Neuropharmacology & Neurotherapeutics
Mar. 02, 2021
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A traumatic brain injury can be caused by a forceful bump, blow, or jolt to the head or body, or from an object that pierces the skull and enters the brain. Not all blows or jolts to the head result in a traumatic brain injury.
Some types of traumatic brain injury can cause temporary or short-term problems with normal brain function, including problems with how the person thinks, understands, moves, communicates, and acts. More serious traumatic brain injuries can lead to severe and permanent disability, and even death.
Some injuries are considered primary, meaning the damage is immediate. Other outcomes of traumatic brain injury can be secondary, meaning they can occur gradually over the course of hours, days, or appear weeks later. These secondary brain injuries are the result of reactive processes that occur after the initial head trauma.
There are two broad types of head injuries: Penetrating and non-penetrating.
Some accidents such as explosions, natural disasters, or other extreme events can cause both penetrating and non- penetrating traumatic brain injury in the same person.
Signs and symptoms. Seek immediate medical attention if you experience any of the following physical, cognitive/behavioral, or sensory symptoms, especially within the first 24 hours after a traumatic brain injury:
Headache, dizziness, confusion, and fatigue tend to start immediately after an injury but resolve over time. Emotional symptoms such as frustration and irritability tend to develop during recovery.
Traumatic brain injury in children. Children might be unable to let others know that they feel different following a blow to the head. A child with a traumatic brain injury may display the following signs or symptoms:
Effects on consciousness
A traumatic brain injury can cause problems with consciousness, awareness, alertness, and responsiveness. Generally, there are four abnormal states that can result from a severe traumatic brain injury:
How traumatic brain injury affects the brain. Traumatic brain injury-related damage can be confined to one area of the brain, known as a focal injury, or it can occur over a more widespread area, known as a diffuse injury. The type of injury also affects how the brain is damaged.
Primary effects on the brain include various types of bleeding and tearing forces that injure nerve fibers and cause inflammation, metabolic changes, and brain swelling.
Examples of secondary damage:
Who is more likely to get a traumatic brain injury?
Adults age 65 and older are at greatest risk for being hospitalized and dying from a traumatic brain injury, most likely from a fall. In every age group, serious traumatic brain injury rates are higher for men than for women. Men are more likely to be hospitalized and are nearly three times more likely to die from a traumatic brain injury than women.
The leading causes of traumatic brain injury include:
How is a traumatic brain injury diagnosed and treated?
Diagnosing traumatic brain injury. All traumatic brain injuries require immediate assessment by a professional who has experience evaluating head injuries. A neurological exam will judge motor and sensory skills and test hearing and speech, coordination and balance, mental status, and changes in mood or behavior, among other abilities. Screening tools for coaches and athletic trainers can identify the most concerning concussions for medical evaluation.
Initial assessments may rely on standardized instruments such as the Acute Concussion Evaluation (ACE) form from the Centers for Disease Control and Prevention (CDC) or the Sport Concussion Assessment Tool 2, which provide a systematic way to assess a person who has suffered a mild traumatic brain injury. Reviewers collect information about the characteristics of the injury, the presence of amnesia (loss of memory) and/or seizures, as well as the presence of physical, cognitive, emotional, and sleep-related symptoms. The ACE is also used to track symptom recovery over time. It also takes into account risk factors (including concussion, headache, and psychiatric history) that can impact how long it takes to recover from a traumatic brain injury.
Diagnostic imaging. When necessary, medical providers will use brain scans to evaluate the extent of the primary brain injuries and determine if surgery will be needed to help repair any damage to the brain. The need for imaging is based on a physical examination by a doctor and a person's symptoms.
Neuropsychological tests to gauge brain functioning are often used along with imaging in people who have suffered mild traumatic brain injury. Such tests involve performing specific cognitive tasks that help assess memory, concentration, information processing, executive functioning, reaction time, and problem solving.
The Glasgow Coma Scale is the most widely used tool for assessing the level of consciousness after traumatic brain injury. The standardized 15-point test measures a person's ability to open his or her eyes and respond to spoken questions or physical prompts for movement.
