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Brain Injury:
Types, Symptoms, Risks and Treatment

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1.What is a brain injury?

Damage to the brain due to physical trauma is called a traumatic brain injury (TBI), and can have severe side effects. It can result from various causes such as motor accidents, sports injuries, a blow to the head from an assault etc. and the brain injury can range from being a mild concussion to being severely debilitating. The brain injury may be accompanied by fracture of the skull, and can be either blunt force trauma or a penetrating injury. The impact to the head can cause the brain to move back and forth inside the skull and hurt itself against the cranium, causing swelling and bleeding.

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2.Symptoms of brain injury

Brain injury assessment

Brain injury is not always apparent. The patient may feel disoriented and confused, or suffer from temporary loss of vision or consciousness. Swelling in brain, bleeding, or any tears in nerves will manifest as different symptoms for patients.

Some symptoms to watch out for in brain injury are:

- Dizziness

- Head spin

- Headaches

- Confusion and disorientation

- Spots in front of the eyes

- Ringing in the ears

- Nausea

More serious symptoms that require medical attention and immediate examination by a brain injury doctor include:

- Seizures

- Loss of motor function and / or balance

- Recurrent headaches which had not been present prior to impact

- Memory loss

- Abnormal eye movement and / or loss of vision

- Mood swings

Ignoring these symptoms can cause further complications and since the brain is a vital organ, particular care and immediate medical attention should be provided if a brain injury is suspected to avoid more serious concerns and even loss of life.

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3.Causes of brain injury

Traumatic brain injury may result from any impact to the head which causes subsequent brain damage. A fall, whiplash or a blow to the head can lead to brain injury if the brain sees extreme back and forth movement where it hits itself against the walls of the cranium, or if the impact results in brain swelling or bleeding.

Tears in the nerves fibres, tumours and strokes can cause different brain injury types that can cause the symptoms mentioned above, and it is best to consult with a specialist brain injury doctor if any of the indications are noticed. Of note is the fact that both open and closed head injuries can result in severe brain damage, and because the brain injury is not visible is not enough cause to ignore the impact, and even mild traumatic brain injury may result in brain nerves swelling and causing damage to the nervous system.

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4.Types of brain injury

Traumatic brain injury

Types of brain injuries can broadly be classified as Traumatic Brain Injury (TBI) or Acquired Brain Injury (ABI).

Traumatic Brain Injury: Sudden traumatic experiences such as accidents, blow to the head and gunshot wounds that cause forceful impact to the brain and subsequent brain damage are collectively referred to as traumatic brain injury. The trauma resulting from such an incident can cause swelling of the brain, nerve tears, brain stem injury (often resulting from incidents causing whiplash) and affect brain function. Traumatic brain injury can result from closed head wounds as well, and manifest through various symptoms in degrees of severity. A mild concussion will require only rest and over the counter medication;

however, a more severe brain injury symptom may be identified only a little later, after some time has passed. It is therefore very necessary to monitor symptoms of brain injury for 48-72 hours after an incident.

Acquired brain injury: An acquired brain injury results from events after birth and are not congenital in nature. They can result from trauma, or from substance abuse or tumours that disrupt blood and oxygen flow to the brain. Paediatric acquired brain injury can affect the mental and emotional well being of children and would need attention from psychologists, in addition to medical treatment from a neurologist.

Skull fracture: A type of traumatic brain injury, a skull fracture can also be a closed injury where the skin covering the skull is not broken, while an open injury is more obvious. This can be identified through symptoms such as bleeding from the nose or ears. Skull fractures can be open or closed, or depressed, where the injury can cause an indentation that reaches into the brain cavity. Severe traumatic brain injury results from a blow strong enough to go through the cranium and impact the brain, and a skull fracture is a typical manifestation of such a brain injury.

Concussion: A concussion is a type of brain injury that is considered mild by itself. It causes a state of confusion and disorientation, and in the immediate aftermath, symptoms such as loss of balance and blurred vision. Sports injuries or sharply banging the head into a hard object while walking may cause concussion. Recovery time for concussions may vary depending on the severity of the brain injury and can be accompanied by mild headaches, irritability, nausea and difficulty hearing and concentrating.

Haemorrhage: A brain haemorrhage can result from a traumatic brain injury causing a physical blow to the head, or from an acquired brain injury such as a tumour that presses on the nerve clusters, or a stroke. A haemorrhage is essentially bleeding, which is more often accompanied by brain swelling. Even a minor brain injury can have caused a haemorrhage with a small blood vessel rupturing in the brain sometime after the initial impact, causing loss of consciousness or a stroke. Bleeding irritates surrounding tissues and causes swelling of the brain, known as cerebral oedema. If unattended, the bleeding can result in the formation of a hematoma which can choke brain cells and cause cell death.

Oedema: Cerebral oedema is swelling of the brain due to trapped fluids. Swelling can happen in the surrounding brain region and put pressure on the nervous system in the brain and up to the spinal regions, causing brain injury resulting brain cell death. The pressure stemming from an oedema causes a lack of oxygen to the brain cells and the resulting cell death manifests as relatively severe brain injury symptoms such as vomiting, unconsciousness, vision loss, stroke or coma. It can occur suddenly or over a period of time, and if suspected and signs of brain injury are noted, a specialized brain injury doctor would need to be consulted with at the earliest to prevent coma or subsequent loss of life.

