Traumatic brain injury and its impact on patients’ lives

ACCIDENTAL OR sports-related traumatic brain injury (TBI) is the primary cause of death and disability among children and young adults in the United States. TBI is also a significant concern for those over 75 who are prone to falling. An estimated five million Americans live with the difficulties of a TBI-related, long-term disability.

Traumatic brain injury is usually caused by a blow or other traumatic injury to the head or body. The degree of damage can depend on several factors, including the nature of the injury and the severity of the impact, such as sports injuries, falls, vehicle-related collisions, violence, explosive blasts (in active-duty military personnel), and other combat injuries.

Mild traumatic brain injury may affect your brain cells temporarily. More serious traumatic brain injury can result in bruising, torn tissues, bleeding and other physical damage to the brain. These injuries can result in long-term complications or death.

According to Dr George Diaz, brain injury and vascular neurologist of Memorial Neuroscience Institute, a part of Memorial Healthcare System in South Florida, traumatic brain injury can have wide-ranging physical and psychological effects.

“Some signs or symptoms may appear immediately after the traumatic event, while others may appear days or weeks later,” Dr Diaz said.

In diagnosing brain injury, aside from the clinical examination, magnetic resonance imaging (MRI) and computerised tomography (CT) scans are very useful tests and can diagnose both acute and chronic brain injuries quickly and with accuracy.

“Many brain injuries result in seizures, and therefore an EEG (electroencephalogram) is also part of the standard workup,” Dr Diaz said.

The signs and symptoms of mild traumatic brain injury may include headache, nausea or vomiting, fatigue or drowsiness, problems with speech, dizziness or loss of balance. Sensory problems, such as blurred vision, ringing in the ears, a bad taste in the mouth or changes in the ability to smell are also signs of brain injury.

Other signs include sensitivity to light or sound; cognitive, behavioural or mental symptoms; loss of consciousness for a few seconds to a few minutes; no loss of consciousness, but a state of being dazed, confused or disoriented; memory or concentration problems; mood changes or mood swings; feeling depressed or anxious; difficulty sleeping; sleeping more than usual and moderate to severe traumatic brain injuries.

Moderate to severe traumatic brain injuries can include any of the signs and symptoms of mild injury, as well as these symptoms that may appear within the first hours to days after a head injury. These can include physical symptoms, loss of consciousness from several minutes to hours; persistent headache or headache that worsens; repeated vomiting or nausea; convulsions or seizures; dilation of one or both pupils of the eyes; clear fluids draining from the nose or ears, inability to awaken from sleep; weakness or numbness in fingers and toes; loss of coordination; cognitive or mental symptoms; profound confusion, agitation, combativeness or other unusual behaviour; slurred speech, coma and other disorders of consciousness.

“Treatment is based on the severity of the injury. Mild traumatic brain injuries usually require no treatment other than rest and over-the-counter pain relievers to treat a headache. Severe injuries may also have other injuries that need to be addressed,” Dr Diaz said.

“Additional treatments in the emergency room or intensive care unit of a hospital will focus on minimising secondary damage due to inflammation, bleeding or reduced oxygen supply to the brain. Medications are also important in the treatment of post-traumatic headaches, seizures and mood disorders, which are very common after significant head trauma,” Dr Diaz added.

Psychological and psychiatric therapy, he said, are also very important in the recovery of any brain-injured patient. Dr Diaz’s expertise has guided medical professionals, evaluated retired National Football League athletes, and has assisted organisations in developing effective strategies for managing TBI and maximising the quality of life of patients.

“Your healthcare provider should assess any type of head or brain injury, even if you do not think the impact was serious. Problems from TBIs can develop right away, but it’s possible to have a mild brain injury and not know it. It is helpful to know what signs to look for, so you can get the medical care you need,” Dr Diaz said.

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