Explanation(sx)

1.inability to stand or balance- TBI suffer from dizziness and disequilibrium (lack of balance while sitting
or standing) at some point in their recovery . Dizziness includes symptoms such as lightheadedness,
vertigo (the sensation that you or your surroundings are moving), and imbalance.
How bad your balance problem is depends on many factors:
1.How serious your brain injury is.
2.Where in your brain you were injured.
3.Other injuries you had along with your brain injury. For example, in a motor vehicle crash, you could
suffer a TBI, cervical spine injury, and rib and leg fractures. All of these injuries will affect your ability to
maintain your balance.
4.Some medications used to manage the medical issues connected with the traumatic event or accident.

TREATMENT
Treatment will depend on the type of head injury you have. It also depends on your overall health.
Some treatments for head injury might include:
-medications to prevent blood clotting or seizures
-surgery to stop bleeding in the brain
-surgery to reduce pressure in the skull, if your brain is swelling
(The prognosis of a head injury depends on the severity. Some people with severe brain injuries may have
life-long changes to their personality or behavior. Other changes may resolve with time and treatment.)
Complications
Altered consciousness
Different states of consciousness include:

Coma. A person in a coma is unconscious, unaware of anything and unable to respond to any
stimulus. This results from widespread damage to all parts of the brain. After a few days to a few
weeks, a person may emerge from a coma or enter a vegetative state.

Vegetative state. Widespread damage to the brain can result in a vegetative state. Although the
person is unaware of his or her surroundings, he or she may open his or her eyes, make sounds,
respond to reflexes, or move.
It's possible that a vegetative state can become permanent, but often individuals progress to a
minimally conscious state.

Minimally conscious state. A minimally conscious state is a condition of severely altered

consciousness but with some evidence of self-awareness or awareness of one's environment. It is
often a transitional state from a coma or vegetative condition to greater recovery.

Locked-in syndrome. A person in a locked-in state is aware of his or her surroundings and
awake, but he or she isn't able to speak or move. The person may be able to communicate with eye
movement or blinking.
This state results from damage limited to the lower brain and brainstem. This rarely occurs after
trauma and is more commonly due to a stroke in that area of the brain.

Brain death. When there is no measurable activity in the brain and the brainstem, this is called
brain death. In a person who has been declared brain dead, removal of breathing devices will result in
cessation of breathing and eventual heart failure. Brain death is considered irreversible.

Seizures
Some people with traumatic brain injury will have seizures within the first week. Some serious injuries
may result in recurring seizures, called post-traumatic epilepsy.
Fluid buildup
Cerebrospinal fluid may build up in the spaces in the brain (cerebral ventricles) of some people who have
had traumatic brain injuries, causing increased pressure and swelling in the brain.
Infections
Skull fractures or penetrating wounds can tear the layers of protective tissues (meninges) that surround
the brain. This can enable bacteria to enter the brain and cause infections. An infection of the meninges
(meningitis) could spread to the rest of the nervous system if not treated.
Blood vessel damage
Several small or large blood vessels in the brain may be damaged in a traumatic brain injury. This damage
could lead to a stroke, blood clots or other problems.
Nerve damage
Injuries to the base of the skull can damage nerves that emerge directly from the brain (cranial nerves).
Cranial nerve damage may result in:

Paralysis of facial muscles

Damage to the nerves responsible for eye movements, which can cause double vision

Damage to the nerves that provide sense of smell

Loss of vision

Loss of facial sensation

Swallowing problems

Intellectual problems
Many people who have had a significant brain injury will experience changes in their thinking (cognitive)
skills. Traumatic brain injury can result in problems with many skills, including:

Cognitive problems

Memory

Learning

Reasoning

Speed of mental processing

Judgment

Attention or concentration

Executive functioning problems

Problem-solving

Multitasking

Organization

Decision-making

Beginning or completing tasks

Communication problems
Language and communications problems are common following traumatic brain injuries. These problems
can cause frustration, conflict and misunderstanding for people with a traumatic brain injury, as well as
family members, friends and care providers.
Communication problems may include:
Cognitive problems

Problems with changes in tone, pitch or

emphasis to express emotions, attitudes or
subtle differences in meaning

Difficulty understanding speech or

writing

Difficulty deciphering nonverbal signals

Trouble reading cues from listeners

Trouble starting or stopping

Difficulty speaking or writing

Inability to organize thoughts and ideas

Trouble following conversations

conversations

Social problems

Trouble with turn taking or topic

selection

Inability to use the muscles needed to

form words (dysarthria)

