Traumatic Brain Injury

What is a traumatic brain injury?

A traumatic brain injury (TBI) is a blow to the head or a shaking, jarring, or jolting movement that causes stretching, swelling, or tearing of brain tissue and delicate nerve fibers. Common causes of TBI include car or motorcycle accidents, bicycle accidents, sports injuries, and falls.

A TBI can be mild, moderate, or severe. Even a mild TBI may become severe if more than one occurs within a short period. This is known as Second Impact Syndrome, or SIS. Types of brain injury include:

• Concussion - temporary loss of brain function
• Contusion - bruising of the brain
• Hemorrhage - bleeding into or around the brain
• Hematoma - blood clot caused by a collection of blood in the brain

Post concussion syndrome is very common. You may have headaches, confusion, and irritability for a long time.

What can I expect in the hospital?

A moderate to severe TBI or a SIS is a medical emergency that requires admission to the hospital. TBI and SIS require careful observation, especially in the first 24 hours.

Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring

• You will be checked often by the hospital staff.
• A heart (cardiac) monitor may be used to keep track of your heartbeat.
• Your blood oxygen level may be monitored by a sensor that is attached to your finger or earlobe.
• You may have a small tube (catheter) placed through your skull to monitor the pressure around your brain.
• You may have finger sticks to check blood sugar regularly.
• You may have a small tube (catheter) placed into your bladder to drain and measure urine.

Testing

Testing may include:

• Neurologic examination: Testing to check your strength, sensation, balance, reflexes, thinking, and memory. Some parts of this test may be repeated many times a day while you are in the hospital.
• X-rays: Pictures of the head to check for bleeding or broken bones in the skull
• Computed tomography (CT) scan: A series of X-rays is taken from different angles and arranged by a computer to show thin cross sections of the head to check for damage to your brain.
• Magnetic resonance imaging (MRI): A powerful magnetic field and radio waves are used to take pictures from different angles to show thin cross sections of the head to check for damage to your brain.
• Electroencephalography (EEG): A test measures and records the electrical activity in the brain.
• Transcranial Doppler: Sound waves and their echoes are passed through your body from a small device that is held against your neck or near your cheekbones or ears to create pictures of the blood vessels in your brain to look for increased pressure or swelling.

Treatment

The treatment for TBI depends on the location and type of the injury and how severely your brain is injured. The goal of treatment is to reduce damage to brain tissues by reducing pressure in the brain and blood pressure, as well as treating bleeding or blood clots.

• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow medicine to be given directly into your blood and to give you fluids, if needed.
• You may receive oxygen through a small tube placed under your nose or through a mask placed over your face. In very severe cases, you may need a tube put into your lungs that is attached to a machine to help you breathe.
• Your healthcare provider may prescribe medicine to:
  • Treat pain
  • Prevent or treat seizures
  • Prevent or treat nausea and vomiting
  • Reduce fluid build-up in the brain and other tissues
  • Help you rest
  • Control blood pressure
• Your provider may recommend other types of therapy to help relieve pain, other symptoms, or side effects of treatment.
• You may need surgery to reduce the pressure on your brain, to control bleeding, or to remove blood clots.
• You may start a TBI rehabilitation program while you are in the hospital that will help you to learn to deal with some of the functions you may have lost due to the injury. Most rehabilitation programs include:
  • Physical therapy to help you regain muscle strength and teach you ways to move safely
  • Occupational therapy to help you relearn ways to do the tasks affected by the TBI
  • Speech therapy to help you if you have problems with swallowing, speaking, or understanding words
• Therapy may include skin care and training to help you control your bladder and bowels.
• You may need help with daily activities.

What can I do to help?

• You will need to tell your healthcare team if you have new or worsening:
  • Seizures or convulsions
  • Trouble with muscle movements, such as swallowing, moving arms and legs
  • Bleeding from your ears or nose
  • Slurred speech
  • Trouble speaking or understanding
  • Change in vision, such as double vision, blurred vision, or trouble seeing out of one or both eyes
  • Trouble staying awake or alert
  • Headache
  • Trouble thinking clearly or remembering
  • Dizziness or lightheadedness
  • Vomiting
  • Unusual behavior or restlessness
  • Personality changes, including irritability
  • Increased thirst and dry mouth
  • Increased urination
• Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on many things, such as your general health, how severe your injury is, the treatment you need, and how well you recover. Talk with your provider about how long your stay may be.

You may need to go to a rehab facility to continue your brain injury rehab program before going home.