Like with any part of the body, your brain can get injured. You may have heard this referenced under many names such as a concussion, stroke, shaken baby syndrome, cerebral contusion or a traumatic brain injury.
Our brain is a huge part of who we are and so a brain injury can have major implications on everything from our personality to our memory to our sleeping patterns to our ability to move. Or you could just get some minor pain and nothing more.
Today, we’re looking at Traumatic Brain Injury (TBI). TBI is a major cause of death and disability in the US, accounting for approximately 30% of all injury-related deaths according to the CDC. In 2010 in the US, about 2.5 million emergency room visits, hospitalizations, or deaths were associated with TBI, usually as a result of a fall and usually in kids or the elderly.
Traumatic vs. Non-Traumatic Brain Injuries
First let’s make sure we separate apples and oranges.
A traumatic brain injury (TBI) is caused a blow to the head, for example as a result of abuse, a vehicle accident or injury incurred by a weapon.
In contrast , a non-traumatic brain injury (NTBI) is caused by a lack of bloodflow to the brain (hypoxia), tumors, an infection, blood clots, strokes, seizures and the like.
For it to be traumatic rather than non-traumatic, there must be an external insult to the body that causes physical harm as opposed to internal forces resulting in damage.
If you’re referring to both TBI and NTBI, we refer to Acquired Brain Injury (ABI).
Symptoms of a TBI
Mild TBI usually just lead to some nausea, neck pain, headaches and tiredness. In the case of moderate to severe TBI, symptoms may include:
- Loss of consciousness
- Alterations in behavior and mood
- Headaches that come and go or get steadily worse or don’t go away
- Confusion
- Dizziness
- Sleepiness
- Tinnitus
- Blurred Vision
- Nausea
- Vomiting
- Seizures
- Movement difficulties
- Speech impairments
- Seizures
Mild, Moderate or Severe TBI
The severity of a TBI is defined by the duration of loss of consciousness with or without a coma rating scale, post-traumatic amnesia (PTA) and brain imaging.
| Severity | Time Unconscious | PTA Duration | Imaging Results |
| Mild | Seconds to minutes | Less than an hour | Normal |
| Moderate | 1-24 hours | 1-24 hours | Abnormal |
| Severe | 24+ hours | 24+ hours | Abnormal |
Further Sub-Categorizations for TBI:
- Loss of consciousness where the person cannot be woken up called a coma.
- Someone is awake but is totally unaware of their surroundings known as a vegetative state. If this last for months it is known as a persistent vegetative state.
- Intermittent responsiveness to surroundings is known as a minimally responsive state.
Treatment of TBI
Mild TBIs are treated with painkillers to help with headaches and neck pain. Over a few days or weeks, the TBI takes care of itself. For moderate to severe TBI however, the symptoms can vary wildly so the treatment options depends on each person’s own needs. Treatments may include medication for seizures, spasticity, surgery, physical and occupational therapy, pain medication, and medication to prevent blood clots.
An excellent review on current TBI treatment regimens has been written by Stein et al. (2017).
Primary and Secondary Brain Injuries
The initial mechanical insult to the brain, perhaps a blow to the head, would cause what is termed the primary injury. Perhaps the brain is jolted around, perhaps there is some internal bleeding or bruising. Over time, if this initial damage isn’t treated, secondary damage can occur. Secondary damage occurs as a result of swelling (edema), impaired blood flow, accumulation of toxic waste such as damaged cellular components and excessive secretion of neurotransmitters. When it rains it pours so to speak.
Preventing secondary brain injuries is key to minimizing the amount of permanent damage the brain sustains.
A Look at the Research
There are a few schools of thought here. One is magnetic stimulation to affect biological changes in the brain like this clinical trial on transcranial magnetic stimulation for mild TBIs or this one on deep brain stimulation for severe TBI. Another is to allow the brain to rewire itself using virtual reality simulations to relearn tasks, as seen in this virtual reality driving simulator study or this one on physical exercise protocols. There are also some more grassroots studies that compare the different types of brain imaging options like fMRI and NIRS or search for TBI biomarkers to improve detection and diagnosis. Very excitingly, stem cell therapies are also being tested for TBI (we’re big fans of stem cells, in all their shapes and types).
Do you have questions about TBI? Have you read about any interesting research on them? What articles on TBI would you like to see next?
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