Fast facts on traumatic brain injury

Here are some key points about traumatic brain injury. More detail and supporting
information is in the main article.
The effect of a TBI can vary depending on the severity of the injury and where it
occurs

Around 1 in 3 injury-related deaths involve a TBI

Roughly 2% of Americans live with a TBI-related disability

The majority of TBIs are caused by falls

TBI symptoms may include confusion, persistent headaches and sleeping problems
If someone receives a head injury and experiences convulsions or slurred speech,
they should seek urgent medical attention

A concussion is classed as a mild TBI

In America, TBI is the third most common injury to result from child abuse

Blood pressure can severely drop after a head injury.

What is a TBI?
 TBIs can be generated in a wide range of ways, from falls to collisions in sport.

TBI is generally the result of a sudden, violent blow or jolt to the head. The brain is
launched into a collision course with the inside of the skull, resulting in possible bruising
of the brain, tearing of nerve fibers and bleeding.

TBI severity varies enormously depending on which part of the brain is affected,
whether it occurred in a specific location or over a widespread area, as well as the
extent of the damage.

In mild cases, the patient may experience only temporary confusion and headache.
Serious TBI can result in a period of unconsciousness,amnesia, disability, coma and
even death.

A head injury usually refers to a traumatic head injury, but is a broader category. Head
injury may also involve damage to other structures (apart from the brain), such as the
scalp or skull.
According to the Centers for Disease Control and Prevention (CDC):

About one third of injury-related American deaths are linked to TBI

About 230,000 hospitalizations occur annually in the US as a result of TBI

1.1 million Americans are treated for TBI and released from an emergency
department

Almost 2% of the US population lives with TBI-related disabilities

About 2 million American adults and children suffer from TBI injury annually

50,000 patients die annually in the US as a result of TBI

Every 15 seconds, one American man, woman or child sustains a significant TBI

The total number of individuals with TBI who are not seen in an emergency
department or receive any care is unknown

Direct medical costs and indirect costs - such as lost productivity - of TBI totaled an
estimated $60 billion in the US in 2000.

Among American children aged up to 14 years, TBI results in an estimated:

2,685 deaths

37,000 hospitalizations

435,000 emergency department visits annually.

Scientists have not managed, thus far, to identify effective medications to improve
outcomes for such patients, despite the extent of the problem.

The CDC also reports that the main causes of TBI are falls (28%), motor vehicle traffic
crashes (20%), struck by/against events (19%) and assaults (11%).

Symptoms of traumatic brain injury

TBI signs and symptoms may sometimes be subtle and might not appear for days or
weeks after the injury. Some patients may look well, even though they may feel or
behave differently.
Our brain controls our movements, thoughts, sensations and behaviors. A TBI can have
several different physical and psychological effects. Initial physical effects are bruising
and swelling. When injured brain tissue swells up pressure is increased; the injured
brain tissue presses against the skull causing additional damage.

The most common signs and symptoms of TBI include:

Confusion

Fatigue (tiredness) and lethargy

Getting lost easily

Persistent headaches

Persistent pain in the neck

Slowness in thinking, speaking, reading or acting

Moodiness - suddenly feeling sad or angry for no apparent reason

Sleep pattern changes - this may include either sleeping much more or much or less
than usual, or having trouble sleeping

Light headedness, dizziness

Becoming more easily distracted

Increased photosensitivity (sensitivity to light)

Increased sensitivity to sounds

Loss of sense of smell or taste

Nausea

Tinnitus (ringing in the ears).

 A child with a TBI may become irritable and listless.

Children - the same signs and symptoms as those listed above are possible. However,
children typically are less likely to let others know how they feel. If a child has received a
blow or jolt to the head and you notice any of the following signs or symptoms, call a
doctor:
Changes in sleeping patterns

Irritability - the child does not stop crying and is hard to console, for example

Listlessness
 Loss of balance

Loss of newly acquired skills (such as toilet training)

Playing behavior changes

Refusal to eat

Loss of interest in their favorite activities or toys

Tiredness

Unsteady walking

Vomiting.

When to see a doctor - according to the Mayo Clinic, you should see a doctor if you
suffered a blow to the head, and should seek emergency medical care if any of the
following signs are present:
Convulsions

Repeated vomiting

Slurred speech

Weakness or numbness in the arms or legs (hands and feet).

The Mayo Clinic also lists two types of signs or symptoms, depending on the severity of
the TBI.

Mild TBI signs and symptoms (concussion) may include:

A short period of unconsciousness

Blurred vision, tinnitus (ringing in the ears), or a bad taste in the mouth

Cannot remember events immediately before and after the injury took place

Confusion

Dizziness or loss of balance

Headache

Headache

Memory problems

Moodiness
 Problems focusing mentally.

