Head Injury

Every year, one million people go to hospital emergency rooms with brain injuries. They are treated and sent home, according to the Centers for Disease Control and Prevention (CDC). Another 230,000 people hospitalized each year for brain injury (Read about "The Brain") end up staying for a period of time in the hospital, but survive. Fifty thousand die. Of those that survive each year, 80 thousand people have injuries that result in long-term disabilities. The Brain Injury Association estimates that 5.3 million Americans are living with disabilities caused by brain injury. That's some 2 percent of the population.

Traumatic brain injury

Traumatic brain injury (TBI) is caused by some sort of external force that damages the brain (Read about "The Brain"), for example, a slamming of the head against the ground or the floor that basically bruises the brain. Many athletes suffer concussions when this happens. You do not have to lose consciousness to have a concussion. Although some athletes may minimize concussions, the American Academy of Neurology says this is a mistake; that there is no such thing as a "minor" concussion; and that repeated concussions can cause, not only permanent brain damage, they can even be fatal.

TBI can also be caused by a forceful hit, a car accident, a fall down some stairs that can result in a fractured skull or a bullet fired from a gun into the head. Many deaths of young children you hear about on the news are TBI's, the result of the child being hit or the child be thrown into or against something.

In an infant, brain injury can result from even less impact. Shaken Baby Syndrome is a term used to describe a range of symptoms resulting from violent shaking of an infant or small child. The National Center on Shaken Baby Syndrome (NCSBS) says the degree of brain damage depends on the amount and duration of the shaking. Signs and symptoms range from irritability and lethargy to seizures (Read about "Seizures"), coma and even death. Infants should never be shaken; Shaken Baby Syndrome is almost always the result of child abuse, according to NCSBS. (Read about "Violence & Abuse")

What happens when the brain is injured

When a TBI occurs, CDC says there are a number of things that can happen. When the skull is fractured, the bones actual hit the brain and can put pressure on it. Even if the skull isn't fractured, the brain will be bruised at the point of impact. Hematomas or blood clots can form, causing further damage and there can be intracranial bleeding. This may require surgery. (Read about "Neurosurgery") As with any injury, the brain can also swell, creating more pressure and causing more damage. (Read about "Hydrocephalus")

Symptoms of a TBI can be mild, moderate or severe, depending on the extent of the damage to the brain. According to the National Institute of Neurological Disorders and Stroke (NINDS), some symptoms are evident immediately, while others do not surface until several days or weeks after the injury. A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. The person may also feel dazed or not like himself for several days or weeks after the initial injury. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention or thinking.

NINDS says that a person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and/or increased confusion, restlessness or agitation. Small children with moderate to severe TBI may show some of these signs as well as signs specific to young children, such as persistent crying, inability to be consoled, and/or refusal to nurse or eat. NINDS says anyone with signs of moderate or severe TBI should receive medical attention as soon as possible.

Leading causes

CDC says males are at twice the risk of TBI as females, with three main causes of brain injury in the United States:

• Traffic accidents, which are the major cause for people 5 to 64 years of age (Read about "Teenage Health Risks" "Car Safety")
• Falls, which are the leading cause of brain injury among people 65 and older (Read about "Accidental Falls")
• Violence including firearms, which result in death the most often. Ninety-one percent of brain injuries from guns are fatal. Two thirds of the firearm deaths are suicidal in nature. (Read about "Suicide Prevention" "Violence and Abuse")

Deaths from traffic accidents are steadily going down. CDC says this is the result of better and earlier medical intervention, but unfortunately, the decrease is being offset by a steady rise in the number of deaths by firearms.

Impacts

TBI results in a number of consequences, both short- and long-term. A concussion suffered by a quarterback can leave him unable to remember where he is and unable to focus. It also leaves him more susceptible to another injury. The damage to the brain from injuries can be cumulative. The Brain Injury Association says that after one injury the risk of a second injury is three time greater; after the second injury, the risk of a third is eight times greater.

Long-term problems fall into several areas according to the CDC:

• Cognition - concentration, memory, judgment and mood (Read about "Dementia")
• Physical - strength, coordination and balance
• Sensation - tactile sensation and other senses such as vision, smell and taste
• Communication - ability to speak, write and understand (Read about "Aphasia")

TBI can also result in epilepsy. (Read about "Epilepsy") NINDS says some studies indicate a link between TBI and other conditions including Alzheimer's disease, Parkinson's disease and dementia. (Read about "Alzheimer's Disease" "Parkinson's Disease" "Dementia") Some people who suffer severe injuries end up in a coma that can last for significant periods of time.

When to seek help

Head injuries are not to be taken lightly. It is impossible to tell what damage the brain has suffered just from looking at someone. Symptoms can be delayed. The American Academy of Family Physicians says to get help if you notice any of the following symptoms:

• Any symptom that is getting worse, such as headaches, nausea or sleepiness (Read about "Headaches")
• Nausea that doesn't go away
• Changes in behavior, such as irritability or confusion
• Dilated pupils (pupils that are bigger than normal) or pupils of different sizes
• Trouble walking or speaking (Read about "Aphasia")
• Drainage of bloody or clear fluids from ears or nose
• Vomiting
• Seizures (Read about "Seizures")
• Weakness or numbness in the arms or legs
• Less serious head injury in a patient taking blood thinners or who has a bleeding disorder such as hemophilia (Read about "Bleeding Disorders")

If a person is knocked unconscious, they should be taken to a hospital as soon as possible. Delay could be life threatening. If you hit or anyone you know hits their head, even mildly, and experience symptoms such as headache, dizziness, problems concentrating or dizziness you should contact your doctor right away.

Rehabilitation is an important part of the recovery process for a TBI patient. (Read about "Rehabilitation") During the acute stage, moderately to severely injured patients may receive treatment and care in an intensive care unit of a hospital. Once stable, the patient may be transferred to a subacute unit of the medical center or to an independent rehabilitation hospital. At this point, there is a wide variety of options for rehabilitation, based on the patient's strengths and needs. Options include home-based rehabilitation, hospital outpatient rehabilitation, inpatient rehabilitation centers, comprehensive day programs at rehabilitation centers, supportive living programs, independent living centers, club-house programs, school-based programs for children and others. The overall goal of rehabilitation after a TBI is to improve the patient's ability to function at home and in society. Therapists help the patient adapt to disabilities or change the patient's living space, called environmental modification, to make everyday activities easier. Some patients may need medication for psychiatric and physical problems resulting from the TBI.

Prevention

Because head injuries can have such a dramatic impact, prevention is important. The Centers for Disease Control and Prevention (CDC) have some safety tips for reducing the risk of suffering a TBI:

• Whenever you or anyone in the family in driving in a car, use seat belts, child safety seats or booster seats correctly. (Read about "Car Safety")
• Use helmets and proper protective gear when playing sports (Read about "Safety Equipment")
• Keep firearms and bullets stored in a locked cabinet when not in use.
• Avoid falls by using handrails and other devices. (Read about "Accidental Falls")

Although head injuries can't always be avoided, you can take steps to reduce your risk. Ask your doctor for guidelines to help keep everyone in healthy shape.

Related Information:

    Aneurysms

    The Spine