Traumatic Brain Injury - Symptoms, Causes, Guidelines

Skull-brain trauma (where trauma means injury) is a collective term for head injuries which lead to a function disorder or injury to the brain. It is usually caused by external forces, for example, as a result of traffic or sports injuries. Physicians differ in the severity of the cerebral trauma (SHT). Here you will find all important information about the various symptoms, examinations and treatment options for traumatic brain injury.

Details About Skull Brain Trauma

In traumatic brain injury, there is an injury to the skull and brain. The brain is one of the most sensitive organs of the human body. It is the seat of consciousness, receives and processes not only sensory impressions but also regulates numerous vital organ functions, such as breathing. If there is a combined injury to the cranial bones and the brain by the external force, such as a fall or blow to the head, this is referred to as a traumatic brain injury.

The brain-brain trauma is a relatively common injury. Doctors differ in severity as well as different forms of traumatic brain injury. In about five per cent of those affected the traumatic brain injury is severe - which leads to a permanent need for long-term care or even death in a part of the injured. An example of a slight form of craniocerebral trauma is a brain vibration.

Skull-brain trauma: Symptoms

Symptoms of craniocerebral trauma depend on the extent of the injury. In general, the following symptoms may occur in traumatic brain injury:
  • A headache
  • Dizziness
  • Nausea, vomiting
  • Unconsciousness
  • Blurred vision
  • Disorientation
Memory gaps ( amnesia ), especially related to the time around the accident

A brain-brain trauma can be divided into three severity grades:

Slight cerebral trauma (grade I): If unconsciousness occurs, it is limited to a maximum of 15 minutes. Normally no neurological consequences occur.

Middle Grave Head Trauma (Grade II): Unconsciousness can last for up to one hour. Late sequences may occur but are not very likely.

Severe cranial brain trauma (grade III): The unconsciousness persists for more than an hour, neurological consequences are assumed.
In order to assess the severity of the traumatic brain injury, doctors also use the so-called Glasgow-Coma scale. Points are awarded for the following criteria:

Opening the eyes: Does it occur spontaneously, only on the occasion of the speech, on pain, or not at all (eg unconsciousness)?

Body motor: Can the person concerned be moved on demand or is mobility restricted?

Verbal responsiveness: Does the person concerned orient himself after the accident and answers questions sensibly?

The better and spontaneously the affected person reacts, based on the respective criterion, the higher the awarded score. Conversely, the lower the score, the more severe the injury. Doctors use the Glasgow Coma Scale (GCS score), taking into account the symptoms to correlate brain trauma with severity.

What symptoms occur through a traumatic brain injury also depends on the nature of the injury. The following forms of head and brain injuries are known:

Headache: Headache or dizziness are possible, consciousness disturbances or neurological symptoms do not occur. In the case of a skull bruise, the brain remains uninjured and does not show any functional impairment.

Brain Commotion: A brain shake corresponds to the grade I of the GCS score, and is thus one of the slight traumatic brain trauma. If it comes to unconsciousness, it can be drawn from a few seconds to 15 minutes. If necessary, the person concerned can no longer remember the time (during or after the accident) (anterograde amnesia); the memory gap may also extend to the time before the accident (retrograde amnesia). Commotio cerebral is accompanied by nausea and vomiting, dizziness and headache. In some cases, a so-called nystagmus occurs - a rapid, repetitive horizontal movement of the eyeballs. You will find further information on brain vibration here.

Brain Contusion: This leads to unconsciousness, which can persist for more than an hour to several days. Occurring neurological symptoms depend on the injured brain region. These include epileptic seizures, paralysis, respiratory or circulatory disorders and coma.

Brain Compression: In this brain trauma, the brain is squeezed either from the outside or by increased pressure from within, for example, by a hemorrhage or swelling of the brain. Severe headaches, dizziness, nausea and other neurological disorders, even a deep unconsciousness are possible signs.

Skull fracture (skull fracture): Under certain circumstances, a gap in the cranial bone can be palpated or a sinus can be seen. Physicians distinguish an open cerebrospinal trauma, in which the brain is partly free, from a covered or closed head injury (the skull is not opened).

