What Is Traumatic Brain Injury (TBI)?

The toll of a severe traumatic brain injury can be enormous for both the individual and his or her family. A traumatic brain injury often leads to life-changing disabilities. Veterans returning from Iraq and Afghanistan have suffered serious brain injuries, often resulting from blasts. Many need long-term or lifelong help to do daily activities. Men are more than twice as likely as women to suffer a TBI.

What is traumatic brain injury?
A TBI is damage caused by a sudden blow or jolt to the head or penetration of the head. The most common causes of TBIs are falls and car accidents. Other causes include sports-related injuries, violent crimes and child abuse.

Damage from a traumatic brain injury occurs from the injury itself or from the effects that follow it. When the brain collides with the skull, it causes tissue damage and swelling. The injury also triggers a cascade of biochemical and cell changes that affect the flow of blood and oxygen to the brain. These after-effects can go on for days to weeks after the initial injury. They can affect not only the brain but other functions of the body as well, such as blood pressure and breathing. If left untreated, these delayed effects can have dire consequences.

Effects of TBIs range from mild to severe:

• A mild TBI, such as a concussion, can cause:
  • Temporary confusion
  • Headache
  • Trouble remembering the actual injury
• With a more severe TBI, you may also have:
  • Worsening headache
  • Nausea and vomiting
  • Dizziness
  • Blurry vision
  • Ringing in the ears
  • Fatigue
  • Mood changes
  • Brief loss of consciousness
  • Seizures
  • Slurred speech
  • Trouble waking up from sleep

When to get immediate medical help
Call 9-1-1 to get emergency medical attention if someone has a head injury and:

• Loss of consciousness or lightheadedness
• A seizure
• Severe neck or head pain
• Problems seeing, speaking or remembering
• Bleeding from the eyes, ears or mouth
• Behavior changes, such as sleepiness, confusion or irritability
• Clear fluid coming from the nose
• Repeated or severe vomiting
• Abnormal breathing or heart rate
• Is under the influence of alcohol or other drugs
• Is under age 2
• Weakness or numbness in the legs
• One or both pupils that are larger than normal
• Trouble walking

Go to the emergency room if, after a head injury, you notice:

• The headache is getting worse
• Vomiting
• Bruising around eyes or behind the ears
• Memory problems
• A dent or hole in the skull bones
• A problem with memory

Note: Symptoms may occur right away or may appear later.

What are the effects of TBI?
Depending on which part of the brain was injured, the effects of a TBI may be short-term or lifelong. The most severe TBI can cause major changes in physical and behavioral abilities and, at worst, coma or death.

• Physical changes
  • Coordination and balance problems
  • Weakness or paralysis
  • Trouble swallowing and speaking
  • Seizures
  • Impaired senses, such as vision, hearing and smell
  • Sleep problems
• Cognitive (thinking) changes
  • Concentration and memory problems
  • Poor judgment and problem-solving skills
  • Language, reading and writing difficulties
• Behavioral and emotional changes
  • Irritability, depression or mood swings
  • Impaired social skills, inappropriate or aggressive behavior

Having a TBI may also cause epilepsy and may increase the chances of developing other brain disorders, such as Parkinsonism or Alzheimer's diseases.

What can you do about a TBI?
Early and aggressive treatment can help reduce long-term problems that stem from TBIs. The earlier treatment begins, the better the outcome may be. Your doctor will monitor the pressure in your brain from swelling and bleeding. About half of people with TBIs need surgery to drain blood or fluid from the brain. For lingering disabilities, rehabilitation is needed. This includes physical, occupational and speech therapies and physical and psychological treatments.

You or your loved one may need help coping with life after a severe TBI. It can be helpful to join a support group for people with TBI or their caregivers - where you can share feelings and experiences.

Related Articles Taking One for the Team: Concussions and Hard-Hitting Sports Treating Depression When There's a Knock to the Noggin: Dealing with a Head Injury

External Sources Heegaard W, Biros M. Traumatic brain injury. Emergency Medicine Clinics of North America. 2007;25:655-678. Accessed December 17, 2007. National Institute on Deafness and Other Communication Disorders. Traumatic brain injury: cognitive and communication disorders. Accessed December 17, 2007. National Institute of Neurological Disorders and Stroke. NINDS traumatic brain injury information page. Accessed December 17, 2007. Family Caregiver Alliance. Fact Sheet: traumatic brain injury. Accessed December 17, 2007. Centers for Disease Control and Prevention. Facts about traumatic brain injury. Accessed December 17, 2007. Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. TBI overview. Accessed December 17, 2007. Defense and Veterans Brain Injury Center. Education. Documentary: understanding traumatic brain injury. Accessed December 17, 2007. Okie S. Traumatic brain injury in the war zone. New England Journal of Medicine. 2005;352(20):2043-2047. Accessed December 17, 2007. Ling GSF. Traumatic brain injury and spinal cord injury. In: Goldman: Cecil Medicine, 23rd ed. Philadelphia, PA: Saunders Elsevier; 2007. Accessed December 17, 2007.

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