Traumatic brain injury (TBI) is a form of injury produced by a sudden and severe blow or jolt to the head that causes brain tissue damage. This damage can range from minor to severe, resulting in a variety of short- and long-term effects on a person's physical, cognitive, and emotional health. TBI is commonly caused by falls, automobile accidents, sports injuries, and physical attacks.
Continue reading to discover more about traumatic brain injury's origins, signs & symptoms, management, diagnosis, risk factors, complications, and prevention.
Traumatic brain injury is a major public health concern across the world. It is a significant cause of mortality and disability, particularly among young people and children, according to the World Health Organization. TBI is classified as mild, moderate, or severe depending on the intensity and duration of symptoms. More severe TBI can result in severe and lifelong impairment, as well as death. Certain injuries are classified as primary, which means they cause immediate damage. Some TBI effects might be secondary, which means they can arise gradually over hours, days, or weeks. Secondary brain injuries are caused by the reactive processes that occur following the initial head trauma.1
Penetrating and non-penetrating head injuries are two main categories of head injuries. Penetrating TBI occurs when an item pierces the skull and penetrates the brain tissue, while non-penetrating TBI occurs when an external force moves the brain within the skull. Causes include falls, car accidents, sports injuries, explosion injuries, and being struck by an item. Explosions, natural disasters, and other catastrophic events can cause both piercing and non-penetrating TBI in the same person.1
TBI can also be classified based on type of lesion. These include:
Hematomas: these are blood clots which can be located on the surface of the brain tissue (subdural) or within the brain (subdural).
Contusion: Bruising of the brain tissue leading to swelling.
Intracerebral Haemorrhage: refers to bleeding inside the brain.
Subarachnoid Haemorrhage (SAH): results from bleeding in the subarachnoid space.
Ischemia: Ischemic injury occurs due to lack of oxygen supply leading to tissue death, and,
Causes of traumatic brain injury
TBI can be brought on by a variety of situations in which the head is struck suddenly and violently. Common reasons include:
Falls: Falls are the main cause of TBI, especially in young children and older people.
Auto-mobile accidents: Accounting for about 20% of all TBI cases, auto accidents are the second most common cause of TBI.
Sports-related injuries: If the correct protective gear such as helmet is not used, contact sports like football, hockey, and soccer can cause traumatic brain injuries (TBI).
Physical attacks: TBI can result from physical assaults such as domestic violence, child abuse and shaken baby syndrome.
Signs and symptoms of traumatic brain injury
The signs and symptoms of TBI can vary depending on the severity and location of the injury. Some of the common symptoms include:
- Dizziness or loss of balance
- Nausea or vomiting
- Confusion or disorientation
- Memory loss or amnesia
- Blurred vision or sensitivity to light
- Mood changes or depression
- Difficulty concentrating or paying attention
- Difficulty sleeping or sleeping too much
- Seizures or convulsions
Children and infants with TBIs may also:
- Be sobbing uncontrollably all the time
- Reject eating, drinking, or breastfeeding3
Management and treatment for traumatic brain injury
The treatment and recovery of TBI depends on factors such as severity, symptoms, and location of injury. In severe cases, the symptoms appear gradually.
Cases with Mild TBI such as concussion are primarily treated with painkillers, rest and symptom monitoring. However severe cases may require hospitalisation, surgery, or rehabilitation therapy. Treatment options may include:
- Medications: Pain relievers, anti-seizure medications, diuretics and antidepressants may be prescribed to manage symptoms
- Surgery: In some cases, surgery may be required to remove blood clots, repair skull fractures, or relieve pressure on the brain
- Rehabilitation therapy: Physical, occupational, and speech therapy may be used to help a person recover from TBI and regain lost skills
Diagnosis of traumatic brain injury
TBIs require an initial evaluation by a qualified physician who conducts a neurological examination to assess hearing, speech, coordination, balance, mental condition, changes in mood or behaviour, as well as motor and sensory capabilities. The Glasgow Coma Scale is a tool used to assess a person's level of consciousness and severity of brain injury.
Diagnostic imaging can aid in understanding the extent of trauma and formulate treatment plans accordingly, these include CT scan or MRI, can be used to assess the extent of the injury and discover brain damage.
Certain factors may increase a person's risk of TBI, including:
- Age: Young children and older adults are at an increased risk of TBI
- Gender: Males are more likely than females to experience TBI
- Occupation: People who work in certain occupations, such as construction, transportation, or military may be at an increased risk of TBI
- Participation in high-risk activities: Activities such as contact sports or extreme sports increase the risk of TBI3
Depending on the extent and location of the injury, TBI complications might vary. Common complications include the following:
- Cognitive and communication issues: TBI can lead to issues with language, memory, and attention
- Behavioural complications: TBI can result in sadness, anxiety, and behavioural disorders. Emotional and behavioural issues
- Seizures: TBI increases the chance of having either short- or long-term seizures
- Post-traumatic headaches: Headaches can persist for weeks or months after a TBI and are a typical consequence
- Sensory issues: tingling pain or itching sensation
- Degenerative brain disease: Increases the likelihood of diseases such as Alzheimers and Parkinsons disease
How can I prevent traumatic brain injury
While TBI is not always preventable, some steps can be taken to reduce the risk of injury, including:
- Buckling up when driving a car or travelling in one
- Wearing a helmet when participating in high-risk activities such as biking or skiing
- Using protective gear when playing contact sports
- Installing safety gates and handrails in homes to prevent falls
- Avoiding alcohol and drugs, which can impair balance and increase the risk of injury
How common is traumatic brain injury?
It is predicted that 69 million people worldwide experience TBI annually, with Southeast Asia and the Western Pacific facing the highest illness burden.4
When should I see a doctor
If you experience a head injury or blow to the head and develop any symptoms of TBI, such as headache, vomiting, dizziness, or confusion, it is important to seek medical attention immediately. Even mild TBI can cause long-term effects, and early diagnosis and treatment can help prevent complications.
Traumatic brain injury is a serious injury that impacts the brain. TBI is often caused by falls, accidents or attacks. Characteristic symptoms include; headaches, dizziness, sickness, nausea, disorientation. You should see a medical practitioner as soon as possible if injury to the head has occurred as symptoms may not present straight away.
- Gasco J, Nader R, editors. Traumatic brain injury (TBI). In: The Essential Neurosurgery Companion. Stuttgart: Georg Thieme Verlag; 2013.
- Traumatic brain injury [Internet]. Aans.org. [cited 2023 Apr 19]. Available from: https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Traumatic-Brain-Injury
- Traumatic brain injury [Internet]. Cleveland Clinic. [cited 2023 Apr 19]. Available from: https://my.clevelandclinic.org/health/diseases/8874-traumatic-brain-injury
- Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the Global Incidence of Traumatic Brain Injury. Journal of Neurosurgery. 2018;130(4):1–18.