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Traumatic brain injury

Traumatic brain injury (TBI) is a mechanical damage to the skull and intracranial formations, namely the brain, vessels, cranial nerves, meninges of the brain.

Head injuries can be classified into open, in which cranial cavity has a contact with the external environment, and closed ones. The main clinical factors that determine the severity of injury include duration of loss of consciousness and amnesia, the degree of consciousness oppression at the time of hospitalization, neurological symptoms in the brainstem.

Causes

The most common causes of TBI are motor vehicle accidents and domestic accidents. For more information on the causes, statistics, and other general data, see the section Information about TBI

Effects, complications

  • The mechanical damage can result in the formation of focal brain injury, which initially causes local damage to the areas of the cerebral cortex accompanied by the formation of its injury zone and (or) intracranial hemorrhage (intracranial hematoma) due to the damage of the vessels of the cerebral membranes or vessels that provide direct feeding to the brain.
  • With the simultaneous influence of various factors of mechanical effect on all brain structures, a person develops a diffuse axonal injury. In particular,diffuse axonal injury is common in car accidents. The injury is characterized by either rupture or damage of long nerve cell appendages - axons, which distorts the transmission of a nerve impulse. The patients with diffuse axonal injury can experience breathing problems, impaired blood flow and disorders of other vital functions caused by a primary damage to the brainstem. The clinical manifestation of diffuse axonal injury is a state of coma that can last several weeks. According to statistics, the mortality rate accounts for 80-90%, while the surviving patients can develop a complication, namely – apallic syndrome, with subsequent transition to the vegetative state.
  • The secondary hypoxic brain injuries can develop due to the late or inadequate treatment of the primary brain injury. They are characterized by the development of (ischemic lesions) of various parts of the brain (ischemic strokes). For example, a late removal of the intracranial hematoma leads to uncontrolled growth of intracranial pressure, edema (brain swelling), impaired blood circulation in various parts of the brain and development of secondary ischemic foci (strokes) in various parts of the brain.

The severity of the trauma is determined by such factors as the duration of amnesia, the degree of the patient's consciousness oppression during the hospitalization and can be aggravated in case of neurological symptoms in the brainstem.

The traumatic brain injury can lead to a coma. This is an extremely unfavorable consequence of the injury when the patient is unconscious, does not perceive the external effect and does not understand the state in which he/she is. Being in a coma is patient lieing soundly with eyes closed.

The outcome of TBI can be even more severe in the case when coma changes to the vegetative state. This condition can occur after a prolonged stay in a coma and in most cases it is observed when the patient wakes up from the traumatic coma. In the vegetative state, the body maintains blood pressure, blood supply, breathing and heart rhythm. A characteristic feature of the vegetative state is a periodic awakening of the patient, which they periodically experience after a period of sleep. However, while being awake, the patient remains unconscious, does not perceive the environment and cannot speak. The patient can manifest the condition, which is common for decortication, signs of pyramidal insufficiency, subcortical symptoms, primitive reflex motor phenomena, for example, a voluntary palmar grasp reflex, symptoms of oral automatism; chaotic movements as a reaction to painful stimuli. The vegetative state can last from several days to a year and even more.

The main signs of the vegetative state:

  • Unconscious state of the patient.
  • Inadequate and disorderly reaction to auditory, visual, tactile or painful stimuli.
  • Change in the periods of awakening and sleep.
  • Functional activity of the hypothalamus and brainstem sufficient to maintain spontaneous breathing and adequate hemodynamics.
  • Spontaneous blinking, normal pupil response to light and corneal reflexes.
  • The patient cannot focus their eyes and cannot perceive the movement of objects.
  • Urinary and fecal incontinence.

The patients who have suffered a trauma with direct damage to the cerebral cortex, as well as secondary ischemic strokes, may develop post-traumatic encephalopathy with characteristic symptoms,

  • Motor disorders, weakness or paralysis, which can cause difficulty in moving, walking and loss of coordination. Hemiparesis or hemiplegia are the terms used to denote movement disorders affecting only one side of the body.
  • Swallowing disorder. If the person develops impaired swallowing, both food and liquid can get into the respiratory tract or lungs but not into the esophagus. The person can therefore develop severe lung inflammation. Swallowing disorder can also cause constipation and dehydration.
  • Speech disorder. Damage to the left hemisphere of the brain results in impaired speech production and understanding, including difficulty reading, writing and counting.
  • Problems of perception. Even with normal vision, the sufferer is unable to understand what he/she sees. Perceptual disorders make it difficult for the person to use everyday objects. For example, the person cannot take a glass and pour water into it and drink it.
  • Cognitive disorders. In these disorders the person’s ability to mental perception and processing of external information becomes impaired. The patient lacks clear and logical thinking, their memory gets worse, they lose their ability to learn, make decisions and plan ahead.
  • Behavioral disorders. The person can experience aggression, slow response, fearfulness, emotional instability and disorganization.
  • Bowel and bladder problems. Stroke can cause a variety of different problems, resulting in either bowel or bladder dysfunction (fecal or urinary incontinence or retention).
  • Psychological disorders. These include mood swings, depression, irritability, episodes of laughing or crying without an evident reason. Depression is a very common problem for people who have suffered stroke. It is often accompanied by loss of appetite, episodes of causeless laughing or crying, insomnia, low self-esteem and an increased sense of anxiety.
  • Post-traumatic Epilepsy.

