Traumatic brain injury (TBI) is caused by an acute bump, blow or penetrating head injury that disrupts the normal brain function. If you ever “saw stars” because of head trauma, even without loss of consciousness, you may have experienced a mild concussion. The source of the experience is due to the physical bruising of the brain against the inside of the skull. Likely, you recovered without a problem.
Not every blow to the head results in TBI. Those that do may have a wide range of severity from mild, a brief change in consciousness or thought process, to severe, a prolonged period of unconsciousness or coma. The lasting effects of TBI are also quite variable, lasting from days or weeks in many cases to prolonged, causing lifelong consequences.
TBI contributes to one third of all trauma related deaths. Although three out of four TBIs are mild, there are 153 people who die every day from sustaining a severe TBI.
According to the CDC, the leading cause of TBI resulting in ED visits, hospitalization and death is from falls, accounting for almost half of all reported cases. The young, up to age 14, and the elderly, those over 65, are a greater risk than the general population, accounting for fifty-four and seventy-nine percent of all TBI cases respectively. The sources of TBI related trauma that result in death are the greatest in ages 65 and older from falls, 25 to 64 years old from intentional self-harm, 5 to 24 years old from motor vehicle accidents, and 0 to 4 years old from assault.
There are four categories of concussion symptoms. “Thinking and remembering” may present as difficulty with reasoning, feeling slow mentally, difficulty concentrating and difficulty remembering new information. “Physical effects” may include fuzzy or blurry vision and headache, nausea and vomiting, sensitivity to noise and light, dizziness, balance problems and feeling tired and no energy. “Sleep patterns” may include sleeping more than usual, less than usual or difficulty falling asleep. “Emotional and mood changes” may include irritability, sadness, emotional lability and nervousness or anxiety. Some symptoms may be noticed immediately, whereas others may not show up for weeks to months after the incident. If presenting symptoms are subtle, they may initially be overlooked by family, physicians and even the patient.
Those with a history of previous concussion are at greater risk to have another and may also find it takes longer to recover with repeated incidents. With the recent attention from the NFL, it is also known that repeated brain trauma may lead to Chronic Traumatic Encephalopathy (CTE), a disease with progressive development of any of the concussion symptoms previously discussed.
Those who experience milder forms of TBI should consult their health care provider as soon as possible. It is important to get adequate rest and limit activity. Protection from additional trauma is critical. Physical activity may need to be restricted for a period of time. Medications should be reviewed, and alcohol should be avoided. Severe TBI which may include loss of consciousness should be evaluated emergently. It should also be treated after the acute phase with a formal rehabilitation program to improve the likelihood of better long term outcomes. More information is available at this link: https://www.cdc.gov/traumaticbraininjury/.
Bradford Croft, DO
East Flagstaff Family Medicine