Traumatic Brain Injury Symptoms, Causes & Treatment Options

Traumatic brain injury (TBI) occurs when forces to the head lead to brain dysfunction. TBIs range in severity from mild concussions with minimal symptoms that may not require emergency medical attention to severe injuries that may require neurosurgery and can result in long-term consequences or death.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is A Traumatic Brain Injury?

Summary

Traumatic brain injury (TBI) results when a force to the head impacts brain function.

TBIs most commonly result from motor vehicle accidents, sports and recreational injuries, and falls. Forces to the head can lead to transient dysfunction of brain cells or a variety of other injuries to the brain, such as bleeding, contusions (bruises), or collections of blood (hematomas).

Symptoms of TBI vary from person to person and may include loss of consciousness, cognitive problems, headache, nausea, sensory changes, and insomnia. Most TBIs are mild TBIs (concussions) that result in a full recovery within days to weeks. However, a small subset of TBIs are more severe, and a small proportion of people who have mild TBIs develop chronic symptoms, such as headaches, dizziness, seizures, or mood problems.

Treatment of mild TBIs typically consists of rest for 24-48 hours, followed by a gradual return to normal activities, as tolerated. Medications may be beneficial for the relief of associated symptoms, but there are no specific treatments for TBIs. In severe cases, neurosurgical interventions may be recommended to reduce the level of pressure inside the skull and protect the brain from further damage. In some cases, neurorehabilitation by a team of multidisciplinary professionals may be recommended.

Recommended care

Traumatic Brain Injury Symptoms

Main symptoms

TBIs can result in a variety of physical and psychological symptoms, which vary in severity from person-to-person. Some symptoms may occur immediately after an injury, while the onset of other symptoms may be delayed for weeks after the injury.

Initial symptoms include:

  • Loss of consciousness following head injury. People often “blackout” for a few seconds or minutes.
  • Altered mental status such as confusion about time, place, or situation
  • Memory difficulty (amnesia) particularly regarding events immediately surrounding the injury
  • Slow reaction time

Most TBIs are mild TBIs (aka concussions). Most people with mild TBIs fully recover within one to two weeks of the event. Symptoms may include:

  • Headaches
  • Nausea or vomiting
  • Fatigue
  • Dizziness
  • Balance and coordination problems
  • Appetite changes
  • Insomnia
  • Impaired concentration
  • Emotional changes: including mood swings, anxiety, or feeling depressed
  • Sensory changes: changes in vision, hearing, or taste

Symptoms of moderate or severe TBI

Most head injuries result in only mild TBIs. However, more significant injuries can cause additional symptoms, in addition to those listed above. These include [1, 2]:

  • Decreased level of consciousness: limited responsiveness to stimuli for more than a few minutes
  • Progressively worsening headache
  • Severe nausea and vomiting
  • Weakness or numbness of single limbs or facial asymmetry
  • Dilated pupils
  • Seizures
  • Fluid dripping from the ears or nose: After a head injury, this could be spinal fluid leaking through a skull fracture.
  • Slow breathing
  • Slow heart rate
  • Slurred speech
  • Difficulty swallowing
  • Loss of bowel or bladder function

Complications of TBI

Although most people who experience brain injuries fully recover, up to 20% of people with even mild TBIs may develop chronic symptoms [3]. These may include ongoing problems with:

  • Headaches
  • Seizures may develop in some patients months or years after the initial injury [1].
  • Dizziness
  • Sensory changes in smell and taste, or less commonly hearing or vision [1]
  • Cognitive problems: People may develop difficulties with learning, memory, concentration, or decision-making. Emerging research also suggests that brain injuries increase the risk of neurodegenerative diseases (dementia) later in life.
  • Emotional problems such as depression, anxiety, mood swings, and emotional outbursts
  • Changes in behavior such as apathy, uncharacteristic risk-taking, or difficulty with self-control [1]

Traumatic Brain Injury Causes

TBIs are caused by events that result in excessive force on the brain. These forces can result in damage to the skull, blood vessels, or brain cells (neurons).

