Traumatic brain injury is a concept many of us have become more and more aware of recently as it has become news in amateur and professional sports and among victims of accidents. Professional football, soccer players, and boxers have developed chronic traumatic encephalopathy (CTE) as a result of repeated concussions during competition.
A traumatic brain injury occurs when a sudden trauma damages the brain. The damage can result when the head suddenly hits an object or when the head hits an object that may pierce the skull and enter the brain tissue. Traumatic brain injury can also result from violent shaking or other movements of the head, like that which may cause whiplash. The kind of traumatic brain injury familiar to most people is a concussion, and concussions account for the majority of traumatic brain injury cases every year.
Initial symptoms of traumatic brain injury can be classified as mild, moderate, or severe, depending on how effects of the injury present right away. Symptoms of a mild traumatic brain injury may include unconsciousness for a few seconds or minutes. Victims may have symptoms such as headache, confusion, lightheadedness, dizziness, blurred vision, tinnitus, fatigue, changes in sleep patterns, and behavioral changes.
A person with a moderate or severe traumatic brain injury will experience these same symptoms but may also have a persisting or increasing headache, nausea or vomiting, seizures, sleep problems, abnormal pupil dilations, slurred speech, loss of coordination or balance, numbness, and increased or increasing confusion and agitation.
Always keep in mind that just because a doctor states your injury is “mild” does not mean that it is not a serious injury. Even so-called mild TBIs can have lasting complications and symptoms.
Traumatic brain injuries can be—and usually are – emergencies. In the case of more severe injuries, the seriousness of the damage can worsen rapidly if there is no treatment provided. Therefore, every degree of brain injury needs an assessment quickly.
In assessing the extent of the injury in a potential traumatic brain injury case, there are questions that the medical staff should be asking:
After a head injury, a victim can experience any of several common symptoms, which include:
Many tests and tools help diagnose a traumatic brain injury.
The Abbreviated Injury Scale is a one-use tool that measures the threat of a brain injury to an individual’s life rather than assessing how severe the injury might be. It scores the injury from 1 (minor) to 6 (not survivable).
The JFK Scale assesses individuals who are barely conscious or in a vegetative state. It is especially helpful in measuring a return to consciousness. The Scale measures 23 different auditory, visual, motor, and automatic bodily functions.
One of the tools used in diagnosing traumatic brain injury is the Glasgow Coma Scale. The Scale is a 15-point test which doctors use to assess the initial severity of the damage by testing a person’s ability to follow directions and move their eyes and limbs. The ability to speak is also a factor. Specifically, doctors assign points to eye-opening responses, verbal responses, and motor responses. Each response has a maximum score, respectively, of four, five, and six points. A person scoring eight points or less is in a coma.
GCS points classify the head injury as:
The first test to be performed will likely be a computerized tomography (CT) scan. The scan uses multiple X-rays images to create a detailed image of the brain. A CT scan will show fractures and bleeding in the brain, blood clots, brain bruises, and brain tissue swelling.
A magnetic resonance image (MRI) used radio waves and magnets to create detailed images of the brain. Doctors might use this test when the victim’s condition is stable or shows no improvement. It also is used when the CT scan did not provide sufficient detail.
The GOAT measures post-traumatic amnesia. It has ten questions that assess temporal and spatial orientation. A maximum of ten points can be scored for each question, and a score of 78 indicates that the patient is emerging from post-traumatic amnesia. There is a separate version used for children.
Because traumatic brain injury can cause intracranial bleeding, which has harmful effects on the brain, monitoring intracranial pressure following a head injury is critical. Severe bleeding and heightened intracranial pressure can lead to strokes and brain aneurysms, severely increasing the damage from the traumatic brain injury.
Other tests include the Glasgow Outcome Scale and the Glasgow Outcome Scale—Extended. This test examines a patient’s level of disability. The Orientation Log tests for an individual’s orientation to time, place, and circumstance over an extended period to measure amnesia. Finally, the Westmead Post-Traumatic Amnesia Scale is a brief test measuring the length of post-traumatic amnesia in patients who have sustained a brain injury.
As you have seen, the diagnosis of traumatic brain injury is a complex process. Anyone suspecting they suffered any degree of traumatic brain injury should seek medical help promptly.