Traumatic Brain Injury

A traumatic brain injury (TBI) happens when an outside force damages your brain and affects how it works. This can occur after a fall, a hard hit to your head, a vehicle accident or when something goes through your skull.

Symptoms can affect your body, thinking and emotions. You may have headaches, confusion, short-term memory loss, and mood or behavior changes. TBIs may be life-threatening. They can cause short-term or long-term health problems that affect many parts of your daily life.

Treatment is available and depends on how serious the injury is.

Types of traumatic brain injuries

There are two types:

• Penetrating TBI: This is when something pierces your skull, enters your brain tissue and damages a part of your brain. Healthcare providers may call these open TBIs.
• Blunt TBI (closed head TBI): This is when something hits your head hard enough that your brain bounces or twists around inside your skull.

What are the severity levels of TBIs?

Healthcare providers classify traumatic brain injuries as being mild, moderate or severe. They may use the term “concussion” when talking about mild TBI. Providers typically group moderate and severe TBIs together.

• Mild TBI: More than 75% of all TBIs are mild. But even mild TBIs may cause significant and long-term issues. For example, you may have trouble returning to your daily routine, including being able to work.
• Moderate and severe TBI: These are medical emergencies. Many develop into significant and long-term health issues.

TBI symptoms

Symptoms vary depending on the severity. Any TBI can cause physical symptoms, problems with thinking or memory, and social or emotional changes.

Mild TBI symptoms

Mild TBI symptoms can appear right away or develop over days. You may not always connect your symptoms to the injury. Symptoms can also change as your brain heals.

Physical problems may include:

• Nausea or vomiting
• Dizziness or balance problems
• Headaches
• Light sensitivity
• Fatigue
• Blurred vision

Thinking or memory symptoms may include:

• Confusion
• Trouble concentrating
• Difficulty thinking clearly
• Short-term memory loss
• Feeling “slowed down”
• Grogginess

Social or emotional changes may include:

• Anxiety
• Nervousness
• Irritability

Sleep changes may include:

• Trouble falling asleep
• Sleeping less than usual
• Sleeping more than usual

Moderate or severe TBI symptoms

These symptoms can be more serious and may also change over time.

Physical symptoms may include:

• Passing out for more than 30 minutes (moderate) or more than 24 hours (severe)
• Coma
• Weakness in your arms or legs
• Problems with balance or coordination
• Hearing or vision problems
• Changes in touch or other senses

Thinking or memory problems may include:

• Confusion
• Trouble concentrating
• Difficulty thinking clearly
• Short-term memory loss
• Trouble communicating
• Grogginess

Social or emotional symptoms may include:

• Anxiety or nervousness
• Irritability, anger or aggression
• Depression
• Trouble managing behavior
• Being more impulsive

TBI symptoms in babies and children

Children and adults often have similar symptoms. But babies may show different signs. TBI signs in babies may include:

• Problems eating or nursing
• Crying that’s hard to soothe

Causes of a TBI

Brain damage causes a TBI. A hard hit to the head can make your brain move, bounce or twist inside your skull. This movement can injure brain tissue and blood vessels. A foreign object entering your skull can also cause damage.

Common causes of a penetrating TBI may include:

• A sharp object, like shrapnel
• A bullet
• A knife

Common causes of non-penetrating TBIs may include:

• Vehicle accidents
• A fall
• A hit in the head
• A sports injury
• An explosion

Complications of a TBI

Mild, moderate and severe TBIs can lead to different complications.

If you have a mild TBI and don’t give your brain time to heal, you have a higher risk of second-impact syndrome. This is a life-threatening condition where your brain suddenly swells after a second injury.

Moderate or severe TBIs can cause long-term problems, like:

• Brain bleeding
• Seizures
• Permanent brain damage and disability
• Shorter life expectancy

How doctors diagnose a traumatic brain injury

If you have a mild TBI, a healthcare provider will examine you and ask about your symptoms. They’ll also want to know how the injury happened. They may order:

• A neurological exam
• Imaging tests (CT scan or MRI)
• Blood tests

If you have a moderate or severe TBI, your provider will likely do blood tests and a CT scan right away. These help them decide on the immediate care you need.

Traumatic brain injury treatments

Treatment depends on whether the TBI is mild, moderate or severe. Your specific care plan will vary based on your symptoms and overall health.

Treatment for a mild TBI

If you have a mild traumatic brain injury, healthcare providers may recommend:

• Rest
• Over-the-counter non-NSAID pain relievers
• Regular check-ups to watch for new or worsening symptoms

Your provider will let you know how often check-ups should be.

Treatment for a moderate or severe TBI

A moderate or severe traumatic brain injury is a medical emergency. Healthcare providers may need to do surgery to:

• Relieve pressure inside your skull.
• Remove debris from a penetrating injury.
• Remove blood clots.
• Repair skull fractures.
• Place monitors to measure pressure and oxygen levels in your brain.

Providers may prescribe medications, including:

• Prescription pain medicines
• Antiseizure medications
• Medication to prevent blood clots (venous thromboembolism)
• Stimulants to increase alertness
• Antidepressants
• Anti-anxiety medications

After surgery, you may need rehabilitation. This helps you recover daily skills and manage thinking, communication or emotional changes. Rehabilitation may include:

• Physical therapy
• Occupational therapy
• Speech therapy
• Respiratory therapy
• Mental health support

When should I see my healthcare provider?

If you have a TBI, get help right away if you have:

• A headache that doesn’t go away or gets worse
• Vomiting that doesn’t stop
• Slurred speech

Can you fully recover from a TBI?

Recovery looks different for everyone. All traumatic brain injuries can create challenges, and some may lead to long-lasting effects. Your provider can explain what to expect based on your specific injury.