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Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object or when an object pierces the skull and enters brain tissue. Symptoms of TBI can be mild, moderate or severe depending on the extent of the damage to the brain. A person with mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or a few minutes. Other symptoms of mild TBI include headache, confusion, light headedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention or thinking. A person with moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness of the extremities, loss of coordination, increased confusion, restlessness and agitation.

About 1.4 million Americans sustain traumatic brain injury each year. Luckily, more than 75% of these injuries are mild concussions. But even minor brain injuries can cause long term problems.

Children with brain injuries may lack the communication skills to report headaches, sensory problems, confusion and similar symptoms. Instead, they may refuse to eat and appear listless or cranky. Their sleep patterns and school performance may change, and they may lose interest in favorite toys or activities.

Problems associated with traumatic brain injuries often come in two stages. The original impact may bruise portions of the brain or directly sever nerve connections. The second stage of the injury occurs when the tissue at the injury site begins to swell. Inside the skull, there is no place for the swelling to go, so the pressure on the brain increases. Intracranial pressure must be monitored closely because it can result in additional damage to the brain.


Causes

Half of all traumatic brain injuries are caused by collisions involving cars, motorcycles and bicycles. Traumatic brain injuries inflicted by firearms have the highest likelihood of causing death. Almost two-thirds of firearms-related brain injuries are self inflicted. Gunshot wounds to the head are fatal 90% of the time. Among older people, falls are the leading cause of traumatic brain injuries. Infants and small children are also vulnerable to traumatic brain injuries, particularly as a result of being shaken violently.

It is recommended that medical attention should be sought when a person has suffered a blow to the head. Anyone with signs of moderate or severe brain injury, such as convulsions, weakness or numbness of the extremities, repeated vomiting, or slurred speech should receive emergency medical care. These types of brain injuries can quickly become life threatening.


Diagnosis

Emergency medical personnel assess the severity of brain injury by determining how well the injured person can follow directions to blink his or her eyes or move extremities. The coherence of the person's speech also provides important clues. Imaging tests are often used to determine the extent of the injury. Skull and neck x-rays can check for bone fractures or spinal instability. Computerized Tomography (CT) scans can uncover evidence of bleeding in the brain (hemorrhage), large blood clots (hematomas), bruised brain tissue (contusions), and brain tissue swelling.


Complications

Some of the complications that can occur with TBI include:


Treatment

Fewer than half the people who suffer severe traumatic brain injury need surgery to remove or repair the damaged portions of their brains. In some cases, there is a collection of blood between the skull and the brain. This is called an intracranial hematoma, which must be surgically drained.

Surgery may also be performed to drain the excess fluid that has accumulated in reaction to the trauma itself. While swelling is a natural reaction for body tissue that has been injured, it can cause additional damage to the brain by increasing the pressure inside the skull. Medications also can be used to decrease the pressure.

Most people who have had a significant brain injury will require rehabilitation. They may need to relearn basic skills, such as walking or talking. The overall goal is to improve their abilities to function at home and in the community.