Traumatic Brain Injury - Symptoms, Treatment, and Management

What Is the Definition of Traumatic Brain Injury (TBI)?

Traumatic brain injury occurs when an impactful force is either accelerated or decelerated and penetrates or hits hard on the head, leading to temporary or permanent brain damage. This will negatively impact the brain, leading to cognitive, social, competency, and economic impairments in the individual. It also affects the individual by making it difficult for them to do major activities. In untreated cases, it can lead to primary cerebral ischemia. Cerebral ischemia is when the brain does not get enough oxygen due to an interrupted blood supply. Hematoma due to traumatic brain injury is a serious complication. Hematoma is the collection of blood or pooling of the blood after an injury, and it can occur intracranially or anywhere inside the head.

What Is the Epidemiology of This Condition?

The reported incidence of traumatic brain injury (TBI) varies widely. At the global level, the incidence of mortality from traumatic brain injury (TBI) is 20 out of 1,00,000 in a year. In India, injuries are the leading cause of death, with 11 percent of total deaths, of which 78 percent are due to road accidents alone. Traumatic brain injury (TBI) patients account for about 40 percent of deaths in the United States.

Road traffic injuries occur more often in males than females. Men aged 5 to 44 are more likely to be among the majority of people suffering from traumatic brain injury (TBI). However, it can occur in any age group, even after that. Infants under five years old are also admitted due to head injuries. Child abuse causes 19 percent of head trauma cases. Around 10 to 20 percent of the affected individuals tend to be in prolonged disability or coma. Males represent more than 75 percent of the total traumatic brain injury (TBI) cases, and females account for more than 20 percent. Sports and recreational activities have also been associated with traumatic brain injury (TBI), accounting for about 21 percent of the total number of cases.

What Are the Symptoms of Traumatic Brain Injury?

• Unconsciousness of the patient or coma for a prolonged duration.

• Headache or feeling pressure in the head.

• Nausea and vomiting.

• Lack of coordination and blurred vision.

• Loss of balance.

• Dizziness and lightheadedness.

• Fatigue and lethargy.

• Lack of sleep.

• Confusion and irritability.

• Mood changes with depression.

• Lack of attention and poor memory.

What Is the Pathophysiology of Traumatic Brain Injury?

Direct tissue damage occurs immediately after a traumatic brain injury (TBI), followed by impaired cerebrospinal fluid regulation. This will lead to brain ischemia and the accumulation of lactic acid, a byproduct of anaerobic glycolysis (conversion of glucose into energy). This occurs because of the lack of oxygen to perform aerobic glycolysis. This accumulation will, in turn, cause edema or swelling and increased membrane permeability. Anaerobic metabolism does not meet energy requirements, so the stores of adenosine triphosphate (ATP) are depleted.

Following this, there is an increase in the release of excitatory neurotransmitters like norepinephrine and epinephrine, which will help in transmitting messages to and from the brain. This, in turn, will increase the levels of free fatty acids intracellularly. These all coordinate together, leading to membrane degradation and cell death.

Events After Traumatic Brain Injury (TBI):

1. Cerebral Blood Flow: The energy levels in the cerebrum are frequently reduced after traumatic brain injury (TBI). Due to this, the metabolic rate is reduced, which in turn affects the recovery. This, in turn, will lead to cerebral ischemia. Ischemia is a condition that occurs due to a lack of blood supply.

2. Cerebral Oxygenation: After traumatic brain injury (TBI), the balance between oxygen consumption and delivery is altered. This will result in brain tissue hypoxia (low oxygen level). Prolonged hypoxia can result in brain damage that is permanent. For this reason, brain tissue oxygenation is a technique introduced to meet oxygen demands.

3. Edema: Edema occurs after traumatic brain injury (TBI) due to mechanical or functional breakdown of the endothelial layer of the brain. The endothelium is the thin lining of blood vessels. The disintegration of the brain wall leads to the transfer of ions from the intracellular and extracellular compartments of the brain. This will result in fluid accumulation. This is also called vasogenic brain edema.

4. Inflammation: The immune system releases a wide range of immunological and inflammatory responses after a traumatic brain injury (TBI). These allow for the formation of immune cells that will infiltrate the injured tissue leading to inflammation.

5. Cerebral Vasospasm: In days 2 to 15 after traumatic brain injury (TBI), hypoperfusion (reduced blood flow) can lead to cerebral vasospasm. Due to the depolarization of the smooth muscle for a prolonged time. This occurs in one-third of traumatic brain injury (TBI) patients, indicating severe brain damage.

6. Necrosis Versus Apoptosis: Necrosis and apoptosis are two different kinds of cell death, while apoptosis refers to programmed cell death. Necrosis will occur after mechanical or ischemic tissue damage. Both mechanisms ultimately lead to brain damage.

What Are the Causes of Traumatic Brain Injury (TBI)?

Significant causes of traumatic brain injury (TBI) include falls, accidents, violence, sports, and construction injuries. Domestic violence, firearms, blast injuries, and explosions are other causes of traumatic brain injury (TBI). The impact's type, intensity, and duration will determine the severity of traumatic brain injury (TBI). In boxers, a chronic blow to the head will lead to punch-drunk syndrome, which is a form of brain injury.

How to Manage Traumatic Brain Injury (TBI)?

In cases of hematoma, surgery is required to remove that in an operating room. The patients are kept in ICU (intensive care unit) for observation after head trauma to notice and treat symptoms immediately. Delayed hematomas can occur, so it is mandatory to keep them in observation for a few days, even if the individual is less symptomatic at the time of admission. Routine follow-up of CT (computed tomography) is taken to analyze any changes in the brain. Post-injury rehabilitation is done to restore cognitive skills and impairments. Rehabilitation aims at restoring the cognitive, social, and understanding skills of the patients.

What Measures Can Be Taken to Prevent Traumatic Brain Injury (TBI)?

• Use of helmets during driving.

• Seat belts in automobiles with constraints for children.

• Avoid alcohol consumption before driving or sporting.

• Use of airbags in a car.

• Avoid distracted driving, such as using a cell phone while driving.

• Prevent falls at home by using handrails in bathrooms.

• Removing tripping hazards in the home when elders and children are at home.

• Use non-slippery mats at home.

• Safety gates usage in stairs.

• Playgrounds should have a shock-absorbing floor.

Conclusion:

Traumatic brain injury (TBI) is a condition that puts the individual at risk of morbidity and mortality. Understanding the pathophysiology of the injury can pave the way for accurate treatment. Monitoring the individual after traumatic brain injury (TBI) is essential to save from brain damage and other serious comorbidities. Prevention of falls and work hazards can be done by following certain precautionary measures.