Cranial base fracture (cranial base fracture): bruises in the area around the eyes, bloody secretions from the nose or ears can indicate a fracture of the cranial base.

Skull-brain trauma: Causes and Risk factors

For protection, the skull bone surrounds the brain. In the front area is the facial skull, consisting of the bony eye and nasal cavities as well as the upper and lower jaw. Most of the brain is surrounded by the posterior brain skull. At the base of the skull, which surrounds the brain from below, there is an opening for the spinal cord. Brain and spinal cord together form the central nervous system (CNS).

In most cases, a violation of these structures, ie a traumatic brain injury, is the result of an accident. Common causes are falls during sports without a protective helmet, such as cycling or skiing or even at work. While a stroke, fall or impact against the head is caused by dull forces, a traumatic brain injury can also be caused by perforating injuries. This means that the cranial bone is perforated by high force and/or a pointed object.

It is estimated that one-third of the cranial brain injuries are accounted for by traffic accidents. Approximately 30 percent of sufferers report further injuries - medical experts also speak of a polytrauma.

Skull-brain trauma: Diagnosis

Often, the accident already indicates a possible traumatic brain injury, for example, because the person concerned has fallen to the head. Often witnesses or rescue workers can also provide the doctor with important information by describing the accident or giving information about the duration of unconsciousness.

If there is a suspicion of a traumatic brain injury, the person concerned must be admitted to a hospital. Here accident surgeons, orthopedists and neurologists usually work hand in hand during diagnosis. In the context of a neurological examination, the physician checks, among other things, whether the person concerned is approachable and oriented. At the same time, he makes sure whether external injuries indicate a traumatic brain injury. In unconscious patients, the pupillary response to a light stimulus (also called a light reaction or a pupillary reflex) provides indications of the extent of the brain injury.

Using imaging techniques such as an X-ray examination or computed tomography (CT), fractures of the cranial and cranial nerves can be clearly identified. Also injuries to the brain like bruises, bruises or bleeding are visible. If there are no obvious changes in CT despite existing symptoms, magnetic resonance tomography (MRI) usually follows.

Skull-brain trauma: Treatment

The therapy for a traumatic brain injury depends primarily on the extent of the injury. Lighter forms, such as a brain-brain trauma grade I (a so-called brain chirp), do not normally require comprehensive treatment. Here the doctor advises to a few days bed rest. In some cases, the patient stays in the hospital for 24 hours. This is particularly true in children. If symptoms of traumatic brain injury occur during this period, consequences such as cerebral hemorrhage can be quickly detected and treated. Complaints such as a headache can be alleviated by appropriate painkillers, for example, paracetamol. Against nausea, active ingredients such as metoclopramide help.

If a more severe traumatic brain injury is present, a hospital stay is required in any case. If the patient is unconscious, the first treatment measures already aim at securing the vital functions (such as circulation and breathing) at the scene of the accident. The next treatment steps depend on the type of injury. An open craniocerebral trauma, partly but also covered skull fractures and cerebral hemorrhages, must usually be supplied by surgery.

For the further treatment of severe injuries to the brain, a recording in a special clinic or a facility for early rehabilitation is useful. In addition to specialists, there is a specialized team of physiotherapists, and speech therapists. Lost physical, mental and linguistic abilities are to be trained and recovered as soon as possible with their support.

Skull-brain trauma: Consequences

It is difficult to make a general statement about the prognosis in a traumatic brain injury because possible consequences depend on the extent of the injury. Light head injury (grade I) usually does not have any consequences. In the case of severe traumatic brain injury, on the other hand, permanent limitations and consequential damage are to be expected. The effects of a brain brain injury also depend on the affected brain region. Thus motor disorders such as sagging or spastic paralysis can result from a brain injury, but mental limitations are also possible. Overall, younger patients have a better prognosis than older ones. About 40 to 50 percent of those affected with severe traumatic brain injury are dying.

