Traumatic Brain Injuries

Traumatic Brain Injury - Helpful Terms

Think of the brain as an egg yolk. The brain is somewhat mobile within the spiny interior of the skull much like an egg yolk is within its eggshell. Under normal circumstances, the delicate brain is protected from contact with the spiny contours of the skull by cerebrospinal fluid. Think of this fluid as egg white. Cerebrospinal fluid surrounds the brain and cushions it from contact with its hard, spiny shell. Traumatic Brain Injury (TBI) occurs when the brain is slammed back and forth against the bony structures inside the skull. This is often caused by some external force or trauma such as car accidents, acts of violence, falls, sports, recreational activities, electrical shocks and lightening strikes. Traumatic brain injury can also occur without any outward physical evidence of injury or trauma. Examples include whiplash and shaken babies.

Acquired Brain Injury (ABI) occurs when the brain is damaged due to conditions not caused by an external force. Some common causes of ABI are strokes, surgery, tumors, toxins, drug overdose, hypoxia, degenerative diseases and near drowning or suffocating. The damage is often caused from a lack of oxygen to the brain.

The term head injury and traumatic brain injury are often used interchangeably. However, most people associate the term "head injury" with some type of external physical damage to the skull.

Brain injuries can be further distinguished as a closed-head injury or an open-head injury. An open-head injury occurs when the skull is penetrated as with a gunshot wound or puncture. In closed-head injuries, the skull is not penetrated. However, they can still result in severe brain injury. Brain injury can be divided between primary and secondary injury.

Primary injury is the initial injury. The following is a list of examples:

	Skull fracture - when this occurs the bone fragments often exert pressure on the brain.
	Contusions or bruises - when this occurs the force of the injury drives the brain against the bony ridges of the inside skull.
	Hematoma (blood clot) – occurs when the injury causes blood vessels to break.
	Lacerations - The frontal and temporal lobes or blood vessels are torn when the brain rotates across ridges inside the skull.
	Diffuse Axonal Injury (brain vault) - occurs when the brain is forcibly rotated and battered within the spiny skull.

Secondary injury is the residual effect of the initial injury and may occur hours and days after the first injury. Some examples are: blood vessel damage, toxic processes, brain swelling, spasms, seizures and infections. Procedures that minimize this damage can be the difference between recovery and permanent brain damage.

Neuropsychological impairments caused by brain injury may be characterized in terms of three functional systems (1) intellect which is the information-handling aspect of behavior. (2) emotionality, which concerns feelings and motivations (3) control, which has to do with how behavior is expressed.

Concussion or Mild Head Injury - A mild head injury, sometimes called a concussion, occurs when the head impacts an object or sustains a violent acceleration/deceleration motion (i.e. whiplash or shaken baby syndrome). Often, a person with a concussion will lose consciousness. If they remain conscious they will appear dazed and confused. They may also suffer from Post Concussion Syndrome (PCS). Symptoms include memory loss, poor concentration, attention disorders, mood swings, personality disorders, fatigue and diminished I.Q. Impairments can be helped by rehabilitation.

Moderate Head Injury - Injuries of this degree usually result from a non-penetrating blow to the head, and/or violent shaking of the head. Moderate head injuries often affect a person’s mental capabilities.

The terms mild, moderate and severe do not indicate the seriousness of the injury or the prognosis. Instead, the terms are based on alertness, amnesia and the length of time a person was unconscious following the injury.

Brain injury can manifest itself in several areas. Here are some common symptoms to look for:

Intellectual Problems - memory lapses, difficulty concentrating, frequently misplacing things, difficulty making decisions, difficulty finding the right words when talking, stuttering or stammering, difficulty doing simple math, poor problem-solving abilities, difficulty understanding written or spoken instructions, difficulty processing information, difficulty sequencing information and difficulty shifting from one task to another.

Physiological Problems - frequent headaches, numbness or tingling in parts of your body, ringing in your ears, racing or pounding heart, increased blood pressure, increased sensitivity to touch, loss of strength, restlessness, difficulty sleeping and appetite disturbances.

Personality Changes – aggressiveness, uncontrollable outbursts of temper, mood swings, submissiveness, talking excessively, writing compulsively, increased frustration, silliness, lack of interest or emotion, easily discouraged, irresponsible or impulsive.

Neurological Disorders – slowed reaction time, a feeling of observing self from afar, hearing sounds or smelling odors that others don’t, seeing dark spots before your eyes, double vision, blurred vision, difficulty seeing at night, sensitivity to temperature changes and sensitivity to light, sound or noise.

	Intellectual Problems - memory lapses, difficulty concentrating, frequently misplacing things, difficulty making decisions, difficulty finding the right words when talking, stuttering or stammering, difficulty doing simple math, poor problem-solving abilities, difficulty understanding written or spoken instructions, difficulty processing information, difficulty sequencing information and difficulty shifting from one task to another.
	Physiological Problems - frequent headaches, numbness or tingling in parts of your body, ringing in your ears, racing or pounding heart, increased blood pressure, increased sensitivity to touch, loss of strength, restlessness, difficulty sleeping and appetite disturbances.
	Personality Changes – aggressiveness, uncontrollable outbursts of temper, mood swings, submissiveness, talking excessively, writing compulsively, increased frustration, silliness, lack of interest or emotion, easily discouraged, irresponsible or impulsive.
	Neurological Disorders – slowed reaction time, a feeling of observing self from afar, hearing sounds or smelling odors that others don’t, seeing dark spots before your eyes, double vision, blurred vision, difficulty seeing at night, sensitivity to temperature changes and sensitivity to light, sound or noise.