Traumatic Brain Injury
What is it?
Traumatic brain injury is a head injury so severe that it damages the brain.
Who gets it?
It is common for children to suffer minor head injuries, especially those under the age of 1 and over the age of 15. However, males between the ages of 15 and 24 are more likely to receive head injuries severe enough to cause brain injury. About 70% of all accidental deaths, adults and children, are due to serious head injuries.
What causes it?
Traumatic brain injury occurs when an injury to the exterior of the head is strong enough to cause damage to the brain. The most common causes are motor vehicle and bicycle accidents, but can also include sports injuries, falls, or acts of violence, such as a gunshot wound or blow to the head. Head injuries that damage the brain can be one of two types. A closed head injury is a brain injury that does not penetrate the brain. The brain is injured when the impact causes the delicate brain tissues to hit the rough, jagged inner surface of the skull. A penetrating head injury is a brain injury that occurs when an object penetrates the skull or the skull is fractured. Bone fragments, foreign material, or dirt can get into the brain, damage brain tissue, and cause infection. However, a child can have a skull fracture without brain injury.
What are the symptoms?
When a head injury bruises or tears the brain tissue or blood vessels around the brain, the inside of the brain bleeds and swells. Swelling creates pressure inside the skull, called intracranial pressure, which can cut off the flow of oxygen to the brain. Symptoms of a traumatic head injury include loss of strength and sensation in any part of the body, confusion, problems with speech and vision, dizziness/loss of balance, severe headache, vomiting, clear fluid draining from the nose or mouth, extreme drowsiness, shock, and loss of consciousness. A concussion is a temporary loss of consciousness immediately after a head injury that may or may not have any other symptoms of brain damage. Symptoms that point to a skull fracture include clear fluid draining from the nose or mouth, bleeding from the ear or blood collecting behind the eardrum, bruising behind the ears or around the eyes, unequal pupil size, and swelling or depression of part of the head. An infant with a skull fracture may have a condition called a growing skull fracture, in which the membranes surrounding the brain stick out through the skull fracture and form a fluid-filled sac. This sac develops over a period of three to six weeks. Children with severe or penetrating head injuries may have seizures immediately after the injury. However, a child who has seizures soon after the injury is less likely to have long-term seizures than a child whose seizures start a week or more after the injury. Head injury can also cause bleeding between the layers of membranes surrounding the brain and in the brain itself, as well as blood clots. A blood clot located between the bones of the skull and the covering of the brain (the dura) is called an epidural hematoma. A blood clot between the dura and the brain tissue itself is called a subdural hematoma. Bleeding inside the brain is called intracerebral hemorrhaging. Bleeding causes symptoms including gradual loss of consciousness, rapid onset of seizures, and severe brain injury that usually results in long-term brain damage. Other long-term symptoms of traumatic brain injury depend upon the severity of the brain injury and include headache, seizures, problems with memory and learning, emotional and behavioral disorders, and sleep disturbances.
How is it diagnosed?
To diagnose a traumatic brain injury, the doctor will take into consideration how the injury occurred, as well as the symptoms. The doctor will perform a careful neurological evaluation, checking the level of consciousness, reflexes, the size of the pupils and their reaction to light, the ears, pulse, blood pressure, and breathing rate. With an instrument called an ophthalmoscope, the doctor can check the inside of the eyes and measure any increased pressure in the brain. A number of diagnostic techniques are used to evaluate the extent of a suspected brain injury. These include computed tomography (CT) scan, magnetic resonance imaging
(MRI), and electroencephalograms (EEG). A positron emission tomography (PET) scan might also be used to evaluate blood flow to the brain. An x-ray will show if blood is collecting in the sinuses, which is a sign of skull fracture. The Glasgow Coma Scale is commonly used to evaluate the degree of brain damage. The point scale ranges from 3 to 15, and is based upon the child’s ability to open his or her eyes, answer questions, and respond to stimulation by moving. A coma is a state of deep unconsciousness in which the person does not respond to stimuli and is unaware of his or her day-to-day physical needs. The higher the score on the Glasgow Coma Scale, the less severe the brain injury.
What is the treatment?
Children with traumatic brain injuries are always hospitalized and observed for changes in consciousness, breathing, blood pressure, and heart rate. The child is kept quiet in a darkened room, with the head of the bed raised to reduce pressure within the brain. Frequent neurological exams will show any changes in pressure in the skull. If fluid is collecting in the brain, a shunt may be inserted to drain the fluid and relieve pressure. If an x-ray or scan shows that bone fragments from a skull fracture are pressing on the brain, the child may need surgery to lift up the fragments and prevent further injury to the brain. Bleeding inside the brain and blood clots may also require surgery to drain the blood or remove the clot. Seizures are treated with anticonvulsant drugs. It may take many years to recover from a traumatic brain injury. Severe brain injuries require a long-term treatment plan, including physical and occupational rehabilitation, behavior management programs, assisted-living programs, and psychotherapy.
Self-care tips
You can help your child avoid traumatic brain injury by making sure he or she wears a protective helmet when riding a bicycle or motorcycle and playing sports, and wears a seatbelt when riding in a motor vehicle. Be a role model by also following these safety rules.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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