traumatic brain injury

Traumatic brain injury: description

Traumatic craniocerebral injury causes damage to the skull and brain. The brain is one of the most sensitive organs of the human body. It is the seat of consciousness, receiving and processing not only sensory impressions, but also regulating many vital organ functions, such as breathing. If it comes from external violence – such as a fall or a blow to the head – to a combined injury of the skull bones and the brain, it is called a craniocerebral trauma.

Traumatic brain injury is a relatively common injury. In Germany, about 250,000 people a year are affected by such a head injury, mostly men. Doctors distinguish different degrees of severity and different forms of craniocerebral trauma. In about five percent of those affected traumatic brain injury is difficult – which leads to a part of the injured to a permanent need for care or even death. An example of a mild form of craniocerebral trauma is a concussion.

concussion

All important information about this mild form of craniocerebral trauma can be found in the concussion contribution.

Traumatic brain injury: symptoms

The symptoms of craniocerebral trauma depend very much on the extent of the injury. In general, the following symptoms can occur in traumatic brain injury:

• a headache
• dizziness
• Nausea, vomiting
• unconsciousness
• blurred vision
• disorientation
• Memory gaps (amnesia), v.a. based on the time around the accident
• coma

Traumatic brain injury can be divided into three severity levels:

• Slight cranial brain injury (grade I): If it comes to a loss of consciousness, this is limited in time to a maximum of 15 minutes. Normally, no neurological consequences occur.
• Moderate cranial brain injury (grade II): The unconsciousness can last for up to an hour. Late effects can occur, but are not very likely.
• Severe cranial brain injury (grade III): The unconsciousness persists for more than one hour, neurological sequelae are to be assumed.

To assess the severity of craniocerebral trauma, doctors also use the so-called Glasgow coma scale. Points are awarded for the following criteria:

• Opening the eyes: Does it happen spontaneously, first on speech, on a pain stimulus or not at all (for example in case of unconsciousness)?
• Body mechanics: Can the affected person move on request or is the mobility impaired?
• Verbal reactivity: Does the person in question act after the accident and answers questions in a meaningful way?

The better and more spontaneously the person affected, based on the respective criterion, reacts, the higher the number of points awarded. Conversely, the lower the score, the more serious the injury. Doctors use the Glasgow coma scale (GCS score), including the symptoms, to assign the brain trauma to a severity level.

The symptoms of craniocerebral injury also depend on the type of injury. The following types of head and brain injuries are known:

• Skull contusion: Headache or dizziness is possible, impaired consciousness or neurological symptoms do not occur. In a cranial bruise, the brain remains unhurt and also has no dysfunction.
• Concussion (Commotio cerebri): A concussion corresponds to grade I of the GCS score and is therefore one of the mild craniocerebral traumas. If it comes to a loss of consciousness, it can last from a few seconds to 15 minutes. If necessary, the person concerned can no longer remember the time during and after the accident (anterograde amnesia), possibly the memory gap also extends to the time before the accident (retrograde amnesia). The Commotio cerebri is accompanied by nausea and vomiting, dizziness and headache. In some cases, so-called nystagmus occurs – a rapid, repetitive horizontal movement of the eyeballs. More information about concussion is available here.
• Brain Bruise (Contusio cerebri): It comes to unconsciousness that can persist for more than an hour to several days. Emerging neurological symptoms depend on the injured brain region. These include epileptic seizures, paralysis, respiratory or circulatory disorders, and coma.
• Brain compression (Compressio cerebri): In this brain trauma, the brain is squeezed either from the outside or by increased pressure from the inside, such as a bleeding or swelling of the brain. Severe headaches, dizziness, nausea and other neurological disorders, even a deep unconsciousness are possible signs.
• Skullcap fracture (skull fracture): Under certain circumstances, a gap in the cranial bone palpable or denting is visible. Physicians distinguish open craniocerebral trauma in which the brain is partially exposed, from a covered or closed head injury (the skull is not opened).
• Skull base fracture (skull base fracture): Bruises around the eyes, bloody nose or ear secretions may indicate fracture of the skull base.

