Most people have minor head injuries during their lifetime, but head trauma causing traumatic brain injury (TBI) is a common cause of serious illness and death. Primary brain injury results directly from trauma. Secondary brain injury is any later injury. Types of TBI include bleeding, concussion (shaken brain), and contusion (bruised brain). Injuries are classified according to severity or type of injury (e.g., closed or open). Injuries are also classified according to the presence of a skull fracture or lesion inside the brain and location of bleeding.
Twice as many males than females have TBIs. TBI is also more common in people younger than 35 than older people.
TBIs result when the head suddenly and violently hits an object, or when an object enters the skull. Common causes are blows to the head, motor vehicle accidents, falls, physical assaults, and sports. Penetrating injuries may be caused by high-speed missiles (bullets) or other objects (knives, tools, or bone pieces).
Low blood pressure, hypoxia, and increased pressure inside the skull (increased intracranial pressure, or ICP) can cause secondary injuries.
Symptoms depend on the injury type and severity. They can start immediately or develop slowly. People with mild TBIs may be conscious or may lose consciousness briefly. Other symptoms include headache, confusion, feeling lightheaded or dizzy, blurred vision, ringing in the ears, and fatigue. Changes in sleep, behavior, or mood can occur. People can have trouble with memory, concentration, attention, or thinking. Moderate or severe TBIs may also cause severe headache, vomiting, nausea, convulsions, inability to wake up, dilated pupils, and slurred speech. Extremity weakness or numbness, loss of coordination, and increased confusion, restlessness, or agitation can occur.
The health care provider does a physical examination (especially eye movement and pupils) and checks ABCs (airway, breathing, circulation). The health care provider uses the Glasgow Coma Scale score (range is from 3 to 15) to decide TBI severity. Computed tomography (CT) is used as part of the initial evaluation for moderate to severe TBIs.
Prevention is best. Minor injuries may need only observation and symptom control (e.g., pain medicine for headaches). In the initial 24 hours, people should be awakened every 2 hours and checked for signs of secondary injury. Elevating the head and sedation may help control the symptoms. Monitoring of all vital functions and intravenous mannitol are used for increased ICP and brain swelling. Deep or severe bleeding may require surgery (e.g., craniotomy to remove clots). Débridement and irrigation of penetrating injuries may be necessary to help reduce infections.
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