Hematoma: An intracranial hematoma is a collection of blood inside the skull region that occurs due to a ruptured blood vessel due to a head injury. This type of brain injury can be potentially life threatening and needs immediate medical attention. The pressure arising from the pooling of the blood within the cranium results in brain injury symptoms that may manifest immediately but can also happen days or weeks later as the pressure on the cells is gradually increased. Lethargy, seizures and unconsciousness are some symptoms of this type of brain injury.

Anoxic brain injury: The nomenclature results from the cause of this type of brain injury which is the complete absence of oxygen to brain cells. Anoxic brain injury may occur during the birthing process where the umbilical cord may wrap around a baby's neck, or if the baby is stuck in the birth canal. In adults, anoxic brain injury can result from being choked till oxygen supply is cut off to the brain for a sufficient amount of time for brain cells to die, stroke, shock, such as in the case of allergies, a blow to the windpipe in case of sports or other injuries or a drug overdose. Cardiac arrest, drowning or poisoning can also be causes of anoxic brain injury and result in brain tissue death due to lack of oxygen.

Hypoxic brain injury: A restriction of oxygen to brain cells causes a type of brain injury known as hypoxic brain injury. While a complete absence is termed anoxic brain injury, a hypoxic brain injury may have the same causes and effects but essentially still retains some amount brain oxygen supply through the blood.

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5.Complications that may arise

Brain injury treatment is often undertaken with urgency and can result in some complications. The symptoms of brain injury may be mitigated, about accompanying complications that may arise include the following:

Epilepsy: Seizures that are recurrent may occur as a side effect of the brain damage resulting from brain injury, depending on what part of the brain damage has occurred in, or more rarely, as a cause of traumatic brain injury treatment itself. Patients who have had a penetrating wound into the brain cavity will see a much higher percentage of epilepsy as a complication and recurrent symptoms of brain injury.

Nerve injuries: Brain injury can cause nerve damage which may not be cured completely. Depending on several factors, it is necessary to consider rehabilitation programs that cater to nerve damage.

Hydrocephalus: Fluid build up in the brain cavity can occur as a complication of a traumatic brain injury, and the resultant pressure can cause further damage to the nervous system. The discovery of hydrocephalus early can help reduce any further brain damage.

Blood clots: Clots can occur in patients of brain injury, and can travel from an extremity to the lung and can cause severe complications and in rare cases, even death, if not attended to with immediacy. Brain injury patients are kept under observation to mitigate the risks of blood clotting in any part of the body.

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6.Diagnosis

Brain injury diagnosis

Once the extent of a head injury is determined, or the formation of a tumour is found, assessment of the brain injury is done as quickly as possible to understand the possible side effects of any brain swelling treatment or brain injury medication. A test called the Glasgow Coma Score is performed to find out the consciousness and responsiveness of a patient of brain injury and diagnostic tests such as a CT scan or an MRI are conducted to determine if hematoma formation is visible and to diagnose the extent of the brain injury. The patient is constantly monitored to determine if there any swelling in the brain or to determine risks of hypoxic anoxic brain injury.

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7.Treatment

Once the extent and type of brain injury is determined, treatment for the brain injury may require surgery to remove any fluid build up causing pressure in the brain cavity, penetrating objects such as shards of bone from the brain cavity after trauma or to remove tumours or hematomas. Once emergency procedures are performed, brain injury rehabilitation is carried on through the use of medication, physiotherapy and psychology. Anticonvulsants are often prescribed to prevent seizures during the immediate brain injury recovery time since the patient is deemed to have reduced motor control and will not be able to prevent inadvertent movements such as pressure on the tongue or thrashing in case of an episode of seizure. Antidepressants and anti-anxiety medication, as well as stimulants may be prescribed, depending on the psychological assessment of the brain injury patient.

Patients may require therapy such as speech therapy during brain injury recovery to aid with slurred speech, a common side effect of traumatic brain injury or brain surgery from non traumatic brain injury. Occupational therapy, physical therapy and cognitive therapy may also be provided to aid rehabilitation of patients.

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8.Preventing brain injury

Brain injury is often an unfortunate result of any incident and if any brain injury symptoms are suspected, they should not be ignored. Simple measures such as avoiding driving under the influence of alcohol or drugs, wearing a seatbelt, wearing protective gear during sports events and childproofing a home can go a long way in preventing traumatic brain injury.

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9.Brain injury FAQs: All your concerns addressed

Treatment brain injury

Q.  How do I know if I or a loved one has a brain injury?

  1. If headaches, seizures or loss of vision become recurrent or persistent, immediately approach a doctor to consult regarding the possibilities of a brain injury. Traumatic brain injury can also manifest symptoms days, and even weeks later, and non traumatic brain injuries can also show symptoms over time which should never be ignored. Undergoing diagnostic tests will help determine if you suffer from brain Injury.

Q.  What measures should I take after surgery for brain injury?

  1. Depending on the severity of your brain injury, the doctor will prescribe medication, rest and long term rehabilitation and care measures, often including psychological assessment and counselling. If the guidelines provided by your medical care practitioner are followed with regards to lifestyle as well as medication, you should see certain improvement during the brain injury recovery time, and after.

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