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TBI Web page
Facts about Traumatic Brain Injury
Introduction
TBI is defined as any type of damage to brain tissue caused by an external mechanical force as evidenced by: loss of consciousness due to brain trauma, post traumatic amnesia, and skull fracture.The severity of TBI has been classified as mild, moderate, and severe. These levels are differentiated clinically. It is important to mention that The Brain Injury Association defines TBI as an "insult to the brain, not degenerative or congenital, that is caused by an external physical force". The classification must be made immediately after the injury.
TBI is an insult to the brain with wide verity of changes including intellectual, emotional, social, vocational, and physical changes. TBI impacts many different functions such as, coordinated movement, reasoning,remembering, and speaking.
Consequences of Traumatic Brain Injury
Aneurysm
Arachnoid/leptomenigeal cysts
Arteriovenous malformations (including carotid/cavernous sinus fistula)
Cerebrospinal fluid leak
Compressive neuropathies
Headache
Motor impairment (spasticity, weakness, ataxia)
Movement disorders
Neuroendocrine dysfunction
Seizures
Sensory dysfunction
Subdural hygroma
Ventricular enlargement (hydrocephalus)
The Etiology of TBI
Brain damage is typically caused in different ways:
Primary Damage or Focal damage is associated with direct impact at the site of injury. Focal damage which is common during motor vehicle accident might result in both coup and countercoup injuries.
Coup injuries happen at the direct site of impact, countercoup is the opposite site of injury.
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Diffuse damage or diffuse axonal injury happens during the stretching and shearing of brain cell axons from each other at the time of impact. This result in the disruption of neural impulses transmit ion.
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Secondary damage happens after the impact within few hours or a day. There are several factors causing the secondary damage including oxygen deprivation, infarction, hemorrhage, brain swelling, and increased intracranial pressure.
In addition to the brain damage, the direct force to the skull might fracture the skull, injure the scalp, block the ventricles and blood vessels, and result in contusions and hematomas. Several neurotransmitters have been implicated in the cascade pathophysiological events following TBI. Excitatory neurotransmitters, such as glutamate and acetylcholine (ACh), have received the most attention, yet alterations in dopamine (DA), serotonin, and gamma-amino butyric acid (GABA) function can also be anticipated. Hypoxia (reduction) or Anoxia (lack) of oxygen is another cause of brain injury. Anoxic deficits are usually related to cardiovascular/ respiratory dysfunction. The most common areas of brain involvement are hippocampus and basal ganglia.
Prevalence and Incidence of TBI
It is estimated incidence is 100 per 100,000 person per year. TBI typically result in life long disability and handicap. There are estimated 1 to 2 million patients with TBI are admitted in the U.S hospitals. It is the most common cause of death and disability for people under the age of 38. Young man between the ages of 15 and 24 are twice as likely as woman to sustain brain injury. 70 % result in mild injury, 20% in moderate to severe injury, and 10 % are fatal. TBI has staggering cost of $4 billion dollars a year in hospitalization and treatment expenses. There is an approximately 75 to 100 billion dollars per year in lost productivity for TBI patients. Rehabilitation appears to reduce these numbers.
Symptoms and signs of TBI
Coma is the most common sign of recent TBI.
Traumatic brain injuries can affect a person cognitively, physically and emotionally.
Cognitive
symptoms may include:
- short term memory loss and/or long term memory loss
- Retrograde Amnesia (memory loss for events immediately prior to injury)
- slowed ability to process information
- Problem with concentration (can attend to any stimulus for only a short time)
- Apraxia: the lack of ability to do certain skill movement despite normal muscle function,coordination, and sensation. Different types of Apraxia include:
- Ideomotor Apraxia
- Ideational Apraxia
- Oral Apraxia
- Constructional Apraxia
- Dressing Apraxia
- Perceptual processing deficit are common and can be seen in disorders such as:
- Form constancy (form perception): recognizing forms and objects as the same in various environment, position, and sizes.
- Topographical orientation: Determining the location of objects and settings and the route to the location.
- Figure ground perception: Differentiating between foreground and background forms and objects.
- Position in space: Determining the spatial relationship of figures and objects to self or other forms and objects.
- Special relations: Determining the position of objects relative to each other.
Physical
symptoms may include:
- seizures of all types
- muscle spasticity
- Visualdeficits include:
- Diplopia (double vision)
- Blurred vision
- visual field loss
- Decreased oculomotor skills
- impaired scanning abilities
- Cortical blindness (damage to occipital lobe)
- loss of smell or taste
- speech impairments such as slow or slurred speech
- Preservative speech
- headaches or migraines
- fatigue,increased need for sleep
- balance problems
- pain
Emotional
symptoms may include:
- a lack of initiating activities, or once started, difficulty in completing tasks without reminders
- increased anxiety
- depression and mood swings
- denial of deficits
- impulsive behavior
- more easily agitated
- egocentric behaviors- difficulty seeing how behaviors can affect others
- Change in personality include:
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Changes in personality may include:
Anger
Loss of temper
Irritability,
Frustration, and Aggression.
(Some of the aggressive acts may be verbal, physical, self-directed, and directed toward others).
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