Traumatic brain injuries (TBI) refer to sudden injuries that cause brain damage. Such injury may arise following a blow or bump to the head. It can be grouped into 2 main types:
• Penetrating (open head injury)
• Non-penetrating (close head injury)
The severity of a TBI may vary from mild, moderate, to severe depending on the initial impact and subsequent brain damage. Depending on the severity, someone may recover within a few days. But in more severe cases, a TBI could lead to more serious symptoms and consequences like coma, and even death.
The symptoms of a TBI also varies depending on the severity and cause of the injury. Symptoms of the injury might occur directly after a blow or at the time of impact but also may appear much later for very trivial cases.
At times, people especially the elderly, don’t feel the effects of the injury for a few days after the blow. Common signs include:
In children and infants, some other signs include:
If you have experienced a blow to the head, especially accompanied by the symptoms mentioned above, it is always a good idea to visit a doctor. Even mild or moderate injuries may require medical attention and appropriate investigations so it is always best to see a doctor and get an accurate diagnosis.
As previously mentioned, a traumatic brain injury is classified into 2 main types:
Non-penetrating/ closed head injury may be caused by:
Penetrating injury may be caused by:
In cases of natural disasters such as an earthquake and other extreme events, it is also possible for someone to experience both penetrating and non-penetrating brain injury at the same time.
If left untreated, a traumatic brain injury can cause long-term and even permanent damage and disabilities. A traumatic brain injury also increases the risk of developing:
Other complications include:
While unlikely for mild to moderate traumatic brain injuries, severe cases can also increase the risks of developing early onset of Alzheimer’s disease, dementia, or movement disorders later in life.
When someone with a traumatic brain injury comes to the emergency room, a doctor will assess the patient’s condition, symptoms, and cause of injury.
To test a patient’s level of consciousness, I generally use the Glasgow Coma Score (GCS). This test assesses the patient’s ability to:
The total score from each category is added together to get the final GCS score:
Following that, other diagnostic imaging tests will be done. These may include:
The first line of investigation in the diagnosis of head injury, a CT scan is a non-invasive imaging test that helps identify skull and skull base fractures, bleeding in the brain, blood clots, and the overall extent of brain injury and underlying brain swelling. CT scans will be taken a few times throughout the recovery process to observe the progression of the injury and treatment.
A non-invasive test that utilises a magnetic field to visualise the soft tissues of the brain. The test may show subtle changes that are not seen in a CT scan, but as the test takes longer than a CT scan, it is usually only done after the patient has stabilised. It can give more detailed information about the brain after the injury and treatment.
A test to find information about the metabolism of the brain. Results of the MRS scan gives to exclude some complications and consequences related to the injury.
Above that, a cerebrospinal fluid (CSF) analysis may also be done. The CSF is collected through a procedure called a spinal tap. This involves inserting a thin, hollow needle between two vertebrae in the lower spine. The CSF analysis in traumatic brain injury is done to diagnose:
The treatment for a TBI will depend on the severity of the condition. For mild cases, the treatment may include symptomatic medications and subsequent clinical assessment with physiotherapy. Surgery is necessary for those with severe head injuries and bleeding or swelling inside the brain.
This treatment works to limit secondary damage immediately after the injury. This may include:
A TBI increases the risk of seizures which may cause additional brain damage. The use of this drug may be continued if seizures continue to happen.
The drug is used to put people to sleep, which is called temporary coma that will help the injured or swollen brain requires less oxygen to function and temporary rest.
To reduce the amount of fluid in tissues, thus reducing the pressure inside the brain.
In some cases, emergency surgery may be necessary to minimise additional damage to the brain. The surgery may be done to:
• Remove blood clots
• Repair skull fractures
• Stop bleeding in the brain
• Relieve pressure inside the skull (by draining CSF or creating a window in the skull)
Referred to as neurocritical care, the intensive care of patients with severe TBI may include:
• Intracranial pressure (ICP) monitor
• Brain oxygen monitor (Licox)
• Ventilator
• Feeding tube
• Seizures and EEG monitoring
• Sedation and pain
• Controlling brain pressure (hypertonic saline)
• Preventing seizures (levetiracetam or phenytoin)
• Preventing infection
This involves cutting a hole in the skull to remove a bone flap. The surgeon can then access the brain through the bone flap to remove the blood clot and repair the damaged brain membrane to prevent brain fluid leak.
Performed when the pressure inside the brain increases to a life-threatening level, the surgery involves removing a large section of bone to allow the brain to swell and expand. The removed bone flap will be stored in a freezer and 1 – 3 months after the swelling has resolved, the bone flap will be replaced (called cranioplasty).
Either a small hole (burr hole) or craniotomy (larger bone opening) is created through the skull to suction out the blood clot, stop the bleeding areas and relieve brain pressure.
Using a synthetic graft, a piece of the patient’s own tissue, or using a flap of tissue to repair affected damage or tear areas in the skull base to prevent CSF leak.
The diagnosis, treatment, and management of traumatic brain injuries differ greatly depending on the severity and cause of injury. While some cases might be mild and come with few symptoms, other cases might be much more severe and even light threatening.
If you experienced a blow to the head or any of the symptoms mentioned above, it is always a good measure to visit a doctor. An accurate diagnosis is the start to effective treatment and recovery.
Senior Consultant
Neuro & Spine Surgeon
MBBS, MSc Surgery, MRCS (Edin),
MMed. Sc (Gen Surg) (S'pore),
FRCS. Surgical Neurology (UK)
Dr Sein Lwin is an experienced Senior Consultant Neuro & Spine Surgeon and the Neurosurgical Director at the Advanced Brain and Spine Surgical Centre.
He is highly experienced in spine surgery and in minimally invasive approaches for spinal cord tumours and degenerative spine surgery. His specialised interests lie in endoscopic endonasal and open skull base surgery, pituitary tumours, vascular surgery, cranial nerve disorders and peripheral nerve conditions.
Many neurological conditions may require urgent attention. If you require immediate care, please contact us.
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We provide quality specialised care for neuro and spine conditions.
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