Traumatic brain injury - often referred to as "head injury" - is damage to brain tissues that results from physical jarring that occurs in such events as motor vehicle accidents, falls, violent blows to the head or sports accidents.
A head injury may be "closed" - from an object striking the head (or the head striking an object) without breaking the skull - or "open" - the skull is broken and an object penetrates into the brain. Either way, the potential exists for considerable damage to brain tissues due to swelling, bleeding and bruising.
It's estimated that while millions of people experience minor head injuries whose symptoms usually resolve on their own, more than a half-million are serious enough to require hospitalization.
According to the Brain Trauma Foundation, traumatic brain injury (TBI) is the leading cause of death and disability in the United States for persons between ages 1 and 44. Approximately 53,000 people die from TBI each year and 5.3 million Americans live with disabilities resulting from TBI. The leading causes of TBI are motor vehicle accidents, sports injuries and falls.
Types of Traumatic Brain Injuries
Common types of traumatic brain injuries include concussions (when the brain is jarred or shaken violently within the skull), subarachnoid hemorrhages (bleeding in the space between the brain and the thin tissues that cover the brain) and subdural hematoma (bleeding within the skull causes compression of brain tissue).
Concussions may or may not cause the victim to experience loss of consciousness, and the unconsciousness may last for a period ranging from a few seconds to a prolonged time - a coma. A neurological examination, including EEG testing and CT or MRI scanning may be required to determine the concussion's severity. Treatment often consists simply of rest, medications and watchful waiting.
However, injuries that involve bleeding within the brain require more aggressive treatment.
Subarachnoid hemorrhage involves bleeding in the space between the brain and the thin tissues that cover it - the subarachnoid space. Subarachnoid hemorrhage can result from medical causes, including ruptured brain aneurysms and arteriovenous malformations and the use of blood thinners, but injury-related subarachnoid hemorrhages are not uncommon. In younger age groups, they often result from motor vehicle accidents. Elderly patients are particularly vulnerable to subarachnoid hemorrhage from falls in which they may strike their heads.
Subdural hematomas can develop rapidly from serious head injuries or more slowly over time from even very minor injuries. "Acute" hematomas fill the brain with blood quickly, compressing brain tissue and presenting the prospect of brain damage and, perhaps, death. "Chronic" subdural hematomas may take days or even weeks for symptoms to become obvious. In either case, the tiny veins between the brain and the dura (the brain's outer covering) stretch and tear. Elderly patients, because their veins are already stretched due to brain shrinkage, are highly vulnerable to this phenomenon and are easily injured from even minor falls.
Because of the potential consequences of these problems, anyone who experiences a blow to the head, even a minor one, should be watched carefully and evaluated by a physician. Subdural hematoma is an emergency condition that requires prompt evaluation and intervention at the first sign of a problem.
Alaska Regional's emergency department specialists, neurologists and neurosurgeons work closely together to ensure quick and effective response to TBI cases.
Depending on the location and severity, injury to the brain can result in a range of symptoms, including headache, loss of consciousness, slurred speech, cognitive problems like confusion and agitation, nausea, weakness or numbness in the extremities and seizures.
A neurological examination, EEG testing and specialized ultrasound, CT or MRI scanning may be performed, depending on the suspected problems.
The immediate issue in rapid treatment of a head injury is to prevent further damage to the head or neck. Emergency specialists will ensure adequate blood and oxygen supply to the brain and minimize the effect of bleeding or inflammation. If a risk of convulsions is present, anti-seizure drugs may be administered. The patient may be placed in a medication-induced coma to reduce oxygen requirements in the brain.
Our neurosurgeons may perform procedures to create an opening in the skull to allow accumulated blood or other fluids to drain and relieve pressure on the brain, to remove clotted blood and to repair skull fractures.
Alaska Regional is home to the state's only dedicated interventional neurovascular laboratory, offering specialized treatment. Referred to as "brain surgery without the surgery," these procedures are typically used for treatment of stroke, aneurysms and other neurological conditions.
Patients with traumatic brain injury most likely will require a rehabilitation program to regain cognitive and motor skills. Our rehabilitation program, brings together the services of physical therapists, occupational therapists, speech pathologists and others, has a distinguished history of helping patients recover their living skills.
For More Information
Brain Trauma Foundation
Brain Injury Association of America, Inc.
National Institutes of Health U.S. National Library of Medicine