Traumatic brain injury: causes and risk factors

For its protection, the skull bone surrounds the brain. In the front area is the facial skull, consisting of the bony eye and nose cavities as well as the upper and lower jaw. Most of the brain is surrounded by the posterior skull. At the base of the skull, which encloses the brain from below, there is an opening as a passageway for the spinal cord. The brain and spinal cord together form the central nervous system (CNS).

In most cases, an injury to these structures, a traumatic brain injury, is the result of an accident. Frequent causes are falls during sports without a safety helmet, such as when cycling or skiing or at work. While a blow, fall or impact against the head is a blunt trauma, traumatic brain injury can also be caused by perforating injuries. This means that the skull bone is broken by high violence and / or a sharp object.

An estimated one third of traumatic brain injuries are accounted for by traffic accidents. In this case, about 30 percent of those affected on further injuries – doctors then speak of a polytrauma.

Traumatic brain injury: examinations and diagnosis

Often, the accident already indicates a possible traumatic brain injury, perhaps because the person has fallen on his head. Often, witnesses or rescue teams can provide the doctor with important information by describing the accident or information about the Duration of unconsciousness do.

If there is suspicion of a traumatic brain injury, the person affected must be hospitalized. Trauma surgeons, orthopedic surgeons and neurologists usually work hand in hand with the diagnosis. As part of a neurological examination, the doctor checks, among other things, whether the person concerned is responsive and oriented. At the same time he pays attention to whether external injuries point to a craniocerebral trauma. In unconscious patients, among other things, the pupil reaction to a light stimulus (also called light reaction or pupillary reflex) provides indications of the extent of the brain injury.

Using imaging techniques such as X-rays or computed tomography (CT), fractures of the skull and base of the skull can be easily recognized. Also, injuries to the brain such as bruises, bruises or bleeding are visible. If there are no obvious changes in the CT despite existing symptoms, this is usually followed by magnetic resonance imaging (MRI).

Traumatic brain injury: Treatment

The therapy for craniocerebral trauma depends primarily on the extent of the injury. Lighter forms, such as grade I traumatic brain injury (a so-called concussion), usually do not require comprehensive treatment. Here the doctor advises to a few days bed rest. In some cases, the patient stays in the hospital for 24 hours for observation. This is especially true in children. If symptoms of craniocerebral trauma increase during this time, episodes such as cerebral hemorrhage can be quickly detected and treated. Complaints such as headaches can be relieved by appropriate painkillers, for example acetaminophen. Nausea is helped by active ingredients such as metoclopramide.

If there is a more serious traumatic brain injury, a hospital stay is required in any case. If the patient is unconscious, the first treatment measures at the scene of the accident aim to secure the vital functions (such as circulation and breathing). The next treatment steps depend on the type of injury. An open traumatic brain injury, but also partially covered skull fractures and cerebral hemorrhages, usually need to be treated by surgery.

For further treatment of severe craniocerebral injuries, admission to a special clinic or facility for early rehabilitation makes sense. In addition to medical specialists, there is a specialized team of physiotherapists, occupational therapists and speech therapists available. Lost physical, mental and linguistic abilities should be trained and regained with their support as early as possible.

Traumatic brain injury: Follow

It is difficult to make a general statement about the prognosis for craniocerebral trauma, since any consequences depend on the extent of the injury. Mild craniocerebral injuries (grade I) usually have no consequences. In severe craniocerebral trauma, on the other hand, permanent restrictions and consequential damage can be expected. The consequences of craniocerebral injury also depend on the affected brain region. For example, a brain injury can result in motor disorders such as flaccid or spastic paralysis, but mental limitations are also possible. Overall, younger patients have a better prognosis than older ones. About 40 to 50 percent of sufferers with a serious traumatic brain injury die from the consequences.