Brief overview
- Course of disease and prognosis: Depends on the severity of the SHT, good prognosis in mild traumatic brain injury, in severe SHT sequelae possible, also fatal courses.
- Symptoms: Depending on severity of SHT, headache, dizziness, nausea, visual disturbances, memory lapses, drowsiness, unconsciousness,
- Causes and risk factors: Injury to skull and brain; mostly accidents, falls during sports, cycling without helmet, accidents at work
- Treatment: Depending on the degree of SHT, in mild cases bed rest, painkillers, anti-nausea medication, in case of skull fractures and/or brain hemorrhages usually surgery
- Examination and diagnosis: medical history, duration of unconsciousness, neurological tests, imaging techniques such as computer tomography (CT), X-ray (less frequently), magnetic resonance imaging (MRI) if necessary
What is traumatic brain injury?
If external force – such as a fall or blow to the head – results in a combined injury to the bones of the skull and the brain, this is known as a traumatic brain injury.
Traumatic brain injury is a relatively common injury. Estimates put the incidence at 200 to 350 cases per 100,000 inhabitants per year. Doctors distinguish between different degrees of severity as well as different forms of traumatic brain injury.
In about five percent of those affected, the traumatic brain injury is severe. In some of the injured, it leads to a permanent need for care or even to death. An example of a mild form of traumatic brain injury is a concussion.
Doctors divide a traumatic brain injury (SHT) into three levels of severity. They also distinguish a closed SHT from an open SHT. In a closed traumatic brain injury, the bony skull and the underlying hard meninges are uninjured.
Concussion
All information about this mild form of traumatic brain injury can be found in the article Concussion.
What are the consequences of a traumatic brain injury?
It is not possible to make a blanket statement about what the consequences of a traumatic brain injury are. The duration of healing and whether late effects from a traumatic brain injury persist depends primarily on the extent of the injury. For mild traumatic brain injury (Grade I), the prognosis is usually good and there are no sequelae to worry about.
In severe traumatic brain injury, on the other hand, permanent limitations and consequential damage are to be expected. How the consequences of a craniocerebral injury manifest themselves also depends on the brain region affected. For example, motor disorders such as flaccid or spastic paralysis are possible, but mental impairments are also possible.
About two-thirds of adult survivors with severe traumatic brain injury become occupationally disabled as a result. For adolescents, this is only about 20 percent of those affected.
What is the life expectancy after severe traumatic brain injury?
No general statements can be made about life expectancy after a severe traumatic brain injury. However, it is assumed that 40 to 50 percent of those affected die as a result of a severe SHT.
How long is a person ill after a traumatic brain injury?
The length of illness after a traumatic brain injury depends on the extent of the injury. For a mild SHT, such as a concussion, victims are often well after a few days of recovery. For a more severe traumatic brain injury, many weeks and months sometimes pass.
Often, a hospital stay is followed by rehabilitation (rehab) to treat the secondary damage of the traumatic brain injury. For some people, the effects of the injury last a lifetime.
What are the symptoms of a traumatic brain injury?
- Headache
- Dizziness
- Nausea, vomiting
- Unconsciousness
- Visual disturbances
- Disorientation
- Memory gaps (amnesia), especially related to the time around the accident
- Coma
Traumatic brain injury can be divided into three levels of severity:
- Mild traumatic brain injury (Grade I): If unconsciousness occurs, it is limited in time to 15 minutes or less. Usually, no neurological sequelae occur.
- Moderate traumatic brain injury (Grade II): Unconsciousness lasts up to one hour. Late effects are possible, but not very likely.
- Severe traumatic brain injury (Grade III): Unconsciousness persists for more than one hour; neurological sequelae are likely.
To assess the severity of traumatic brain injury, doctors use what is known as the Glasgow Coma Scale. Points are assigned for the following criteria:
- Eye opening: Does it occur spontaneously, only when spoken to, in response to a painful stimulus, or not at all (e.g., when unconscious)?
