TRAUMATIC BRAIN INJURY: SYMPTOMS, CAUSES, CONSEQUENCES - NEUROPSYCHOLOGY - 2024

The traumatic brain injury (TBI) is an impact in the brain which occurs due to an external force that can lead to a decrease or alteration of the level of consciousness, which in turn causes a reduction in cognitive abilities and / or physical. In other words, it is any trauma that occurs to the head, whether superficially affecting the scalp or more seriously, affecting the skull and brain tissue.

Additionally, head trauma is one of the most common types of acquired brain damage. Specifically, in Spain and other industrialized countries, head injuries are the main cause of death in young adults.

Trauma can occur when the head is struck or struck suddenly and violently with an object or surface, or when an object pierces the cranial vault and enters nerve tissue.

Among the most common causes of head injuries are traffic accidents, falls, work accidents, or violent assaults. Signs and symptoms can range on a continuum from mild, moderate, or severe, depending on the extent of nerve damage and injury.

Therefore, the severity can range from a mild bump or contusion, to severe bruising in areas of the brain. Specifically, the most common injuries include: contusions, skull fractures or wounds to the scalp.

The consequences and treatment of head injuries vary greatly between different cases, depending on both the cause of the injury and the severity of the injury.

Characteristics of traumatic brain injury

A head injury or traumatic brain injury occurs when an external mechanical force causes damage and injury to the brain.

When an object violently hits the skull, a wide variety of medical conditions can appear: headache, confusion, lightheadedness, dizziness, blurred vision, fatigue, sleepiness, loss of consciousness, and other neurological and cognitive symptoms.

Due mainly to the structural configuration of the skull, head injuries will cause damage both in the affected areas, that is, those that receive the impact, as well as in others further away as a consequence of the blow-back effect.

Statistics

Head injuries represent an important public health problem due to their frequency in the general population and the consequences or consequences associated with them.

In the United States, each year approximately 230,000 people are hospitalized in emergency departments with severe traumatic brain injuries, while approximately another million people suffer minor or minor traumatic incidents.

Of the severe cases, more than 99,000 people will suffer significant sequelae, making it possible for them to remain in a state of chronic disability.

In addition, head injuries are two or three times more frequent in men than in women, while the age group most affected is the period between 15 and 24 years of age. However, after age 60 the risk also increases.

Symptoms and signs

The most characteristic signs and symptoms in head injuries are physical injuries to the head:

• Scalp.
• Skull.
• Brain tissue.

Damage to the brain or nerve tissue may occur at the moment of impact or develop later. Some of the physical injuries resulting from head trauma are:

• Superficial bleeding on the scalp.
• Hematoma on the surface of the scalp.
• Accumulation of blood in intracranial and intracerebral areas.
• Interruption of blood and oxygen flow in intracerabral areas.
• Development of blood clots.
• Cranial fracture with possible subsidence of bone regions.
• Meningeal layers fracture.
• Concussion or concussion: violent impact of the brain against the walls of the skull due to external trauma.
• Laceration and / or tear of brain tissue.
• Brain edema (accumulation of fluid in brain areas).
• Intracranial hypertension (increased blood pressure).
• Brain infection, hydrocephalus, seizures, etc.

In addition to these signs that are evident at the time of impact or trauma, there are head injuries that can have significant physical or neurological consequences.

Despite the fact that the clinical course is quite heterogeneous, a set of symptoms that appear frequently immediately after the traumatic event or a few days later have been identified.

Specifically, depending on the severity of the traumatic injury, we can distinguish various symptoms:

-Mild head injury

The signs and symptoms related to mild head injury may affect the physical, sensory and cognitive areas.

Physical symptoms

• Alteration of the level of consciousness: loss of consciousness, daze, confusion, spatial-temporal disorientation, etc.
• Headache.
• Fatigue, tiredness, or drowsiness.
• Dizziness, loss of balance
• Nausea, vomiting

Sensory symptoms

• Blurred or double vision
• Auditory ringing.
• Light and auditory sensitivity.
• Changes in the perception of tastes or smells.

Cognitive and neuropsychiatric symptoms

• Concentration and attention problems.
• Memory deficits
• Humor changes.
• Feeling anxious

-Moderate-severe head injury

In the case of signs and symptoms related to moderate-severe head injury, they will mainly affect the physical and / or cognitive area and may include all those related to mild head injury.