Effects and possible consequences of traumatic brain injury

Like the many organs of the human body, the cerebrum is paired: it consists of two halves, the hemispheres connected by the so-called beam. The brain works asymmetrically, ie the control of the right side of the body is largely a matter of the left hemisphere and vice versa. Each of the two hemispheres is responsible for certain activities. This is referred to as a lateralization of the functions. However, some functions are controlled by both brain halves.

In the case of the most strongly lateralized function, the language, the ability to understand the two hemispheres is in principle present, but in a large part of the human body, the left hemisphere assumes this task. In the case of musicality, the reverse is true: the right hemisphere is usually "more musical" than the left hemisphere. A part of the patients, who were injured in the speech center on the left side, astonishedly recovered speech after some time. Obviously, the right hemisphere had assumed the task. Even in the case of small children with incomplete language development, a transfer of speech functions to the uninjured hemisphere can be observed. 

This suggests that each function is applied in both hemispheres, But the extent of the abilities in these functions is very different in the cerebral hemispheres. In general, the left hemisphere processes information more analytically, whereas the right-hand side is more synthetic, holistic. For central tasks such as the control of cardiac activity and respiration, as well as the digestive organs, the root or cerebellum is responsible.

If the brain is damaged by an accident, it depends on which regions are affected. Depending on the degree and place of the injury, malfunctions occur according to the jurisdiction of these injuries: For example, persons with a left hemisphere injury are found to have linguistic impairments; In the case of an injury to the right hemisphere, perception, attention, and orientation are more frequently disturbed. In a right-brain injury, it often leads to a neglect, to the neglect of a body or space side. Whether and how pronounced functional disorders remain can not be assessed initially after an injury. The following is a list of symptoms observed after cranial brain trauma.

Post-commotional syndrome:- After a slight cranial brain trauma ( Commotio cerebral), also known as brain spasms in the people's mouth, it can lead to a diffuse headache, dizziness, nausea, rapid fatigue and irritability, apathy, and increased sweating. These general troubles occur frequently but gradually recede after a few weeks.

Disturbances of consciousness:- After a severe traumatic brain injury, a condition usually occurs after the accident in which the patient has closed his eyes as if he were half asleep. From which he can not be awakened by anything. The so-called coma can last several hours, days or even weeks. As long as the patient is comatose, there is still an acute disease of the brain. The pressure inside the skull can be further increased and the brain function can be disturbed by water deposits in the brain tissue. In parts of the brain, the metabolic processes can be severely impaired. If the patient returns from the coma, this is shown by the fact that he has more frequently opened his eyes. It is possible that with awakening all mental functions return.

If the patient has opened the eyes temporarily, but can not fix anything and do not return his or her mental functions, it is called coma vigil or apallic syndrome. Since the conscious mental functions have been lost to the person concerned, so to speak, he "looks into the void", so to say "blindness of soul." Although doctors assume that waking coma patients are unconscious, they still react to external stimuli. Studies have shown in recent years that certain cerebral palsy patients are still active. The question as to whether and how much of the affected person perceives the outside world can not yet be answered. The apallic state may persist or regress over time.

Posttraumatic brain performance weakness:- After severe brain damage, psychological changes of any degree are observed. Thus, as a result of a posttraumatic loss of brain performance, a general slowing, easy fatigue, lethargy, weakness of attention and concentration, memory and mental disorder, depressive mood, headache, and dizziness can occur. Also, speech disorders ( aphasia ) and disturbances in the conversion of movement sequences and action plans ( apraxia ) are frequent. One speaks of an "organic psychosyndrome" because of the comprehensive symptom complex. 

Very often, difficulties with concentration occur in patients with an SHT. It is usually no longer possible to do two things at the same time, or the attention goes out after a short time. The speed of the thought-processes lingered. Almost all skull-injured persons have a reduced load-bearing capacity, which means they tire very quickly and need more rest periods than before the accident.

