Traumatic brain injuries, or TBIs, occur when the brain experiences sudden trauma or damage, typically from blows to the head or violent jolts. TBI can result from both closed injuries—in which the head experiences blunt force trauma but the skull remains intact—and open injuries that pierce the skull and damage brain tissue directly.
Injuries can be incurred from a variety of sources, including sports-related injuries, falls, or car accidents. Symptoms can range from mild to severe depending on the location and extent of the damage. The most common type of traumatic brain injury is a concussion. This type of TBI often presents with mild symptoms but can still impact brain function, whether temporarily or permanently. A TBI may or may not involve loss of consciousness.
Traumatic brain injuries are divided into primary and secondary types. Individuals with primary brain injuries experience the full force of their injury at the time of the incident. Secondary brain injuries evolve over time following the moment of injury, causing symptoms to change, worsen, or intensify hours to days after the traumatic event.
people experience TBI annually
Estimated deaths from traumatic brain injury in 2020
of all TBI-related hospitalizations were people aged 75 and older
The most common causes of traumatic brain injury are falls, motor vehicle crashes, firearm-related incidents, and physical assaults.
Research shows that several demographics are more likely to experience TBI:
Young children, particularly from birth to four years of age
Young adults between the ages of 15 and 24
People who are incarcerated
Members of the military
Men are hospitalized nearly twice as often for TBI-related issues and are statistically three times more likely to die as a result of traumatic brain injury
Despite current studies showing that men are more likely to experience a traumatic brain injury, much of this research fails to account for the fact that women are more likely than men to experience TBI from intimate partner violence. In fact, up to 94% of injuries women sustain from intimate partner violence are to the neck or head. Eve Valera, PhD, Associate Professor of Psychiatry at Harvard Medical School, notes that this underrepresentation of women in TBI studies has led to a significant knowledge gap. “[T]here remains relatively little research on females or sex and gender differences [related to TBI],” Valera says, even though “data indicate that a substantial number of women who have experienced physical [intimate partner violence] have sustained a [brain injury] from an abusive partner.” (Learn more about the connection between TBI and domestic violence.)
Additionally, athletes who participate in high-contact sports are also at a higher risk for developing TBI and TBI-related disorders. Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder that seems to be connected to repetitive head injuries, such as those incurred in high-contact sports like football, soccer, or boxing. While it’s clear a correlation exists between CTE and repeated head trauma, researchers are not yet certain of the precise relationship between CTE and TBI. Additionally, there is no way to accurately predict how many head injuries a person can suffer before developing CTE.
Traumatic brain injuries resulting from damage to crucial nerve fibers in the brain are known as diffuse axonal injuries or DAIs. When the body experiences a traumatic impact, the sudden, jarring movement can cause cranial nerve fibers to tear as the brain shifts position and makes contact with sharp bones on the inside of the skull, such as the sphenoid bone.
Due to the nature of DAIs, the resulting damage is often difficult to visualize and is not always readily apparent on CT scans and MRIs. Diffuse axonal brain injuries can result in coma and often damage many different sections of the brain.
Traumatic Brain Injury Signs and Symptoms
While some signs and symptoms of traumatic brain injury are overt and easy to spot, others are more difficult to detect. TBI symptoms also vary depending on the severity and location of the damage.
Common signs and symptoms of a mild traumatic brain injury, such as a concussion, include:
Fatigue or lethargy
Ringing in the ears
Other symptoms can include changes in personality and behavior, difficulty with memory and concentration, and disruptions to one’s typical sleep patterns.
In addition to the above symptoms, individuals with moderate and severe TBIs may experience:
Nausea and vomiting
A persistent headache, or one that continues to worsen
Seizures or convulsions
Speech changes (including slurring or difficulty recalling words)
Loss of coordination
Confusion, restlessness, or agitation
Weakness or numbness in the arms, legs, hands, or feet
Pupil dilation in one or both eyes
If you or a loved one has suffered a head injury and is experiencing any of the above symptoms, seek out medical attention as soon as possible. Even mild brain injuries are serious and should be evaluated by a qualified medical professional.
In order to diagnose a traumatic brain injury and assess its severity, medical professionals will gather information about the nature and cause of the injury. In many cases, they may also conduct brain imaging tests and a physical examination.
Prompt medical attention is crucial in assessing and treating potential TBIs. Medical professionals assessing someone for a potential TBI may need to know:
How the injury occurred
If the injured person lost consciousness (and for how long)
Information about the severity of the injury or traumatic event
Whether the injured individual experienced whiplash or other jarring movements
If the injured person has experienced changes in alertness, coordination, cognition, or communication
The Glasgow Coma Scale is a test often given to people who have suffered a traumatic brain injury. It scores brain injury severity on a scale of 3 to 15 points, with a higher score indicating less severe injury. Doctors and emergency medical responders administer this test to assess a person’s level of consciousness and awareness following a traumatic event. This may involve evaluating verbal responses, motor responses, and a person’s ability to open their eyes and maintain focus and visual contact.
In addition to this initial assessment, doctors will likely order brain imaging tests like CT scans and MRIs to assess the damage sustained during and after an injury. Additionally, a doctor may want to track swelling by inserting an intracranial pressure monitor probe into the injured person’s skull. Depending on the cause and nature of the brain injury, doctors may also order X-rays of the neck and skull to check for fractures or spinal damage.
Traumatic Brain Injury Treatment Options
Treatments for traumatic brain injury initially focus on stabilizing the individual and preventing risk of further injury. Immediately following the injury, doctors will closely monitor blood pressure, blood flow, and brain oxygen levels until the person’s condition is deemed stable. Some people recovering from TBI will require surgery. Surgery is typically performed to repair ruptured blood vessels in the brain (known as hematomas) or bruised brain tissue (known as contusions).
If brain damage is severe, doctors may also recommend starting rehabilitation treatments soon after the initial injury. While little can be done to reverse brain damage incurred by the initial traumatic event, many people with TBI do make progress with skilled therapy and individualized treatment programs.
A rehabilitation program for traumatic brain injury may include:
Speech and language therapy
Rehabilitation for TBI focuses on promoting an individual’s return to their highest level of independent function. Therapists and medical professionals will also consider factors like ongoing safety and quality of life when working with people recovering from traumatic brain injuries. Because all brain injuries are different, recommended TBI treatment plans will depend on the type and severity of a person’s injury, their overall health, and the degree of any resulting impairments.
A traumatic brain injury treatment plan may address:
Cognitive skills (including reasoning, attention, problem solving, and safety awareness)
Family and caregiver support and education
Because recovering from a traumatic brain injury is a long and involved process, an individual may progress through many levels of care with the goal of returning to their prior level of function and place of living if possible. This may start with acute care in a hospital setting and then progress to subacute rehabilitation, followed by rehabilitation in skilled nursing or other inpatient facilities. After that, individuals may return home and continue to receive in-home therapy services or attend day-treatment programs if warranted.
Many active, ongoing research efforts seek to better understand the causes, effects, and potential treatment options for traumatic brain injury. The National Institute of Neurological Disorders and Stroke (NINDS) is currently focused on preventing and mitigating the damage that occurs following a TBI-related event.
Through our Next Generation Research Grants, the American Brain Foundation has funded important research into traumatic brain injury. Holly Hinson, MD, MCR, FAAN, was awarded a Next Generation Research Grant in 2012 for research into a previously undefined syndrome now known as paroxysmal sympathetic hyperactivity or sympathetic storming. Dr. Hinson’s American Brain Foundation-funded research has already helped to classify and identify patients with traumatic brain injuries who are at increased risk for developing this syndrome.
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