Moderate to severe TBI signs and symptoms may include:

Agitation, confrontational

Continuous headache

Convulsion or seizures

Coordination problems

One or both pupils of the eyes are dilated

Patient does not wake up from sleep

Persistent nausea and/or vomiting

Profound confusion

Slurred speech

Weakness and numbness in hands, feet, arms or legs.

Causes of traumatic brain injury

TBI is caused by a severe jolt or blow to the head, or a head injury that penetrates and
disrupts normal brain function.

Our brains are like a mass of gelatin which is protected from jolts and bumps by the
cerebrospinal fluid around it - the brain literally floats in this fluid inside the skull. A
violent blow or jolt to the head can push the brain against the inner wall of the skull,
which can lead to the tearing of fibers and bleeding in and around the brain.

Not only can a blow cause injury to the brain, sudden and rapid acceleration or
significant deceleration may cause TBI well.
 Falls are the most common source of TBIs in America.

According to the CDC, the leading causes of TBI in the US are:

Falls 28% - most commonly affecting children aged up to 4 years and adults over 75
years

Motor vehicle accidents 20% - highest among people aged 15-19 years

Struck by/against events 19% - including colliding with a moving or stationary

object. About 1.6-3.8 million sports and recreation-related TBI occur in the USA annually.
Most are mild and receive no hospital or emergency treatment

Assaults 11%- TBIs caused by firearm use are the leading cause of deaths related
to TBI. 90% of patients with a firearm-related TBI die. Nearly two thirds of TBIs caused by
firearms are classified as suicidal with intent. For military personnel in war zones, the
leading cause of TBI are blasts. In the majority of cases, the skull remains intact and the
damage is thought to be caused by a pressure wave from the explosion which passes
through the brain causing injury
 Non motorized pedal cycles (bicycles, tricycles, etc.) 3%

Transport 2%

Suicide 1%.

Child abuse: TBI is the third most common injury to result from child abuse in the US.

Other causes of TBI include domestic violence, and work-related and industrial
accidents.

Diagnosing traumatic brain injury

TBIs require rapid diagnosis and treatment because they are frequently medical
emergencies which can easily and quickly lead to complications.

The Glasgow Coma Scale

Doctors often use the Glasgow Coma Scale (GCS) before deciding whether to use a CT
scan. The GCS is a way for doctors and nurses to assess the severity of brain damage
following a head injury. It scores patients according to verbal responses, motor responses
(physical reflexes), and how easily they can open their eyes.

Eyes - Glasgow Coma Scale

Score of 1 - does not open eyes.

Score of 2 - opens eyes in response to painful stimuli (when given pain).
Score of 3 - opens eyes in response to voice.
Score of 4 - opens eyes spontaneously.

Verbal - Glasgow Coma Scale

Score of 1 - makes no sound.

Score of 2 - incomprehensible sounds (mumbles).
Score of 3 - utters inappropriate words.
 Score of 4 - confused, disorientated.
Score of 5 - oriented, chats normally.

Motor (physical reflexes) - Glasgow Coma Scale

Score of 1 - makes no movements.

Score of 2 - extension to painful stimuli (straightens limb when given pain).
Score of 3 - abnormal flexion to painful stimuli (moves in a strange way when given
pain).
Score of 4 - flexion/withdrawal to painful stimuli (moves away when given pain).
Score of 5 - localizes painful stimuli (can pinpoint where pain is).
Score of 6 - obeys commands.

Brain injury will be classified in the Glasgow Coma Scale as:

Coma = a score of 8 or less.

Moderate = a score of 9 to 12.
Minor = a score of 13 or more.

Imaging scans of the brain

Imaging scans of the brain will help determine whether there is any brain injury/damage,
and where. Examples include the following:
 Brain imaging is essential for assessing the internal damage.

CT (computed tomography) scan - also known as a CAT (Computer Axial

Tomography) scan. It is a medical imaging method that employs tomography.
Tomography is the process of generating a two-dimensional image of a slice or section
through a 3-dimensional object (a tomogram).

The medical device is called a CTG scanner; it is a large machine and uses X-rays. It
used to be called an EMI scan, because it was developed by the company EMI.

X-ray - X-rays are still used for head trauma. But experts say they are not so useful. If a
head injury is mild no imaging is usually needed, while a severe injury would merit the
more accurate CT scan.
MRI (magnetic resonance imaging) scan - an MRI machine uses a magnetic field and
radio waves to create detailed images of the body, which in this case would be the
brain.

Most MRI machines look like a long tube, with a large magnet present in the circular
area. When beginning the process of taking an MRI, the patient is laid down on a table.
Then depending on where the MRI needs to be taken, the technician slides a coil to the
specific area being imaged.