At the same time, learning and memory disorders often occur, especially after damage to the left hemisphere. A memory disorder ( amnesia ) can manifest itself both in the inability to remember the past (retrograde amnesia), as well as to store new memory contents (anterograde amnesia). In retrograde amnesia, the patient can not remember a time before the brain damage. This duration is in the range of seconds to months. Anterograde amnesia is the most common form of memory disorder. The patient has difficulty in memorizing new information, which causes him great problems in living together. Often, the ability to remember new names or appointments is severely impaired.

Disorders of memory and attention may lead to orientation problems. The patient is not, or only inadequately, aware of the time, place and situation in which he is. Often he can not make any personal data. Patients often have problems chronologically. This applies both to past events and future events.

The mood of people with severe cerebral injuries can be subject to severe fluctuations, the affected persons are often more easily irritable than before the accident. Apart from abnormalities in the feeling area, there are also disturbances in social behavior. Thus, for example, they burst into tears, even at small occasions, or laugh inappropriately violently elsewhere. 

Personality changes:- After a severe injury to the brain and brain, a profound and lasting change in the psychological state of the patient can occur. In the case of personality changes, two forms can be distinguished: in the first case, the patient behaves more aggressively and more distantly. He can not control himself. This is the case when the regions which are above the eye sockets are injured in the frontal brain. In the second case, the person concerned behaves rather impotently and apathetically; Other areas of the forebrain are injured.

Some patients are tragically unable to recognize that they are impaired and therefore lack the willingness and opportunity to deal with the actual problems. Other patients experience their limitations in daily life again very consciously and react to it discouraged or sad. The daily frustrations faced by these patients could be a reason for their drive and self-initiative being diminished.

Speech disorders (aphasia):- A speech disorder usually occurs after damage to the motor (Broca center) or sensory ( Wernicke center ) regions in the left hemisphere. Here, the language regions are found in most people. Only in a few cases are these functions in the right or in both brain sides. In the case of damage to the speech regions, speech disorders (aphasia) occur. Typical of this is a cumbersome, painstaking and slow speech with an unclear pronunciation. In content, questions can be answered meaningfully, but the affected person can usually not produce complete or grammatically error-free sentences. An aphasia can occur in very different degrees of severity. In some patients, only minor uncertainties are found, for example, when finding words.

Those affected by aphasia can suffer from uncontrolled anger outbursts, curses or abuse others without wanting or be able to influence them. Later, the persons affected are usually themselves irritated by their behavior and often also ashamed. Many aphasia patients are disturbed in their drive or are depressed. One can, in turn, assume that these are reactions to the experience of a frustrating everyday life.

Disorders of the action of the action:- In the case of injuries to the brain, there may be disturbances in the movement of action intentions in movements and actions (apraxia). Despite the ability to move and perceive, parts of actions are repeated, omitted, or elements of previous actions taken. This affects everyday movements like a greeting and acts like the self-sufficient preparation of a cup of coffee. Although the patient knows what to do, it is not possible for him to carry out the necessary work steps correctly.

Patients often do not know how to deal with specific objects, they show a certain perplexity in dealing with objects and use them incorrectly. For example, try to cut the meat with the fork. In the case of multi-part actions, the affected parties also exchange the chronological sequence. As a result, patients with apraxia have difficulties in tightening, since several steps have to be performed in succession.

Computational disorders:- In some patients, there are problems with the computer ( dyscalculia ). The ability to write and read numbers is impaired. Even if the numbers are controlled, difficulties can arise during the calculation.

Facial field failures/facial field restrictions:-  If hemorrhages have occurred in the occipital lobe due to the SHT, half-face facial defects (hemianopsia) may occur. There are different types of facial constraints. It may affect the right or left facial field, or only a small section. In the case of damage in the area of the left visual cortex, the right facial field has failed, for example, in both eyes. Thus the person concerned can not perceive, when he is looking straight ahead, a line of sight coming from the right. This gives him considerable problems when walking, as he overlooks things and hits obstacles on the right. Reading is also difficult for the patient in this disorder.