Behavioral changes
People who've experienced brain injury often experience changes in behaviors. These may include:

Difficulty with self-control

Lack of awareness of abilities

Risky behavior

Inaccurate self-image

Difficulty in social situations

Verbal or physical outbursts

Emotional changes
Emotional changes may include:

Depression

Anxiety

Mood swings

Irritability

Lack of empathy for others

Anger

Insomnia

Changes in self-esteem

Sensory problems
Problems involving senses may include:

Persistent ringing in the ears

Difficulty recognizing objects

Impaired hand-eye coordination

Blind spots or double vision

A bitter taste, a bad smell or difficulty smelling

Skin tingling, pain or itching

Trouble with balance or dizziness

Degenerative brain diseases

A traumatic brain injury may increase the risk of diseases that result in the gradual degeneration of brain
cells and gradual loss of brain functions, though this risk cannot yet be determined with any certainty for
an individual. These include:

Alzheimer's disease, which primarily causes the progressive loss of memory and other thinking
skills

Parkinson's disease, a progressive condition that causes movement problems, such as tremors,
rigidity and slow movements

Dementia pugilistica most often associated with repetitive blows to the head in career boxing
which causes symptoms of dementia and movement problems

Diagnosis

Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed
view of the brain. A CT scan can quickly visualize fractures and uncover evidence of bleeding in the
brain (hemorrhage), blood clots (hematomas), bruised brain tissue (contusions) and brain tissue
swelling.

Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create
a detailed view of the brain. This test may be used after the person's condition has been stabilized.

Intracranial pressure monitor

Tissue swelling from a traumatic brain injury can increase pressure inside the skull and cause additional
damage to the brain. Doctors may insert a probe through the skull to monitor this pressure.

Glasgow Coma Scale

Treatments and drugs

Mild injury
-no treatment other than rest and over-the-counter pain relievers to treat a headache.
-with a mild traumatic brain injury usually needs to be monitored closely at home for any persistent,
worsening or new symptoms.
-moderate to severe traumatic brain injuries focuses on making sure the person has an adequate oxygen
and blood supply, maintaining blood pressure, and preventing any further injury to the head or neck.
Medications

Diuretics. These drugs reduce the amount of fluid in tissues and increase urine output. Diuretics,
given intravenously to people with traumatic brain injury, help reduce pressure inside the brain.

Anti-seizure drugs. People who've had a moderate to severe traumatic brain injury are at risk of
having seizures during the first week after their injury.
An anti-seizure drug may be given during the first week to avoid any additional brain damage that
might be caused by a seizure. Additional anti-seizure treatments are used only if seizures occur.

Coma-inducing drugs. Doctors sometimes use drugs to put people into temporary comas
because a comatose brain needs less oxygen to function. This is especially helpful if blood vessels,
compressed by increased pressure in the brain, are unable to deliver the usual amount of nutrients and
oxygen to brain cells.

Surgery

Removing clotted blood (hematomas). Bleeding outside or within the brain can result in a
collection of clotted blood (hematoma) that puts pressure on the brain and damages brain tissue.

Repairing skull fractures. Surgery may be needed to repair severe skull fractures or to remove
pieces of skull in the brain.

Opening a window in the skull. Surgery may be used to relieve pressure inside the skull by
draining accumulated cerebral spinal fluid or creating a window in the skull that provides more room
for swollen tissues.

Pathophysiology
If there is strong hard blow to your head can cause your brain to strike the inside of your skull
during impact your brain squises the inside of your skull sending shock waves through your brain .
this shock waves tear or strentch the axon of some neurons
Axon damages- axonal shearing/diffuse axonal injury. The damage axon reduced normal brain
action by
Axon may die-can lead to breakdown communication among neurons and brain
Thorn axon quick detenerate releasing toxic level of chemicals called neurotransmitters into
extracellular space
Other neuron will die within 24 to 48 hrs worsening the injury
Fluid in brain is cerebrospinal fluid
Sx
Whole brain headache
Brain stem nausea,dizziness
Frontal and cerebelum poor ms coordination
Occipital- light sensitivity,blurred vision
Temporal ringing in the ear
Cerebellum slurred speeach
Frontal -loc