Physical symptoms

• Alteration of the level of consciousness: loss of consciousness, daze, confusion, spatial-temporal disorientation, etc.
• Convulsive episodes
• Pupillary dilation.
• Presence of liquid substance in powdery mildew and / or nose.
• Weakness and numbness of the upper and lower extremities.
• Recurring nausea and vomiting.

Cognitive and neuropsychiatric symptoms

• State of deep confusion.
• Agitation, aggressiveness.
• Abnormal behavior patterns.
• Language deficits.

Most frequent causes

There are numerous events or conditions that can cause traumatic damage to the brain.

The most common cause of head injury is traffic accidents, accounting for approximately 50% of cases. On the other hand, physical activity and some sports modalities can also cause accidents and are considered the second most prevalent cause.

In addition, routine accidents and falls are another common cause, especially in people over 65 years of age.

Other less frequent causes such as gunshot wounds or use of forceps during birth have also been identified.

Systematically, the most common causes of head injuries are:

• Traffic accidents: collisions between cars, motorcycles or bicycles is one of the most common causes of TCE.
• Sports accidents: in relation to sports, injuries caused by accidents in soccer, boxing, baseball, skateboarding, hockey, etc., can also be the cause of TBI.
• Falls: the most frequent TBI scenarios in the case of falls are tripping on building stairs or ladders, falls from the bed, slips during the shower or in the bathroom.
• Violence: Many of the injuries that involve TCE are caused by gunshot wound, domestic violence, or child neglect.

Types of head trauma

There are a wide variety of classification criteria for head injuries: clinical factors, severity, injury, etiology, etc.

According to the type of injury:

- Open TBI: when a cranial occurs and the brain tissue is exposed to the outside.

- Closed TBI: when there is no open injury and the damage occurs secondary to the traumatic event.

According to the location of the injury

- Encephalic: injuries directly affect brain tissue.

- Cranial: the lesions affect the interior of the skull, but do not involve other secondary ones at the cerebral level.

- Epicranial: the lesions affect the outside of the skull.

According to severity

-Mild TBI: the patient is fully oriented and maintains alertness. Significant and permanent neurological deficits do not usually appear. Despite this, at the time of the trauma there may be loss of consciousness and post-traumatic amnesia.

-Moderate TBI: in moderate TBI there is a decrease in awareness or alertness and signs of neurological deficits may appear.

-Severe TBI: in the most severe type there is a serious decrease in the level of consciousness. The patient presents totally isolated from the surrounding environment without presenting a response to verbal commands or environmental stimulation. Severe TBIs are associated with both significant brain damage and the development of significant neurological consequences.

Diagnosis

Head injuries are considered an emergency medical condition, which is why they are treated in medical services with special priority.

The first diagnostic action used in TBI has to do with determining the level of consciousness that the patient presents. The most widely used scale is the Glasgow Coma Scale (GCS), which offers us an initial index of severity. On the other hand, all the information related to the traumatic event is collected: how it occurred, where, initial symptoms, altered consciousness, etc.

In addition, some brain imaging techniques (magnetic resonance imaging or computed tomography) are used to locate the possible presence of brain lesions that require emergency medical intervention.

Consequences or possible complications

Normally, head injuries will cause different types of deficits: memory, attention, concentration, decision-making, problem-solving or even behavioral changes.

Complications and sequelae will fundamentally depend on the severity of the traumatic event. In mild type TBI, they may present minimal sequelae, however in the more serious, more severe ones may appear: chronic coma, physical disability, profound cognitive deficits, etc.

Treatments used

In any case, all those individuals who have just suffered a TBI should receive urgent medical attention.

The treatments used in the acute phase are aimed at controlling the immediate signs and symptoms of the traumatic event. It is essential to maintain vital signs and control possible bleeding and fractures.

In addition to the use of pharmacological measures, in some cases it may be necessary to address medical complications through surgical procedures to repair fractures, lacerations, bone inlays, development of clots, etc.

In the sub-acute phase, all therapeutic interventions will be oriented towards the recovery of the patient's level of consciousness and the affected cognitive and physical areas.

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