skull.

TBI can be mild, moderate or severe. A concussion is a mild TBI; its effects can be serious, but most people fully recover in time. Severe TBI can bring serious physical and psychological problems, coma and even death.

Causes

Closed head injuries:

• falls — the most common cause in adults 65 and older;
• motor vehicle crashes — the most common cause in young adults;
• sports injuries and being struck by an object;
• child abuse — the most common cause in children under 4;
• blast injuries from explosions.

Penetrating injuries: bullets or shrapnel; weapons such as a hammer, knife or baseball bat; a bone fragment driven into the skull. Explosions, natural disasters and other extreme events can cause both kinds at once.

Who is at risk

• Men are more likely than women to have a TBI, and a serious one.
• Adults 65 and older are most at risk of being hospitalized or dying from TBI.

Symptoms

Mild TBI:

• sometimes a brief loss of consciousness (many people stay conscious);
• headache, confusion, lightheadedness, dizziness;
• blurred vision or tired eyes, ringing in the ears, a bad taste in the mouth;
• fatigue, changed sleep, mood or behavior changes;
• trouble with memory, concentration, attention or thinking.

Moderate or severe TBI can add:

• a headache that worsens or won't go away;
• repeated vomiting or nausea;
• seizures, or being unable to wake;
• a dilated pupil in one or both eyes;
• slurred speech, weakness or numbness in the limbs, lost coordination;
• growing confusion, restlessness or agitation.

Diagnosis

After a head injury, get medical care as soon as possible. Your provider will ask about symptoms and the injury, do a neurologic exam, and may use CT or MRI, the Glasgow coma scale (rating the ability to open the eyes, speak and move), and neuropsychological tests.

Treatment

Mild TBI: mainly rest, and over-the-counter pain relievers for headache. Follow your provider's plan for rest and a gradual return to activity — doing too much too soon can slow recovery. Call if symptoms don't improve or new ones appear.

Moderate to severe TBI: first, stabilize the patient — control blood pressure, check pressure inside the skull, and keep blood and oxygen flowing to the brain. Then:

• Surgery to remove clots (hematomas) or dead tissue, repair skull fractures or relieve pressure;
• Medicines: anti-anxiety drugs, anticoagulants against clots, anticonvulsants against seizures, antidepressants, muscle relaxants, stimulants;
• Rehabilitation: physical, occupational and speech therapy (including for swallowing), psychological, vocational and cognitive therapy.

Some people have permanent disabilities, and TBI raises the risk of anxiety, depression and PTSD; treating these improves quality of life.

Prevention

• Always wear a seatbelt; use car seats and boosters for children.
• Never drive under the influence of drugs or alcohol.
• Wear a well-fitting helmet for cycling, skateboarding, hockey and football.
• Prevent falls: stair railings, grab bars in the tub, no tripping hazards, window guards and safety gates for small children, and regular exercise for balance and strength.

Sources

Based on "Traumatic Brain Injury," MedlinePlus, U.S. National Library of Medicine; a work of the United States government in the public domain.