Common events leading to brain injury

TBI is a major cause of death and disability. Injuries often occur during common daily activities. Common events leading to brain injury include [1, 2]:

  • Transportation injuries including motor vehicle crashes, bike accidents, and collisions with pedestrians are the leading cause of TBIs in many parts of the world.
  • Sports and other recreational activities account for more than 20% of TBIs among children and adolescents.
  • Falls are a major cause of TBI among older adults and children.
  • Violence: Head injuries can occur from blows to the head, explosive devices, or gunshot.

How injury causes brain damage

TBIs can result in transient dysfunction of brain cells or long-term damage to brain tissue. Brain tissue can be damaged in a variety of ways that range in severity. These include:

  • Transient neuronal dysfunction: In mild TBIs (concussions), rotational forces are thought to disrupt the membranes surrounding brain cells (neurons) and temporarily suppress brain cell activity [4].
  • Brain contusions: Bruising of the brain may be associated with increased pressure inside the skull and require surgery.
  • Diffuse axonal injury: Strong forces can cause widespread tearing of brain cells. This is one of the main mechanisms of injury in “shaken baby syndrome” [1].
  • Hematomas: Collections of blood inside the skull may compress the brain and cause further injury.
  • Skull fractures

Traumatic Brain Injury Symptom Checker

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Treatment Options, Relief, and Prevention for a Traumatic Brain Injury

Treatment

A variety of treatments may be recommended depending on the severity of injury and particular symptoms. Most people have mild TBIs that can be safely managed with supportive measures and observation at home following evaluation by a medical professional.

  • Cognitive and physical rest: Avoidance of any activities (e.g., computer or phone use, exercise) that exacerbate symptoms is typically recommended for 24-48 hours following a mild TBI. After this initial period, activities can be reintroduced each day, starting with light routine activities and progressing to more strenuous activities, as long as symptoms are not exacerbated [4].
  • Medications as described below
  • Neurorehabilitation: A variety of rehabilitation exercises may be helpful, which can be offered by teams consisting of a combination of physicians, neuropsychologists, counselors, speech therapists, occupational therapists, physical therapists, and case managers [3].

Medications

Although no medications exist specifically for TBI, a variety of medications may be recommended to help relieve symptoms of TBI. These include:

  • Pain medications such as acetaminophen (Tylenol) or ibuprofen (Motrin) for headache relief
  • Anti-nausea medications such as ondansetron (Zofran) or metoclopramide (Reglan) for relief of nausea
  • Psychotropic medications: In some cases, your doctor may recommend medications to help treat mood, anxiety, and concentration problems associated with TBI.

Treatment of severe TBIs

Brain injury is classified into primary injury (occurs at time of trauma) and secondary injury, which are biologic changes that may occur due to inflammation or changes in blood flow. Many treatments for moderate and severe TBIs aim to reduce the impacts of secondary injury [5].

  • Initial stabilization: Severe injuries may require placement of a breathing tube to ensure adequate respiration and placement of a collar to stabilize the neck.
  • Surgery: Some patients with TBIs are recommended surgical interventions to drain large collections of blood (hematomas) or reduce high levels of intracranial pressure, in order to prevent further brain damage [5].

Prevention

Head injuries are common but often preventable. To reduce the risk of a TBI, consider the following actions [2]:

  • Car safety: Drive at safe speeds, obey traffic signals, be aware of other drivers or pedestrians, wear a seatbelt every time you drive or ride in a vehicle, and make sure your car is in adequate condition with functional airbags.
  • Alcohol and drug abuse: Never drive while intoxicated or accept a ride from someone who is under the influence.
  • Helmets: Always wear a helmet when riding a bicycle or playing contact sports.
  • Follow safety instructions at recreational facilities such as beaches, pools, or water parks.
  • Fall prevention: Make efforts to maximize home safety, especially if you live with young or elderly family members (especially those with vision or balance difficulties). Secure loose rugs or cords, put away toys, and consider install window guards.

When to Seek Further Consultation for a Traumatic Brain Injury

Following any brain injury

Anytime someone has a head injury that results in neurologic symptoms (including but not limited to loss of consciousness, confusion, memory changes, or headache), a medical evaluation and treatment recommendations should be pursued.

Severe symptoms

If anyone suffers a head injury that results in prolonged loss of consciousness, slurred speech, dilated pupils, or any of the other symptoms of severe head injuries listed above, 911 should be called for immediate medical attention.