TBI

About this condition

What Are Traumatic Brain Injuries and Concussions?

Trauma to the head occurs when you hit your head, or when your head is hit by someone or something else. It could be from an acorn falling from a tree, someone’s fist or head, or a bullet or shrapnel penetrating the skull. Any of these head traumas can cause a traumatic brain injury, or TBI, which, simply put, is brain damage from an injury.

Other trauma, like a car accident, a fall, or anything that exerts a strong force on your body can also cause a TBI. A force strong enough to move your body weight is strong enough to shift the brain inside the skull and cause mild TBI, known as mTBI or concussion. Although called mild, mTBI is a serious condition, and there is evidence that having one concussion makes it more likely that a second or more will occur. Multiple concussions cause brain damage to accumulate and this is known to result in serious problems, including chronic traumatic encephalopathy—a cause of dementia.

How Can Anyone Tell If They Have a TBI or Concussion?

Although a trauma or accident doesn’t always cause TBI or concussion, it can. That is why it is important to have a doctor look for signs of brain injury if you have taken a hit to your head from any cause or “flown through the air” for any reason. This is even more true if you have symptoms of a brain injury, which can sometimes be hard to detect.

A few symptoms are signs that a brain injury might be severe. They could be from bleeding into your brain or a bony skull injury that is putting pressure on your brain. If these are present, seek emergency care right away:

headache (if worst you’ve ever had, seek emergency care)
repeated vomiting
slurred speech
not remembering the details of the trauma
having blacked out or lost consciousness during or after the trauma

Other symptoms of TBI are listed below; these should also be checked out by a doctor.

difficulty concentrating, thinking, or responding to others
confusion, not knowing exactly where you are or why
feeling sad, anxious, or agitated, or having trouble controlling emotions
nausea or feeling sick to your stomach
dizziness or a feeling of being unsteady on your feet
blurry vision
being more sensitive to light or sound than usual
feeling very sleepy when it isn’t your usual bedtime
pain in your neck, face, or head

If you can, bring someone who knows you along when you go to get care. This will help you stay safe and help the doctor know if the way you are acting is the same or different than before the trauma. The medical team will check for other injuries, ask about what happened, and whether you have any of the symptoms of TBI or concussion listed here. They may ask you and anyone you brought with you if your behavior or thinking abilities have changed. The medical team may order brain imaging with x-ray, CT, or MRI depending on your symptoms. They may also be able to diagnose a concussion or TBI just from your symptoms and without pictures of your head and brain.

How Is a Concussion or TBI Treated?

A TBI is usually a medical emergency, and doctors will act quickly to assess the situation and prevent further injury to the brain from swelling or hemorrhage. If pressure is building up inside the skull, an emergency doctor may may insert a probe to monitor pressure or cut a small window in the skull to relieve the pressure. If brain images reveal blood clots or skull fragments surgery may be needed to have these removed. After a TBI, doctors will monitor a person very carefully—often in the hospital—and may also prescribe medicines to help the brain heal by preventing swelling, seizures, or other problems. Depending on how badly the brain was injured and what part of the brain was injured, rehabilitation including physical therapy, speech therapy, and occupational therapy might be needed.

After a concussion, doctors usually prescribe rest. New evidence is suggesting, however, that it may be best for people to continue working and going to school but to take breaks if they feel tired or have symptoms get worse. An easy recommendation to remember is to “take it easy.”

Whether a person returns to work or school or takes time off to rest, it is recommended to avoid vigorous exercise for a few days. It is also very important to wait to return to athletic activity for a couple of weeks or until all symptoms are gone. This helps the brain heal but also protects it from a second injury during a vulnerable time of healing. Usually people have full recovery from a single concussion after 3 to 4 weeks.

It is important to treat any pain after a concussion or brain injury. Pain takes energy that the brain needs for healing and also makes it hard to sleep. Many people are sleepier than usual right after a concussion but then have difficulty sleeping, or insomnia, later. Sleep problems can be treated with light therapy, cognitive-behavioral therapy for insomnia, or melatonin. Getting good sleep is also important for recovery, so it is important to talk with your doctor if you have trouble with sleep. Similarly, if a person has mood swings or depression during recovery, the medical team can assist with those problems, which also promotes recovery.

How Can A Person Live Well With TBI or Concussion?

Living well after a TBI depends very much on how severe the injury was and how a person takes care of herself or himself afterwards. It is very important to follow through with any physical, speech, or occupational therapy prescribed, even if it feels like it isn’t doing much. Fortunately, the brain is more like clay than stone, which is referred to as plasticity—in short, it means the brain can change and heal with time and training. Brain healing can take longer than bone or muscle healing though, which is why it is good to be patient and stick with treatment.

Living well after a concussion also requires self-care. After concussion and until all symptoms resolve, people should take more frequent breaks and avoid stress if possible. The most important thing to do after a concussion, however, is to prevent having another one. Everyone can reduce their risk of concussion by

wearing seatbelts and not driving while drowsy or under the influence
using a helmet during high-speed or high-impact sports (football, hockey, skiing, cycling),
taking safety precautions when working in high places, like a roof,
avoiding falls (especially for seniors or toddlers)

As for all people, recovering from a brain injury or not, getting enough sleep, eating a heart- and brain-healthy diet, exercising regularly, and staying mentally and socially active all promote health and wellbeing.

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