The coil is the part of the machine that receives the MR signal. MRI scans are good for
examining the brainstem and deep brain structures. The doctor may inject a special dye
which shows up on the scans and distinguishes healthy tissue from damaged tissue.

Angiography - a medical imaging technique used to visualize the inside, or lumen, of

blood vessels and organs of the body. This may be used to detect blood vessel
pathology when risk factors, such as penetrating head trauma are involved.

EEG (electroencephalography) - the device measures the electrical activity within the
brain. Electrodes are placed on the patient's scalp; they pick up electrical impulses that
occur in the brain. These impulses are recorded on the EEG device. An EEG can tell
whether the patient is having non-convulsive seizures.

Intracranial pressure monitor - a device is placed inside the head. It senses the
pressure inside the skull and sends its measurements to a recording device. Brain
injuries tend to result in swelling of brain tissue which may cause additional damage to
the brain.

Treatment options for traumatic brain injury

Most concussion or mild traumatic brain injury (MTBI) symptoms will go away without
treatment. In the US, approximately 1% of patients with MTBI require surgery. Click
here to read more about MTBI. In more severe cases the patient will be hospitalized
and will require intensive care.

When treating TBI, the focus of emergency care is to prevent any worsening of brain
damage. The greatest risk of further brain damage is when the brain swells. The human
skull is made of bone and is not very flexible; any swelling soon results in an increase of
pressure. If blood vessels were damaged when the injury occurred, there is a further
risk of pooled blood or clots accumulating in this small space (inside the skull where
pressure is rising).

Swelling of the brain within the skull can put undue pressure on the surrounding tissues.

The increased pressure in the brain can cause:

Damage to brain tissue, just because of the pressure itself

The blood vessels to get squeezed, undermining their ability to supply the brain cells
with oxygen and essential nutrients.

Blood pressure - brain injuries can result in a serious drop in blood pressure, further
reducing blood supply to the brain.

Medications:
 Diuretics - a diuretic is anything that encourages the formation of urine by the
kidneys; in other words, they increase urine output and reduce the amount of fluid in
tissue. These are administered intravenously. Mannitol is the most commonly used
diuretic for TBI patients. Some studies suggest that children may benefit from certain
concentrations of saline solution.

Anti-seizure medication - the risk of seizures during the first week following the
traumatic injury is higher for patients with moderate to severe TBI. This medication may
be administered to prevent further brain damage caused by seizures.

Coma-inducing medications - comatose patients require less oxygen. Doctors may

sometimes deliberately induce coma if the blood vessels are unable to supply adequate
amounts of food and oxygen to the brain.

Rehabilitation - a number of TBI patients with significant injury need rehabilitation. This
may involve relearning how to walk, talk and carry out tasks which used to be done
automatically. The aim is to help the patient gain as much physical independence as
possible.

Typically, therapy starts in the hospital, and later continues in a residential treatment
facility, or in outpatient services. Depending on the patients' needs, they will be treated
by either a physical therapist (UK: physiotherapist) or occupational therapist, or both.

Surgery:

Removing hematomas - a hematoma is an abnormal collection of blood (localized)

which is either partially clotted or completely clotted. Often, when TBI patients arrive in
hospital they are taken straight to the operating theater and have large deposits of clotted
blood removed from between the skull and the brain, resulting in a reduction of pressure
inside the skull, preventing further brain damage.

Skull fractures - if any part of the skull is pressing into the brain it will need to be
surgically repaired. In most cases skull fractureswhich are not pressing into the brain
heal on their own.
Create an opening in the skull - this is done to relieve the pressure inside the skull.
This procedure is only done if other interventions have not worked.

Tips that can aid recovery:

Avoid activities which could cause another blow/jolt to the head

 Do exactly what doctors and other healthcare professionals recommend. Do not take
drugs your physician has not approved

Do not rush back to daily professional or school activities

Get plenty of rest

If you have memory problems, write things down

Only drive a car, ride a bicycle/motorbike, or use heavy equipment when the doctor
says it is OK to do so. People's reflexes after a TBI may be slower

Seek help in re-learning skills that were lost.

TBI is a leading cause of death and disability around the globe and presents a major worldwide
social, economic, and health problem. It is the number one cause of coma it plays the leading
role in disability due to trauma,and is the leading cause of brain damage in children and young
adults.

Findings on the frequency of each level of severity vary based on the definitions and methods
used in studies. A World Health Organization study estimated that between 70 and 90% of head
injuries that receive treatment are mild, and a US study found that moderate and severe injuries
each account for 10% of TBIs, with the rest mild.

In its 2015 report on road safety, the World Health Organization says
1.25 million people have died globally due to road accidents, with
motorcyclists comprising 23% of deaths