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Traumatic Brain Injury

When an accident results in a traumatic brain injury, treatment often begins at one of Beaumont's emergency departments, which offer state-of-the-art imaging and advanced telemetry for fast, accurate diagnosis of traumatic brain injuries.

Research has shown that prompt, aggressive traumatic brain injury treatment is key to the best long-term outcomes. At Beaumont, our multidisciplinary team, including emergency staff, trauma surgeons, neurosurgeons and rehabilitation specialists, work together to begin immediate treatment. Planning for recovery begins within 24 to 48 hours of the patient's admission to ensure the best outcome.

Head injuries are one of the most common causes of disability and death. The injury can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone(s), or from internal bleeding and damage to the brain. 

A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the head. Head injuries are also commonly referred to as brain injury, or traumatic brain injury (TBI), depending on the extent of the head trauma.

What is a concussion?

A concussion is an injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event.

What is a contusion?

A contusion is a bruise to the brain. A contusion causes bleeding and swelling inside of the brain around the area where the head was struck.

What is a skull fracture?

A skull fracture is a break in the skull bone. There are four major types of skull fractures, including the following:

Linear Skull Fractures

This type accounts for almost 70 percent of skull fractures. In a linear fracture, there is a break in the bone, but it does not move the bone. These patients are usually observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. No interventions are usually necessary.

Depressed Skull Fractures

This type of fracture may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. Usually, this type of skull fracture requires surgical intervention to help correct the deformity.

Diastatic Skull Fractures (children)

These are fractures that occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse with the growth of the child. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants.

Basilar Skull Fracture

This is the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Victims with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These patients require close observation in the hospital.

What causes bruising and internal damage to the brain?

When there is a direct blow to the head, shaking of a child (as seen in many cases of child abuse), or a whiplash-type injury (as seen in motor vehicle accidents), the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countercoup. A bruise directly related to trauma, at the site of impact, is called a coup lesion (pronounced COO). As the brain jolts backwards, it can hit the skull on the opposite side and cause a bruise called a countercoup lesion. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain.

Symptoms of Traumatic Brain Injury

The following are the most common symptoms of a head injury. However, each person may experience symptoms differently. There may be varying degrees of symptoms associated with the severity of the head injury. The symptoms of a mild head injury may include:

  • mild head injury
    • raised, swollen area from a bump or a bruise
    • small, superficial (shallow) cut in the scalp
    • headache
    • sensitivity to noise and light
    • irritability
    • confusion
    • lightheadedness and/or dizziness
    • problems with balance
    • nausea
    • problems with memory and/or concentration
    • change in sleep patterns
    • blurred vision
    • "tired" eyes
    • ringing in the ears (tinnitus)
    • alteration in taste
    • fatigue/lethargy
  • moderate to severe head injury (that requires immediate medical attention)-symptoms may include any of the above plus: 
    • loss of consciousness
    • severe headache that does not go away
    • repeated nausea and vomiting
    • loss of short term memory, such as difficulty remembering the events that led right up to and through the traumatic event
    • slurred speech
    • difficulty with walking
    • weakness in one side or area of the body
    • sweating
    • pale in color
    • seizures or convulsions
    • behavior changes including irritable
    • blood or clear fluid draining from the ears or nose
    • one pupil (dark area in the center of the eye) looks larger than the other eye
    • deep cut or laceration in the scalp
    • open wound in the head
    • foreign object penetrating the head
    • coma (a state of unconsciousness from which a person cannot be awakened; responds only minimally, if at all, to stimuli; and exhibits no voluntary activities)
    • vegetative state (a condition of brain damage in which a person has lost his thinking abilities and awareness of hiss surroundings, but retains some basic functions such as breathing and blood circulation)
    • locked-in syndrome (a neurological condition in which a person is conscious and can think and reason, but cannot speak or move)

The symptoms of a head injury may resemble other problems or medical conditions. Always consult your physician for diagnosis.

Diagnosis of Traumatic Brain Injury

The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.

Diagnostic tests may include:

  • blood tests
  • x-ray
  • MRI
  • CT scan
  • electroencephalogram (EEG)

Traumatic Brain Injury Treatment

Specific traumatic brain injury treatment will be determined based on:

  • age, overall health, and medical history
  • extent of the head injury
  • type of head injury
  • tolerance for specific medications, procedures, or therapies
  • expectations for the course of the head injury
  • your opinion or preference

Depending on the severity of the injury, traumatic brain injury treatment may include:

  • ice
  • rest
  • topical antibiotic ointment and adhesive bandage
  • observation
  • immediate medical attention
  • stitches
  • hospitalization for observation
  • diagnostic tests
  • surgery

Treatment of traumatic brain injury is individualized depending on the extent of the condition and the presence of other injuries. If you have a brain injury, you may require monitoring for increased intracranial pressure (pressure inside the skull). Head injury may cause the brain to swell. Since the brain is covered by the skull, there is only a small amount of room for it to swell. This causes pressure inside the skull to increase, which can lead to brain damage.

How is ICP monitored?

Intracranial pressure is measured in two ways. One way is to place a small hollow tube (catheter) into the fluid-filled space in the brain (ventricle). Other times, a small hollow device (bolt) is placed through the skull into the space just between the skull and the brain. Both devices are inserted by the physician either in the intensive care unit or in the operating room. The ICP device is then attached to a monitor that gives a constant reading of the pressure inside the skull. If the pressure goes up, it can be treated right away. While the ICP device is in place you will be given medicine to stay comfortable. When the swelling has gone down and there is little chance of more swelling, the device will be removed.

Care often is initially handled in our neurosurgical intensive care areas, which feature state-of-the-art real-time intracranial pressure monitoring.