Season 2 Episode 5
Traumatic Brain Injury
In this episode we will discuss a closed head traumatic brain injury.
Our guest is Jean Marie, a co-host of PodcastDX. Jean sustained a closed head mild TBI while on active duty in the U.S. Army.
Although there are several types of TBI, closed head injury is the most common type. Usually this is in the form of a concussion, or mild traumatic brain injury. A moderate TBI where the patient loses consciousness from 20 minutes to 6 hours is the type discussed in this episode. A severe TBI is defined as a patient unconscious for greater than 6 hours
Chiari Malformation: Sudden Onset of Symptoms After Trauma
Odontoid Process Pressing into spinal cord
Before Injury (normal) After Injury (TBI)
What is Traumatic Brain Injury?
Traumatic brain injury, often referred to as TBI, is most often an acute event similar to other injuries. That is where the similarity between traumatic brain injury and other injuries ends. One moment the person is normal and the next moment life has abruptly changed.
In most other aspects, a traumatic brain injury is very different. Since our brain defines who we are, the consequences of a brain injury can affect all aspects of our lives, including our personality. A brain injury is different from a broken limb or punctured lung. An injury in these areas limit the use of a specific part of your body, but your personality and mental abilities remain unchanged. Most often, these body structures heal and regain their previous function.
Brain injuries do not heal like other injuries. Recovery is a functional recovery, based on mechanisms that remain uncertain. No two brain injuries are alike and the consequence of two similar injuries may be very different. Symptoms may appear right away or may not be present for days or weeks after the injury.
One of the consequences of brain injury is that the person often does not realize that a brain injury has occurred.
What are the Effects of TBI?
Most people are unaware of the scope of TBI or its overwhelming nature. TBI is a common injury and may be missed initially when the medical team is focused on saving the individual’s life. Before medical knowledge and technology advanced to control breathing with respirators and decrease intracranial pressure, which is the pressure in the fluid surrounding the brain, the death rate from traumatic brain injuries was very high. Although the medical technology has advanced significantly, the effects of TBI are significant.
A brain injury can be classified as mild if loss of consciousness and/or confusion and disorientation is shorter than 30 minutes. While MRI and CAT scans are often normal, the individual has cognitive problems such as headache, difficulty thinking, memory problems, attention deficits, mood swings and frustration. These injuries are commonly overlooked. Even though this type of TBI is called “mild”, the effect on the family and the injured person can be devastating. Follow this link for more information on Mild TBI.
Severe brain injury is associated with loss of consciousness for more than 30 minutes and memory loss after the injury or penetrating skull injury longer than 24 hours. The deficits range from impairment of higher level cognitive functions to comatose states. Survivors may have limited function of arms or legs, abnormal speech or language, loss of thinking ability or emotional problems. The range of injuries and degree of recovery is very variable and varies on an individual basis. Follow this link for more information on Severe TBI.
The effects of TBI can be profound. Individuals with severe injuries can be left in long-term unresponsive states. For many people with severe TBI, long-term rehabilitation is often necessary to maximize function and independence. Even with mild TBI, the consequences to a person’s life can be dramatic. Change in brain function can have a dramatic impact on family, job, social and community interaction.
What are the Causes of TBI?
The number of people with Traumatic Brain Injury (TBI) is difficult to assess accurately but is much larger than most people would expect. According to the CDC (United States Centers for Disease Control and Prevention), there are approximately 1.5 million people in the U.S. who suffer from a traumatic brain injury each year. 50,000 people die from TBI each year and 85,000 people suffer long term disabilities. In the U.S., more than 5.3 million people live with disabilities caused by TBI. Patients admitted to a hospital for TBI are included in this count, while those treated in an emergency room or doctor’s office are not counted.
The causes of TBI are diverse. The top three causes are: car accident, firearms and falls. Firearm injuries are often fatal: 9 out of 10 people die from their injuries. Young adults and the elderly are the age groups at highest risk for TBI. Along with a traumatic brain injury, persons are also susceptible to spinal cord injuries which is another type of traumatic injury that can result out of vehicle crashes, firearms and falls. Prevention of TBI is the best approach since there is no cure.
Mechanisms of Injury
These mechanisms are the highest causes of brain injury: Open head Injury, Closed Head Injury, Deceleration Injuries, Chemical/Toxic, Hypoxia, Tumors, Infections and Stroke.
1. Open Head Injury
Results from bullet wounds, etc.
Largely focal damage
Penetration of the skull
Effects can be just as serious as closed brain injury
2. Closed Head Injury
Resulting from a slip and fall, motor vehicle crashes, etc.
Focal damage and diffuse damage to axons
Effects tend to be broad (diffuse)
No penetration to the skull
3. Deceleration Injuries (Diffuse Axonal Injury)
The skull is hard and inflexible while the brain is soft with the consistency of gelatin. The brain is encased inside the skull. During the movement of the skull through space (acceleration) and the rapid discontinuation of this action when the skull meets a stationary object (deceleration) causes the brain to move inside the skull. The brain moves at a different rate than the skull because it is soft. Different parts of the brain move at different speeds because of their relative lightness or heaviness. The differential movement of the skull and the brain when the head is struck results in direct brain injury, due to diffuse axonal shearing, contusion and brain swelling.
Diffuse axonal shearing: when the brain is slammed back and forth inside the skull it is alternately compressed and stretched because of the gelatinous consistency. The long, fragile axons of the neurons (single nerve cells in the brain and spinal cord) are also compressed and stretched. If the impact is strong enough, axons can be stretched until they are torn. This is called axonal shearing. When this happens, the neuron dies. After a severe brain injury, there is massive axonal shearing and neuron death.
4. Chemical / Toxic
Also known as metabolic disorders
This occurs when harmful chemicals damage the neurons
Chemicals and toxins can include insecticides, solvents, carbon monoxide poisoning, lead poisoning, etc.
5. Hypoxia (Lack of Oxygen)
If the blood flow is depleted of oxygen, then irreversible brain injury can occur from anoxia (no oxygen) or hypoxia (reduced oxygen)
It may take only a few minutes for this to occur
This condition may be caused by heart attacks, respiratory failure, drops in blood pressure and a low oxygen environment
This type of brain injury can result in severe cognitive and memory deficits
Tumors caused by cancer can grow on or over the brain
Tumors can cause brain injury by invading the spaces of the brain and causing direct damage
Damage can also result from pressure effects around an enlarged tumor
Surgical procedures to remove the tumor may also contribute to brain injury
The brain and surrounding membranes are very prone to infections if the special blood-brain protective system is breached
Viruses and bacteria can cause serious and life-threatening diseases of the brain (encephalitis) and meninges (meningitis)
If blood flow is blocked through a cerebral vascular accident (stroke), cell death in the area deprived of blood will result
If there is bleeding in or over the brain (hemorrhage or hematoma) because of a tear in an artery or vein, loss of blood flow and injury to the brain tissue by the blood will also result in brain damage.