May 30, 2017

Understanding Traumatic Brain Injuries

A traumatic brain injury, which is caused by trauma rather than disease, disrupts how the brain works. The injury may result from any bump, blow, or jolt to the head or penetrating injury of the skull by a foreign object, such as a knife or a bullet, Centers for Disease Control and Prevention data shows.

In a March 2010 report on TBI in the U.S., the CDC called the injury an important public health problem, often referred to as a “silent epidemic” since symptoms may not be readily apparent.

Symptoms may range widely from a “mild” to “moderate” to “severe.” Mild TBIs consists of a brief dazed period or loss of consciousness [LOC] for less than 30 minutes. A moderate TBI involves LOC for more than 30 minutes but no longer than six hours. In a severe TBI, LOC persists for more than six hours (also called a coma), and there may be long-term disability or death. The longer the period of unconsciousness extends the greater the likelihood of post-traumatic loss of memory or amnesia.

Statistics show that in the United States 5.3 million people live with TBI-related disability. Every year, at least 1.7 million TBIs occur either alone or along with injuries or illnesses. At least three TBIs occur every minute. TBIs cost Americans $76.5 billion in medical care, rehabilitation, and loss of work every year.

According to the CDC, leading causes of TBI include:

  • Falls
  • Motor vehicle traffic injury, which is also the leading cause of TBI-related death
  • Struck by/against events including colliding with a moving or stationary object
  • Assaults

Groups at highest risk of these incidents are:

  • Males overall
  • Youngest children and older adults as far as fall-related TBI.
  • Adolescents (ages 15-24 years) as far as motor vehicle-related TBIs.
  • Aged 75 or older as far as TBI-related hospitalization and being more likely to die from either TBI alone or along with other injuries or illnesses) than any other group.

According to the Mayo Clinic, severe complications may include seizures which may occur within the first week, increased pressure on the brain from cerebrospinal fluid building up in the cerebral ventricles, penetrating wounds that may lead to infection, blood vessel damage, and nerve damage.

However, the most common type of TBI, a concussion, often suffered in contact sports, such as football, is usually minor and not life threatening. Rarely, a concussion may be complicated by brain hemorrhage or bleeding on the brain or post-concussion syndrome where some symptoms last a longer period of time. So how do you know when a bump on the head is serious enough to go to the emergency room?

Emergency symptoms may include: loss of consciousness greater than 30 seconds or longer, a headache that worsens, seizures, persistent confusion, pupils that are unequal in size, weakness in arms or legs, repeated vomiting, slurred speech or problems walking. Even if emergency medical care is not required, watching closely for 24 to 48 hours and follow-up with a doctor within that time is recommended.

“If someone is vomiting, if there’s a seizure, a loss of consciousness or blood coming out of the head, you want to go straight to the ER,” Dr. Jam Ghajar, a neurosurgeon and president of the Brain Trauma Foundation told ABC Good Morning America in a 2009 report. The report followed the death of actress Natasha Richardson from a ski accident, which raised questions about head injuries. “If they’re feeling suddenly sleepy, go to the ER. Kids can also act squirmy, moody and slur their speech . . . Eye dilation is a sign someone is going into a coma. There’s a brain bleed that’s constricting those vessels.”

Even if children are walking around, the frontal lobe, which controls ability to focus and understand, may be affected, so Ghajar advises parents to: “Ask them questions, ask them to follow your finger.”

While most people with a concussion recover quickly and fully, once someone has a concussion he or she is more likely to experience another one.

Evidence is also growing through studies on a progressive brain disorder called chronic traumatic encephalopathy that the impact of multiple concussions may be cumulative, persistent and permanent.

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