Traumatic Brain Injuries (TBI)

 

Traumatic Brain Injuries (TBI): 

The injury can be penetrating, such as a gunshot wound, or a non-penetrating injury, such as being struck in the head in a car accident. Anyone can experience a TBI, although nearly 80% of them happen to males. TBIs are also more common among older people.

The severity of the head injury is decided by several different factors, such as loss of consciousness, certain neurological symptoms that happened at the time of the injury, loss of memory for the injury and time surrounding it, and abnormalities on head CT or brain MRI.

Diffuse axonal injury is the shearing (tearing) of the brain's long connecting nerve fibers (axons) that happen when the brain is injured as it shifts and rotates inside the bony skull. DAI usually causes coma and injury to many different parts of the brain. The changes in the brain are often microscopic and may not be clear on computed tomography (CT scan) or magnetic resonance imaging (MRI) scans. On microscopic examination the axons first appear dilated and then club shaped and finally as round balls known as retraction bulbs which shows transected axons. There will be increased concentration of Beta amyloid precursor protein and it can be proved by immunohistochemistry.

 

Types and grades of TBI

Mild concussion: 

Concussions are the most common type of TBI. It includes brief alterations of consciousness or loss of consciousness for less than 30 minutes. Concussion is a transient paralytic state due to head injury, which is of instantaneous onset, does not show any evidence of structural cerebral injury and is always followed by amnesia from actual moment of accident. Shear stresses are instrumental in causing neuronal damage. Con­cus­sion is followed by post-concussion state char­acterized by headache, unsteadiness, and anxiety. Retrograde amnesia is inevitably associated with concussion, and it may also be transient.

Moderate TBI: 

This type of head injury is associated with loss of consciousness for over 30 minutes but less than one day. Confusion can last for up to one week.

Severe TBI: individuals with this type of head injury lose consciousness for over one full day. These injuries are typically associated with changes on head CT or brain MRI.

Uncomplicated TBI:

Head CT/brain MRI are normal, regardless of mild, moderate, or severe grade.

Complicated TBI: 

Head CT or brain MRI shows changes, such as bleeding.

Closed: 

A closed TBI means an outside force causes a blow or jolt to the head that did not penetrate the skull.

Open: 

This injury occurs when a bullet, knife, or something else goes through the skull. If the object goes into the brain, it directly damages brain tissue.

Nontraumatic: 

Also known as a hypoxic/anoxic brain injury. They can result from strokes, seizures, and events like choking and near-fatal drowning.

 

 

Chronic traumatic encephalopathy (Dementia Pugilistica/fist fighter’s dementia/ boxer's madness/ punch drunk syndrome)

It is neurodegenerative disease linked to repeated trauma to the head. The encephalopathy symptoms can include behavioral problems, mood problems, and problems with thinking. Most cases have occurred in athletes involved in striking based combat sports, such as boxing.

Causes:

Falls account for almost half of emergency department visits.

Domestic violence, assaults, child abuse and shaken baby syndrome.

Gunshot wounds, including attempted suicides.

Motor vehicle accidents, sports, recreational work, and military injuries etc.

#traumatic brain injury #brain injury