Brain Injury (Traumatic Brain Injury): Specialists & Information

Traumatic brain injury is usually the result of an accident or a fall. 

In car accidents, for example, the head often strikes the steering wheel or windshield with full force. Cycling without a helmet also poses a significant risk. According to statistics, 95 percent of cyclists killed in accidents were not wearing helmets. Half of them died from a traumatic brain injury.

Various sports also carry the risk of head and brain injuries, such as ice hockey and American football.

Scientific studies have even found a link between the hard blows to the head that frequently occur in these sports and trauma-related diseases such as

• Alzheimer’s,
• dementia, or
• depression.

20 percent of all traumatic brain injuries result from falls during leisure activities, at home, or at work.

Violent crimes can also cause traumatic brain injury, for example, through blows or kicks to the head.

Other causes include epileptic seizures and fainting spells resulting from cardiac arrhythmias or alcohol and drug abuse.

Generally, a distinction can be made between direct and indirect injury. In the case of direct injury, the brain sustains immediate damage from an external force. If the meninges are also injured in the process, this constitutes an open traumatic brain injury. Indirect injuries, on the other hand, include fluid accumulation in the brain or bleeding resulting from the forceful impact.

The symptoms depend on the severity of the injury. According to the Glasgow Coma Scale (GCS), traumatic brain injury is classified into mild, moderate, and severe forms.

The classification into the three severity levels

• Grade 1: Concussion,
• Grade 2: Brain contusion, and
• Grade 3: cerebral contusion

is also commonly used.

A Grade I traumatic brain injury corresponds to a concussion (commotio cerebri). The brain injury is mild, non-penetrating, and temporary. Immediately after the accident or fall, patients lose consciousness for a few seconds to a maximum of ten minutes. Other typical symptoms include:

• nausea and vomiting,
• a memory gap covering the accident itself and a certain period of time immediately preceding the accident (retrograde amnesia).

Following a Grade I traumatic brain injury, a condition known as post-concussion syndrome may develop. This can involve symptoms such as

• nausea,
• apathy,
• headaches, or
• dizziness

may persist for several weeks.

A cerebral contusion, also known as a brain contusion, corresponds to a Grade II traumatic brain injury. The symptoms are similar to those of a Grade I injury, but the loss of consciousness usually lasts longer than ten minutes. Memory lapses are also more extensive and often cover a period of more than one day.

In addition, patients may suffer from neurological symptoms such as paralysis or speech difficulties.

Grade III, known as compressio cerebri or brain contusion, is the most severe form of traumatic brain injury. Patients remain unconscious for more than an hour, and the brain shows severe injuries.

Cerebral edema or bleeding in the brain can lead to a life-threatening increase in intracranial pressure. In cases of open traumatic brain injury, there is also direct contact with the outside environment, resulting in an increased risk of infection.

If the patient is responsive, the doctor will ask about

• the circumstances of the accident,
• possible symptoms, and
• the progression of symptoms.

If the patient is unconscious, witnesses and/or family members may be able to help.

Using clinical neurological examinations, the doctor then assesses

• the level of consciousness, including speech,
• the function of the cranial nerves,
• motor function, and
• sensation.

The trauma is then assessed using the Glasgow Coma Scale.

Depending on the severity, a computed tomography (CT) scan may be necessary for further diagnosis. This procedure can help identify

• tissue damage,
• increased intracranial pressure, and
• bleeding sites

in the brain. A CT scan involves a certain amount of radiation exposure. For this reason, a magnetic resonance imaging (MRI) scan may be performed instead for children under certain circumstances.

A mild traumatic brain injury can also be ruled out through a simple blood test. Following a TBI, there is a rapid increase in S-100 protein, a marker of brain damage.

Treatment varies depending on the severity of the injury.

A mild traumatic brain injury does not always require hospitalization. The doctor may prescribe pain medication to treat any headaches. Physical therapy, as well as cold and heat treatments, can also help alleviate symptoms.

In cases of moderate or severe trauma, however, emergency medical treatment begins at the scene of the accident. The patient’s blood pressure and breathing must be kept stable under all circumstances.

Severe cases require mechanical ventilation, as oxygen deprivation is one of the most common causes of permanent brain damage. If the trauma has caused space-occupying hemorrhages, surgical intervention may also be considered as part of treatment. Such bleeding can otherwise cause a massive increase in intracranial pressure.

Complications such as bleeding or comatose states can occur in the context of traumatic brain injury. Therefore, patients must be monitored in the hospital for an extended period of time.

Mild traumatic brain injuries usually heal without any lasting effects. In cases of severe trauma, however, up to 40 percent of patients die. Between 2 and 14 percent remain in a coma, and 10 to 30 percent are left with disabilities or impairments.

The general rule is: The sooner the injury is treated, the better the prognosis.