Many athletic organizations recommend establishing a baseline picture of an athlete's brain function at the beginning of each season, ideally before any head injuries occur. Baseline testing should begin as soon as a child begins a competitive sport. Brain function tests yield information about an individual's memory, attention, and ability to concentrate and solve problems. Brain function tests can be repeated at regular intervals (every one to two years) and also after a suspected concussion. The results may help healthcare providers identify any effects from an injury and allow them to make more informed decisions about whether a person is ready to return to their normal activities.
Treating traumatic brain injury. Many factors—including the size, severity, and location of the brain injury—influence how a traumatic brain injury is treated and how quickly a person might recover. One of the critical elements to a person's prognosis is the severity of the injury. Although brain injury often occurs at the moment of head impact, much of the damage related to severe traumatic brain injury develops from secondary injuries which happen days or weeks after the initial trauma. For this reason, people who receive immediate medical attention at a certified trauma center tend to have the best health outcomes.
Mild traumatic brain injury
Some people with mild traumatic brain injury such as concussion may not require treatment other than rest and over-the-counter pain relievers. Treatment should focus on symptom relief and “brain rest.” Monitoring by a healthcare practitioner is important to note any worsening of symptoms or new ones.
Children and teens who have a sports-related concussion should stop playing immediately and return to play only after being approved by a concussion injury specialist.
Preventing future concussions is critical. While most people recover fully from a first concussion within a few weeks, the rate of recovery from a second or third concussion is generally slower.
Even after symptoms resolve entirely, people should return to their daily activities gradually once they are given permission by a doctor. There is no clear timeline for a safe return to normal activities although there are guidelines such as those from the American Academy of Neurology and the American Medical Society for Sports Medicine to help determine when athletes can return to practice or competition. Further research is needed to better understand the effects of mild traumatic brain injury on the brain and to determine when it is safe to resume normal activities.
People with a mild traumatic brain injury should:
These symptoms may be related even if they occurred several weeks after the injury.
Medications to treat some of the symptoms of traumatic brain injury may include:
Severe traumatic brain injury
Immediate treatment for someone who has suffered a severe traumatic brain injury focuses on preventing death; stabilizing the person's spinal cord, heart, lung, and other vital organ functions; ensuring proper oxygen delivery and breathing; controlling blood pressure; and preventing further brain damage. Emergency care staff will monitor the flow of blood to the brain, brain temperature, pressure inside the skull, and the brain's oxygen supply.
Surgery may be needed to for emergency medical care and to treat secondary damage, including:
In-hospital strategies for managing people with severe traumatic brain injury aim to prevent conditions including:
People with traumatic brain injuries may need nutritional supplements to minimize the effects that vitamin, mineral, and other dietary deficiencies may cause over time. Some individuals may even require tube feeding to maintain the proper balance of nutrients.
After the acute care period of in-hospital treatment, people with severe traumatic brain injury are often transferred to a rehabilitation center where a multidisciplinary team of health care providers help with recovery.
The rehabilitation team includes neurologists, nurses, psychologists, nutritionists, as well as physical, occupational, vocational, speech, and respiratory therapists.
Therapy is aimed at improving the person's ability to handle activities of daily living and to address cognitive, physical, occupational, and emotional difficulties. Treatment may be needed on a short-term basis or throughout a person's life. Some therapy is provided through outpatient services.
Cognitive rehabilitation therapy (CRT) is a strategy aimed at helping individuals regain their normal brain function through an individualized training program. Using this strategy, people may also learn compensatory strategies for coping with persistent deficiencies involving memory, problem solving, and the thinking skills to get things done. CRT programs tend to be highly individualized and their success varies. A 2011 Institute of Medicine report concluded that cognitive rehabilitation interventions need to be developed and assessed more thoroughly.
Other factors that influence recovery include genes and age.
Genes—Genetics may play a role in how quickly and completely a person recovers from a traumatic brain injury. For example, researchers have found that apolipoprotein E ε4 (ApoE4) — a genetic variant associated with higher risks for Alzheimer's disease — is associated with worse health outcomes following a traumatic brain injury. Much work remains to be done to understand how genetic factors, as well as how specific types of head injuries, affect recovery. This research may lead to new treatment strategies and improved outcomes for people with traumatic brain injury.
