Traumatic brain injury (TBI) is a severe and debilitating loss that occurs when the brain is strike or jolted from outside forces. Greater than 30% of all injury and related deaths car accidents result in TBI. Millions of dollars are required to care for these victims over their lifetime.
Every day, 138 people in the United States die from injuries that include TBI. Those who survive a TBI can face effects lasting a few days to disabilities which may last the rest of their lives. According to the Center of Disease Control, In 2010, about 2.5 million emergency department visits, hospitalizations, or deaths were associated with TBI—either alone or in combination with other injuries—in the United States. Traumatic brain injuries contributed to the deaths of more than 50,000 people. Among all age groups, motor vehicle crashes were the third overall leading cause of traumatic brain injury at 14%, and the second leading cause of TBI-related deaths.
Effects of a traumatic brain injury can include impaired amnesia, loss of consciousness, depression, confusion, memory loss, headache, dizziness, blurry vision, nausea and vomiting, sensory loss, difficulty, speaking, insomnia, and personality changes. The severity of symptoms depends on the extent of the injury. Mild traumatic brain injuries generally present at the time of the injury and are usually temporary. Moderate traumatic brain injuries are similar to those of mild traumatic brain injury but more serious and last longer periods of time. Severe traumatic brain injuries globally affect the person on a permanent basis as a true loss of quality of life.
There are various types of brain injuries. A Diffuse Axonal Injury can be caused by shaking or strong rotation of the head, as with Shaken Baby Syndrome, or by rotational forces, such as with a car accident. Injury occurs because the unmoving brain lags behind the movement of the skull, causing brain structures to tear. There is extensive tearing of nerve tissue throughout the brain. This can cause brain chemicals to be released, causing additional injury. The tearing of the nerve tissue disrupts the brain’s regular communication and chemical processes. This disturbance in the brain can produce temporary or permanent widespread brain damage, coma, or death. A person with a diffuse axonal injury could present a variety of functional impairments depending on where the shearing (tears) occurred in the brain.
There are also concussions which is the most common type of traumatic brain injury. A concussion is caused when the brain receives trauma from an impact or a sudden momentum or movement change. The blood vessels in the brain may stretch and cranial nerves may be damaged. A person may or may not experience a brief loss of consciousness (not exceeding 20 minutes). A person may remain conscious, but feel “dazed” or “punch drunk”. Skull fracture, brain bleeding, or swelling may or may not be present. Therefore, concussion is sometimes defined by exclusion and is considered a complex neurobehavioral syndrome. It may take a few months to a few years for a concussion to heal. In addition, Coup-Contrecoup Injury describes contusions that are both at the site of the impact and on the complete opposite side of the brain. This occurs when the force impacting the head is not only great enough to cause a contusion at the site of impact, but also is able to move the brain and cause it to slam into the opposite side of the skull, which causes the additional contusion.
Further, there is closed head injuries when a person receives an impact to the head from an outside force, but the skull does not fracture or displace this condition is termed a "closed head injury". Again, separate terminology is added to describe the brain injury. For example, a person may have a closed head injury with a severe traumatic brain injury. With a closed head injury, when the brain swells, the brain has no place to expand. This can cause an increase in intracranial pressure, which is the pressure within the skull. If the brain swells and has no place to expand, this can cause brain tissues to compress, causing further injury. As the brain swells, it may expand through any available opening in the skull, including the eye sockets. When the brain expands through the eye sockets, it can compress and impair the functions of the eye nerves. For instance, if an eye nerve, Cranial Nerve III, is compressed, a person's pupil (the dark center part of the eye) will appear dilated (big). This is one reason why medical personal may monitor a person's pupil size and intracranial pressure.
Brain injury can be diagnosed through a number of studies:
3T Brain MRI with SWI and DTI sequencesSusceptibility weighted imaging (SWI) is a higher contrasting methodology where the magnitude and phase data are combined to produce an enhanced contrast magnitude image which is exquisitely sensitive to venous blood, hemorrhage and iron storage. Diffusion tensor imaging (DTI) provides information regarding the brain injury as it pertains to the microstructure by quantifying water diffusion over the brain’s surface. This provides a much clearer picture of the sustained traumatic brain injury.
Computed tomography (CT) is a diagnostic medical image that produces multiple pictures of the inside of the body through cross-sectional imaging. CT scanning provides more detailed information on head injuries, stroke, brain tumors and other brain diseases than regular radiographs (x-rays).CT scanning of the head is typically used to detect bleeding, brain injury and skull fractures.
A positron emission tomography (PET) scan is an imaging test that helps reveal how your tissues and organs are functioning using a radioactive drug to show this activity.The tracer collects in areas of your body that have higher levels of chemical activity, which often correspond to areas of disease. On a PET scan, these areas show up as bright spots revealing or evaluating several conditions, including some cancers, heart disease and brain disorders.
A single-photon emission computerized tomography (SPECT) scan lets your doctor analyze the function of your brain through nuclear imaging that creates a 3-D image. A SPECT scan produces images that show how your organs work. For instance, a SPECT scan can show what areas of your brain are more active or less active.
Functional magnetic resonance imaging (fMRI) measures the metabolic changes that occur within the brain. It may be used to examine the brain’s anatomy, determine which parts of the brain are handling critical functions, evaluate the effects of stroke or trauma that cannot be found with other imaging techniques.
Magnetic Resonance (MR) spectroscopy measures biochemical changes in the brain by comparing the chemical composition of normal brain tissue with abnormal tumor tissue. MR spectroscopy analyzes molecules such as hydrogen ions or protons to look for issues.
Glasgow Coma Score
The Glasgow Coma Scale (GCS) is a neurological scale which aims to give reliable and objective way of recording the conscious state of a person for initial as well as subsequent assessment. It is often used as baseline to assess the extent of a person’s traumatic brain injury.
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