- Body motor function: Does the patient move when prompted or is the ability to move restricted?
The better and more spontaneously the affected person reacts, in relation to the respective criterion, the higher the score awarded. Conversely, the lower the score, the more severe the injury. Doctors use the Glasgow Coma Scale (GCS score) with the inclusion of symptoms to assign brain trauma to a severity level.
The symptoms that result from traumatic brain injury also depend on the type of injury. The following forms of head and brain injuries are known:
- Cranial contusion: headache or dizziness is possible, disturbances of consciousness or neurological symptoms do not occur. In the case of a skull contusion, the brain remains uninjured and does not exhibit any functional disturbance.
For all information on this mild form of traumatic brain injury, see the article Concussion.
- Brain contusion (contusio cerebri): Unconsciousness occurs, lasting from more than an hour to several days. Neurological symptoms that occur depend on the region of the brain that is injured. These include epileptic seizures, paralysis, respiratory or circulatory problems, and coma.
- Cerebral contusion (Compressio cerebri): In this traumatic brain injury, the brain is bruised either externally or by increased pressure from within, such as bleeding or swelling of the brain. Severe headache, dizziness, nausea, further neurological disturbances or deep unconsciousness are possible signs.
- Cranial calvaria fracture (skull fracture): A split in the skull bone may be palpable or an indentation may be visible. Medical professionals distinguish an open head trauma, in which the brain is partially exposed, from a covered or closed head injury (the skull is not opened).
What are the causes and risks of traumatic brain injury?
The skull bone surrounds the brain for its protection. In front is the facial skull, consisting of the bony eye and nose sockets and the upper and lower jaws. Most of the brain is surrounded by the posterior cranium. The base of the skull surrounds the brain from below. The passageway for the spinal cord is also located there.
The brain and spinal cord together form the central nervous system (CNS).
In most cases, a traumatic brain injury is the result of an accident. Common causes are falls while playing sports without a helmet, such as riding a bike or skiing, or at work. In addition to blunt force trauma (such as a blow or impact), perforating (piercing) injuries are also possible.
It is estimated that one third of craniocerebral injuries are the result of traffic accidents. One in three of those affected also suffers other injuries – doctors then refer to this as a polytrauma.
What is the treatment for a traumatic brain injury?
If the symptoms of a traumatic brain injury increase during this time, the consequences, such as a cerebral hemorrhage, can be quickly recognized and treated. Painkillers, such as paracetamol, are used to treat symptoms such as headaches. Active substances such as metoclopramide help to combat nausea.
If there is a more serious traumatic brain injury, hospitalization is always necessary. If the patient is unconscious, the first treatment measures at the scene of the accident are aimed at securing vital functions (such as circulation and breathing).
Further treatment steps depend on the type of injury. Open craniocerebral trauma, but in some cases also covered skull fractures and cerebral hemorrhages, must usually be treated by surgery.
For further treatment of severe craniocerebral injuries, admission to a specialized hospital or early rehabilitation facility is advisable. Here, a specialized team of medical specialists, physiotherapists, occupational therapists and speech therapists is available. The goal is to train and regain physical, mental and speech abilities.
How does the doctor diagnose a traumatic brain injury?
If a craniocerebral trauma is suspected, the affected person must be admitted to a hospital. Here, trauma surgeons, orthopedists and neurologists usually work hand in hand in the diagnosis. During a neurological examination, the doctor checks, among other things, whether the person concerned is responsive and oriented.
At the same time, he looks to see whether external injuries indicate a traumatic brain injury. In unconscious patients, the pupillary reaction to a light stimulus (also known as the light reaction or pupillary reflex), among other things, provides information about the extent of the brain injury.
With the help of imaging procedures such as an X-ray examination or – nowadays mostly preferred – computer tomography (CT), fractures of the skull bones and skull base can be easily detected. Injuries to the brain such as contusions, bruises or bleeding are also visible.
If no obvious changes can be seen in the CT despite existing complaints, a magnetic resonance imaging (MRI) usually follows.
