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Traumatic brain injury (TBI)

Brief anatomy and physiology

The largest part of the brain (cerebral cortex) is divided into 2 main areas, the left and the right hemisphere. Cells from these 2 areas control most of the motor and sensory functions, and consciousness. In particular, there are specific areas that are responsible for functions and senses, such as sight, speech, hearing, behavior, memory, movement, touch, and thought.

The brainstem controls vital functions such as respiration, blood pressure, heart rate, and eye movement. It connects the hemispheres with the other part of the central nervous system (the spinal cord) and it functions as the central circuit of all nervous system functions. If the brainstem is injured by a direct blow to the head and/or pressed by a swelling of the brain (cerebral edema), these vital functions may be disrupted.

 

1 Recovery from coma
2 Types of residual damage
3 Rehabilitation
4 Chronic subdural hematoma
5 Acute subdural hematoma
6 Epidural hematoma
7 Skull fractures
8 Intracerebral hematoma (contusion)
9 Frequently asked questions

 

Frequently asked questions

What are Changes in the Level of Consciousness?

Brain injuries, whether mild, moderate, or severe, may also cause a change in a person’s ability to react and respond to the external environment. This is called a “change in the patient’s level of consciousness.” The level of consciousness varies from fully alert, to the appropriate answering when the patient wakes up from and lethargy, to the reduction of reactions and finally, to a coma. Coma represents the complete loss of consciousness and the inability to respond to environmental stimuli in any other way other than reflexively. Both the degree and duration of coma reflect the severity of the brain injury. The longer a patient stays in a coma, the less likely they are to have a good prognosis. Only after sufficient alertness is achieved may the characteristics and properties of the patient’s reactions be noticed and assessed. The content of the patient’s reactions is the most important element assessed when determining any change in personality, behaviour, and quality of life. The changes due to brain injury may range from mild or barely noticeable to very significant. Given the complexity of the brain, it is very difficult to predict the extent of these changes. There are no tests or x-rays depicting these changes. This uncertainty of the outcome is the most difficult part that patients’ families face.

What is Secondary Injury?

If the edema is severe, it may not be possible to reduce the pressure inside the skull. This puts even more strain on the already injured brain cells, and can put pressure on the brain stem, controlling all vital functions. This is called “herniation” and is a life-threatening complication.
Not only does the associated with edema and hematoma cause herniation, but they can also cause a reduction in the blood flow to the brain and, consequently, . This means that could also be complicated by reduced blood flow (ischemia). In this case, the neurons do not receive sufficient amounts of nutrients, such as oxygen and glucose. Ischemia then may cause an even greater damage to the neurons and leads to even greater cerebral edema and further reduction of the cerebral blood flow.

How can a traumatic brain injury be treated?

The of a traumatic brain injury depends on its severity. In more severe cases, surgery may be required in order to reduce the increased intracranial pressure by removing the hematomas. Medical actions to reduce intracranial pressure include hyperventilation (increased respiration), various medications, lowering of the body temperature and induce coma by using sedatives (sedation). The physician may also place an intracranial recorder inside or on the brain to measure intracranial pressure and/or cerebral blood flow so that the results of the various treatments can be recorded and the desired corrections can be made. Intracranial pressure can be successfully controlled by medication alone, and may not ultimately be that severe to require surgery. In combination with other means of controlling an elevated intracranial pressure, the patient must be constantly oxygenated properly and the patient’s blood pressure needs to be monitored. It may be necessary for the patient to have mechanical ventilation to get oxygen, in order to control the respiratory rate and lung pressure. Seizures may occur in any brain injury. If seizures occur, the appropriate medication is administered.

What symptoms may be caused?

What symptoms may be caused?”]Closed traumatic brain injuries usually occur when the head comes in violent contact with another object, in a way that causes the brain to move abruptly inside the skull. When fragile brain tissue gets this violent push, it is subject to focal (i.e. localized) and diffuse brain injury. There are varying degrees of traumatic brain injuries, from mild to severe. A mild traumatic brain injury usually results in reversible brain damage and, thus, temporarily affects the patient’s neurological functions; a severe injury almost always causes neurological damage. The location and severity of the injury determine the nature and degree of permanence of these neurological problems.

What is a traumatic brain injury?

A traumatic brain injury is an injury to the skull and brain. It can be closed, which means that the brain is not exposed or in danger of being exposed to the external environment, or open, when the brain is exposed to the external environment. In closed injury a may also be present, while in open one there is always a fracture. Hematoma may also be present in traumatic brain injury. A hematoma is called when it is outside the dura mater of the brain. A hematoma between the dura mater and the brain is called subdural, while when the hematoma is inside the brain it is called intracerebral.
The human brain is very sensitive and well protected from injury. It is tightly surrounded by membranes (called meninges), inside the hard skull which is also covered by a muscle sheath. The cells that make up the brain are fragile and can be easily injured if stretched or torn. This happens when a blow to the head causes the brain to collide with the hard and uneven inner surface of the bones, inside the skull.

The swelling that occurs after each injury exerts even more pressure on the cells and reduces blood flow. Adequate flow and oxygenation are vital for the brain cells. Any deprivation of blood or oxygen can cause an even greater harm.

How is traumatic brain injury diagnosed?

What are the Changes in the Level of Consciousness?

The presence of a traumatic brain injury is attested by a history of blow to the head and/or the presence of physical signs of head injury, such as open rupturing trauma, abrasions, or bruises on the skull or face. Blood or cerebrospinal fluid (CSF) flowing from the nose or ear may also indicate a trauma to the skull. Battle sign (bruising behind the ear) and bruising of the eyelids are both indicative of skull base fractures and are certain signs of craniocerebral injury. In addition, there may be neurological problems, which may be general, such as coma, lethargy or drowsiness, or seizures, and/or focal, (localized), such as paralysis of one arm and/or leg, or speech disorders. Diagnostic tests, such as computed tomography, are used in an effort to identify possible organic damage caused by the injury. This can be blood clots (hematoma), skull fracture, etc.

If detected, these abnormalities may mean that special is required. However, surgery can only reduce the pressure on the brain, but it cannot improve cerebral edema or brain cell damage.

What is Primary Injury?

When the head receives a strong blow, the meninges and skull act as a protective barrier to the edema that follows. Cerebral edema can cause an increase in pressure in the skull, resulting in an increase in intracranial pressure, and nerve cells become even more damaged. Another cause for the increased intracranial pressure and cell damage associated with brain injury is hematoma. The space inside the skull is just enough for the brain, cerebrospinal fluid and blood. Any increase in mass or volume damages the neurons and reduces the blood supply to the brain.