Traumatic brain injury

Traumatic brain injury (TBI), also known as the cranial injury occurs when external force such as a blow, jolt, or other head injury causes brain damage. Mild brain injury may cause temporary dysfunction of brain cells and more serious injury results in bruising, bleeding and physical damage to the brain. Half of these brain injuries lead to hospitalization of the patient. Survivors of TBI may have inability with certain aspects for a few days, or the disabilities may last for their whole life.


The cranial injury can be mild, moderate or severe depending on the extent of brain damage. The symptoms may not be apparent for some days or weeks following the injury.

In the case of a mild injury, the following symptoms may be seen:

  • Headache or neck pain

  • Ringing in the ears

  • Nausea

  • Dizziness

  • Tiredness

Moderate to severe injury may produce the below symptoms:

  • Nausea or repeated vomiting

  • A headache that worsens and does not go away

  • Slurring of speech

  • Dilated pupils

  • Inability to wake up from sleep

  • Convulsions or seizures

  • Weakness or numbness in the arms and legs


The causes of TBI include falls, accidents, sports injuries, and firearms. Firearm injuries are usually fatal. The other causes are:

  • A blast from an explosive device

  • A severe jolt (either rotational or spinning)

  • An object penetrating the skull

  • A severe blow

  • Gunshot wounds, domestic violence or child abuse

Risk factors

Every individual is at risk of having TBI but the risk is little high in children (aged around four years), young adults (aged between 15 and 24) and older adults (aged 75 years and above). Nearly half of the head injuries occur while driving motor vehicles.


TBI can lead to several complications, either immediately or little later after the injury. The complications are more in the case of severe injuries. Complications with TBI include:

  • Infections can occur due to the entry of the bacteria through the penetrating wounds

  • Blood vessel damage, which can lead to the formation of blood clots, stroke or other problems

  • Fluid buildup can occur in some cases and leads to an increased pressure and swelling in the brain

  • Nerve damage may occur if injury occurs to the base of the skull

  • Intellectual problems may arise if significant injury has occurred

  • Behavioral changes such as difficulty with self-control, and lack of awareness of abilities

  • Emotional disturbances like depression, anxiety, mood swings

  • Communication problems

  • Altered consciousness

  • Seizures

As it is an emergency situation, an immediate diagnosis needs to be done. Glasgow Coma Scale (GCS) is used to assess the severity of brain damage using a 15-point scoring. Higher the scores, severe is the damage. Imaging tests are performed to detect the exact locations.

Test type Purpose of the test

Computerized tomography (CT) scan

Creates detailed images of the brain using X-rays To visualize the presence of fractures, bleeding, bruising, clotting or swelling

Magnetic resonance imaging (MRI)

Creates detailed images of the brain using radio waves and magnets Usually, it is used after the person has got stabilized

Intracranial pressure monitoring

To measure the pressure inside the skull

Traumatic brain injury treatment depends on how severe the injury is.

Mild injury:

It does not require any treatment or may be relieved with painkillers. However, the patient should be monitored regularly to check for the worsening of symptoms.

Moderate to severe injuries:

Immediate medical attention is required for such cases. They are treated in the ICU (Intensive Care Unit) or emergency ward to minimize secondary damage to the brain. The following medications may be recommended:

Intravenous Diuretics– to remove excess fluid and reduce the pressure in the brain

Anti-seizure drugs– given during the first week of the injury to prevent further damage to the brain

Coma-inducing drugs– to reduce the oxygen demand of the brain if required

Surgery–more than half of the severely-injured patients require surgery to remove or repair hematomas or contusions, skull fractures, open a window in the skull to relieve pressure and to remove blood clots

In the case of severe injuries, rehabilitation may be required which includes care from the following specialists:

  • Physical therapist

  • Physiatrist

  • Occupational therapist

  • Recreational therapist

  • Neuropsychologist

  • Rehabilitation nurse

  • Speech and language therapist

  • Vocational counselor

You can prevent the brain injuries by taking the below measures:

  • Wearing seat belts while traveling

  • Avoiding the use of alcohol or drugs when you have to drive

  • Wearing helmets

  • Getting your eyes regularly checked up

  • Special care must be given to older adults to prevent the falls by:

    • Installing handrails in the bathroom

    • Improving lighting of the house

    • Keeping home and stairs clean

Also prevent head injuries in children by installing window guards, avoiding them to play on fire escapes or balconies.