Half-sided neglect (neglect):- As a result of an injury to the brain, a patient may neglect one of his / her body halves or even a space half if the facial field is not affected. Without being aware of the sense of awareness or the orientation, there is then a hiding of sensory stimuli on a body side. Half-sided neglect is more frequent after the injury to the right hemisphere. Injuries of the right hemisphere lead to neglect of the left hemisphere or hemispheres. In this case, for example, the person concerned would only shave his right facial, wash only his right half of the body, and eat only the right half of his plate. Also, the patient - unlike a patient with a facial defect - would not pay attention to persons who come from the left. In reading, patients with left-sided facial defects and patients with neglect show similar disorders. Only the disturbance in a neglect is usually much more pronounced; The patients begin to read in the middle of the line. Very often, people suffer from a neglected phenomenon, without being aware of it, that is, they can not recognize their own fault (anosognosia ).

Malfunction of the fine motor:-
In addition to the disturbances of the language and the language understanding, there are often difficulties in the precise control of movements, for example, in the case of seeing or in the dexterity.

Paralysis, spasticity:- In the neighborhood of the language centers, there are motorized and sensitive regions, which are responsible for the movement control and the body perception of the opposite side of the body. Paralyzes, like speech disorders, are a frequent symptom after cranial-brain injuries. Both disturbances often occur together. In the case of partial paralysis (hemiplegia), a paralysis of the opposite half of the body occurs by injury to a cerebral hemisphere. Frequently, the affected side of one's own body and the surrounding space can not be perceived (neglect). The sensation in the paralyzed areas can be disturbed. Often the patient is not aware of his disorder.

Spastic paralyzes are associated with increased muscle tension. All four limbs or only one-half of the body can be affected. Arbitrary movements are more difficult and the patient often suffers from pain. Since pain the spasticity almost always increases, pain must be avoided. In particular, careful handling of the shoulder-arm region must be taken into consideration when dealing with an injured person.

Speech disorder:- In speech disorders (dysarthria n), in contrast to the speech disorder, only the speech motor is disturbed. Patients with a speech disorder can easily understand, read and write, but no longer clearly and intelligibly pronounce sounds, words and sentences due to their brain injury. If breathing and vocalization are impaired. Symptomatic is a horse, pressed, weak, breathed or nasal-sounding voice.

Swallowing disorders:- Dysphagia occurs more often after brain injury than before. Especially in the first phase after the accident, difficulties with eating, drinking and coughing can occur. Swallowing disorders can affect chewing and swallow during eating and drinking as well as the interplay of mouth and facial muscles in general. These difficulties are caused by sensory disturbances, paralysis and coordination problems of movements in the mouth, throat and laryngeal areas.

If the voice of a patient sounds moist or rattling, or if he declares that the food is "stuck in his throat", these may indicate a swallowing disorder that should be taken seriously. Swallowing is a serious threat to the organism, as swallowing is one of the life-giving functions. Without swallowing neither solid nor liquid food can be absorbed. There is also a risk that food and fluid will enter the esophagus instead of the esophagus. This can lead to life-threatening pulmonary infections.

Cognitive disorders:- Both perception of the space, as well as self-perception or hearing or sight, can be disturbed. Patients lose their ability to perceive a space as a whole. In the affected person, the feeling of "being lost in space" arises. He can no longer estimate its dimensions, boundaries, and perspectives.

In the case of disturbances of self-awareness, the patient can no longer recognize his own body as a cohesive organism, he loses the feeling "for himself".

If vision or hearing centers or their nerve tracts are injured in the brain, disturbances of hearing or vision occur. If visual pathways or the visual cortex in the brain are damaged, limitations of the facial field may occur

Regulatory disorders:- The brain has many functions in maintaining the inner milieu (homeostasis) in the human organism and its interaction with the environment. It monitors complex control circuits that regulate food intake, body temperature, blood circulation, acid-base balance, water and electrolyte balance, and breathing within the organism. These functions can be impaired by damage to the brain.

Epilepsy:- After a traumatic brain injury, injuries can develop in the brain, which can cause epileptic seizures. The risk of scarring is higher after open brain injuries than after closed ones. Epileptic seizures can be counteracted with antiepileptic drugs. In some cases, the surgical removal of the cerebral scar is also possible.