Rehabilitation

In Germany and other the countries of the European Union, patients with the traumatic brain injury start their rehabilitation directly in the intensive care unit. Then, depending on the degree of the primary brain lesion, doctors develop rehabilitation programs and determine the further direction of the patient’s treatment.

With an early recovery and rehabilitation, millions of people who have suffered TBI can return to their normal life.

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Development of the traumatic brain injury

The main causes of TBI include motor vehicle accidents, falls and sports injuries. Despite the fact that the brain is enclosed in a secure skull membrane, it is very vulnerable.

Classification of the head injuries

Concussion is an instant failure of the brain. It is the mildest form of the traumatic brain injury with a brief loss of consciousness. When patients regain consciousness they complain of headache, dizziness, nausea and vomitin. Tinnitus, sweating, sleep disorder are common as well. The vital bodily functions do not suffer any significant deviations. Patient’s general condition usually improves during the first, rarely the second day. If any symptoms are found, the patient should be examined to rule out the possibility of the concussion. This TBI is treatable.

Diagnostics of a traumatic brain injury

Unfortunately, there are no clear signs that can indicate an irreversible damage to the brain due to a certain trauma. To diagnose this disease in time, doctors take into account any complaints and symptoms that patient have.
Here are some of them:

Rehabilitation of TBI patients

Each patient has a different rehabilitation period. It depends on the type of the injury and the degree of brain damage. All necessary procedures are prescribed to each patient individually. The goal of rehabilitation after traumatic brain injury is to restore as many lost brain functions as possible. The program includes therapy that aims to restore vital functions, namely speech and movement. In addition, the specialists help patients to overcome complications caused by incurable traumas, as well as develop certain methods, which can compensate lost abilities developed due to the improper functioning of the CNS.

Symptoms of Traumatic Brain Injury

Traumatic brain injury can affect any area and function of the brain. A failure in the work of the brain leads to excessive drowsiness, attention defecit, difficulty concentrating, memory disorder, depression, irritability, emotional outbursts, sleep disorders, a low libido, difficulties in switching between two tasks and slow thinking.

Traumatic Brain Injuries in Children

Unfortunately, head injuries in children are quite common. An annual number of hospitalizations accounts for approximately one hundred thousand traumatic brain injury cases affecting children. The causes of such injuries are road accidents, bike falls, sports injuries, falls from a height and child abuse. There are some features peculiar only to children's injuries. Both symptoms and effects of traumatic brain injuries in children are very different from those of adults. For example, it is much more difficult to determine the degree of brain damage and any possible dysfunctions in a child. After analyzing the results of studies at school and higher educational institutions, the coefficient of mental development and professional activity (for adults), doctors can determine the severity of the injury. At one time it was believed that children are more resistant to brain injuries than adults, because their growing brain could restore itself faster over time. However, more and more studies point to the opposite. In fact, compared with adults, children are more susceptible to irreversible brain damage, even if the force of the blow is the same.

Traumatic brain injury increases the risk of developing Parkinson's disease

During the research, it was found that TBI is one of the key factors leading to the destruction of neurons directly related to the development of Parkinson's disease.

Statins will protect the brain in case of a head injury

The use of statins in case of the head injury prevents complications and sometimes even death among middle-aged and elderly people.

Smell and Taste after TBI

The methods of examining smell disorders in patients with traumatic brain injuries are divided into objective and subjective, as well as into qualitative and quantitative. Severe patients with acute TBI are examined by means of the Borchtein’s method. The procedure is quite simple and the patient should be conscious when undergoing this examination. The test involves the use of the following set of odorous substances:

Hearing after TBI

In case of traumatic brain injury, hearing loss is most commonly caused by the cracks in the pyramid of the temporal bone. The less common causes of hearing loss include traumatic damages to the central auditory pathways in the nuclear region (in this case, hearing loss develops on the affected side) or traumatic damages to the middle brain (hearing loss occurs from two sides and more greatly affects the spoken language).

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