Age—Studies suggest that age and the number of head injuries a person has suffered over his or her lifetime are two critical factors that impact recovery. For example, traumatic brain injury-related brain swelling in children can be very different from the same condition in adults, even when the primary injuries are similar. Brain swelling in newborns, young infants, and teenagers often occurs much more quickly than it does in older individuals. Evidence from very limited CTE studies suggest that younger people (ages 20 to 40) tend to have behavioral and mood changes associated with CTE, while those who are older (ages 50+) have more cognitive difficulties.
Compared with younger adults with the same traumatic brain injury severity, older adults are likely to have less complete recovery. Older people also have more medical issues and are often taking multiple medications that may complicate treatment (e.g., blood-thinning agents when there is a risk of bleeding into the head). Further research is needed to determine if and how treatment strategies may need to be adjusted based on a person's age.
Preventing traumatic brain injury. The best treatment for traumatic brain injury is prevention. Unlike most neurological disorders, head injuries can be prevented. According to the CDC, the following actions can help prevent traumatic brain injuries:
What are the latest updates on traumatic brain injuries?
The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and use that knowledge to reduce the burden of neurological disease. NINDS, a component of NIH, supports research across the full range of traumatic brain injuryseverity. Here is a list of efforts and developments.
Clinical research. Despite recent progress in understanding what happens in the brain following traumatic brain injury, more than 30 large clinical trials have failed to identify specific treatments that make a dependable and measurable difference in people with traumatic brain injury. A key challenge facing doctors and scientists is the fact that each person with a traumatic brain injury has a unique set of circumstances based on such multiple variables as the location and severity of the injury, the person's age and overall heath, and the time between the injury and the initiation of treatment. These factors, along with differences in care across treatment centers, highlight the importance of coordinating research efforts so that the results of potential new treatments can be confidently measured.
NINDS co-leads the Strategies to Innovate EmeRgENcy Care Clinical Trials (SIREN) network, with projects that include traumatic brain injury trials — one of which is looking at brain tissue oxygen monitoring to improve neurologic outcome in the most severely injured people with traumatic brain injury.
Harnessing the efforts of the many physicians and scientists working on developing better treatments for traumatic brain injury requires everyone to collect the same types of information from people, including details about injuries and treatment results. To lay the groundwork for these studies, NINDS started the Common Data Elements project. This effort brings the research community together to develop data collection standards.
Interagency and international research collaboration
NIH research projects on traumatic brain injury and other disorders can be found using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies. RePORTER also includes links to publications from these projects and other resources.
How can I or my loved one help improve care for people with a traumatic brain injury?
Consider participating in a clinical trial so clinicians and scientists can learn more about traumatic brain injury and related disorders. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.
All types of volunteers are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.
For information about participating in clinical research visit NIH Clinical Research Trials and You. Learn about clinical trials currently looking for people with traumatic brain injury at Clinicaltrials.gov.
People with a traumatic brain injury also can support traumatic brain injury research by designating the donation of brain tissue before they die. The study of human brain tissue is essential to increasing the understanding of how the nervous system functions.
The NIH NeuroBioBank is an effort to coordinate the network of brain banks it supports across the country to advance research through the collection and distribution of post-mortem brain tissue. Stakeholder groups include brain and tissue repositories, researchers, NIH program staff, information technology experts, disease advocacy groups, and most importantly individuals seeking information about opportunities to donate. It ensures protection of the privacy and wishes of donors.
Where can I find more information about traumatic brain injury?
Information may be available from the following resources:
Brain Injury Association of America
Phone: 703-761-0750 or 800-444-6443
Brain Injury Resource Center
Brain Trauma Foundation
Defense and Veterans Brain Injury Center
National Library of Medicine
Phone: 301-594-5983 or 888-346-3656
National Rehabilitation Information Center
Phone: 630-961-1400 or 800-844-6556
U.S. Centers for Disease Control and Prevention (CDC) - Heads Up to Concussion
Phone: 800-232-4636 or 888-232-6348
U.S. Centers for Disease Control and Prevention (CDC) - TBI & Concussion
Phone: 800-232-4636 or 888-232-6348
Content source: https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi Accessed July 17, 2023.
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