This is the first part of our three-part series about traumatic brain injury. Today we will be discussing the ‘basics’, including an introduction, the causes, symptoms and common complications experienced as a direct result of this type of brain injury. The second part of the series will be about diagnosing and treating brain injuries and the final part will be about recovery and outpatient services.
An introduction:
A traumatic brain injury usually results from some form of violent impact or blow to the head or body, however, there are cases where it can result from objects, such as a bullet or shattered piece of skull, penetrating the brain tissue. A traumatic brain injury can be more serious resulting in bruising, torn tissue, bleeding or physical damage to the brain, or it can be mild, where the brain cells are affected temporarily. It is never expected of the individual or their family (or friends or passerbys) to judge the severity of the injury. In most cases, you should always see or at least speak with your GP because even mild injuries to the brain cause serious damage that requires prompt attention and an accurate diagnosis. In cases where you are exceptionally worried, or notice any of the symptoms described below, you should contact 999 immediately or go to your local A&E.
Causes:
The degree of damage as a result of a traumatic injury can vary based on several factors, such as the force of impact or the nature of the injury. The most common events causing a traumatic brain injury include vehicle-related collisions, falls, violence, combat injuries or sports injuries. Throughout this blog post, we will be writing about the moderate-severe traumatic injuries, however our specialist consultant, Dr Martine Stoffels, assesses a variety in an outpatient setting.
Symptoms:
There are no clear cut-symptoms that an individual will experience or show after a traumatic brain injury. Additionally, people can experience, or even notice, symptoms days after the injury rather than straight after. With that being said, here are some of the ‘typical’ symptoms:
Physical symptoms:
- Loss of consciousness – can be from several minutes to several hours
- Inability to awaken from sleep
- Repeated vomiting
- Nausea
- Persistent headaches or a mild headache that worsens
- Pupil dilation – can be one or both pupils
- Seizures or convulsions
- Clear fluid draining from ears or nose
- Loss of coordination
- Weakness or numbness in fingers and toes
Cognitive symptoms & change in presentation
- Confusion
- Agitation or combativeness
- Exhibiting behaviours that are typically unusual for that person
- Slurred speech
- Disorder of consciousness, including a coma
Complications as a result of the brain injury:
This links in with symptoms, however, complications can occur immediately or very soon after the traumatic brain injury and their long-term impact is not always so predictable. Those who have been subjected to serious trauma can experience a greater number and more severe complications than those who have experienced milder trauma.
Physical complications:
- Cerebrospinal fluid build-up in the brain: This can be very serious and can cause increased pressure and swelling in the brain.
- Infections: Injuries as a result of objects penetrating the brain or fractures in the skull can tear the protective tissues that surround the brain allowing bacteria to enter the brain and cause infection. This infection, called meningitis, if left untreated can spread to the rest of the nervous system and cause severe damage.
- Vertigo: A condition characterised by dizziness.
- Frequent headaches: This is very common following the traumatic brain injury and can continue to occur for several months.
- Small or large blood vessel damage in the brain: This can be very severe and lead to a stroke, blood clot or other complications.
- Seizures: People who have never experienced seizures before may begin to as a direct result of the brain damage. These seizures may only occur in the early stages or persist for years or could be life-long.
- Cranial nerve damage (injury to the base of the skull): Potentially resulting in hearing loss, ringing in the ears, dizziness, loss of vision or double vision, swallowing problems, loss of taste/smell or altered taste/smell and paralysis of facial muscles.
Changes to the state of consciousness:
- Minimally conscious state: Some signs of self-awareness or environmental awareness.
- Vegetative state: The person is unaware of their surroundings but they may open their eyes, make sounds or respond to stimuli. This is usually a result of a brain injury that has caused more widespread damage.
- Coma: Unconscious, unaware or anything and unable to respond. This is usually a result of a brain injury that has caused more widespread damage.
- Brain death:This means that there is no measurable activity in the brain and brain stem and the person is declared by medical professionals as brain dead. This is considered irreversible and once the life support machine is turned off, breathing will stop and heart failure will eventually occur.
Cognitive problems:
- Cognition: Changes in memory, learning, reasoning, judgment, attention or concentration.
- Executive functioning:Difficulties with multi-tasking, organisation, beginning or completing tasks, planning, decision-making or problem-solving.
Behavioural & psychological changes:
- Behavioural: Verbal or physical outbursts, difficulties in social situations and with exhibiting self control and engaging in risky behaviours.
- Psychological: Depression. anxiety, mood swings, lack of empathy, anger, insomnia and irritability. Many of which are a result of the complications experienced as a result of the traumatic brain injury
Communication problems:
- Cognitive:Difficulty speaking, writing or understanding speech, inability to organise thoughts or follow a conversation.
- Social:Conversation troubles, such as difficulties reading cues and on-verbal signals, taking turns, starting and stopping conversations or managing changes in pitch, tone and emphasis to express emotions.