25 Oct Traumatic Brain Injury

Traumatic brain injury (TBI) is a complex category of clinical conditions defined by a functionally significant alteration of brain function and/or structure resulting from the application of external physical force (including acceleration/deceleration and/or blast forces).
TBI occurs along a continuum of injury severity and can produce a broad range of neuropsychiatric disturbances of variable duration which are recognized during medical disability evaluation. The heterogeneity and complexity of both TBI and its sequelae present challenges in clinical care, research, public policy, and medicolegal proceedings.
The effects of injury and the course of recovery vary, with:

• injury severity (mild, moderate, orsevere)
• comorbid or complicating neuropsychiatric conditions
• psychosocial circumstances potentially influencing outcomes

What is TBI?

Traumatic brain injury is defined as an event-related disruption in brain function and/or structure as a consequence of external physical forces (e.g., acceleration/deceleration, blast), resulting in the acute disruption of cognitive and/or elementary neurological functions. This term should be strictly reserved for biomechanical force-induced injuries; acquired brain injury (or ABI) may be used to denote brain injury resulting from other etiologies, such as anoxia, stroke, tumors, infection, or toxins. This is best done by a competent clinical practitioner during medical disability evaluation.

TBI may be classified as either penetrating or nonpenetrating, based on whether or not the cranium has been breached.
Outcomes related to penetrating injuries are largely influenced by:

• the nature and extent of neuroanatomy compromised by the penetrating object(s)
• the additional risk for complication, particularly infection

Nonpenetrating injuries are far more common and are divided into three categories based upon severity: mild, moderate, and severe.
Keep in mind that the terms “mild,” “moderate” and “severe” are used to describe the effect of the injury on brain function. A mild injury to the brain is still a serious injury that requires prompt attention and an accurate diagnosis after a medical disability evaluation.

Causes

While performing a medical disability evaluation of a TBI suspect patient, it is crucial to include in the history- taking the cause of the injury so to get a glimpse of the possible destructive pattern of neurological structures.
Among the leading causes are:

• falls
• motor vehicle crashes and traffic-related accidents
• being struck by or against an object
• assaults

Many TBIs, especially in young people, happen while playing sports or doing recreational activities. Also a traumatic brain injury can ensue after an episode attack in patients with epilepsy, where they can fall or struck their head against rough and hard surfaces. Also some activities that lead to emergency department visits for TBI are bicycling, football, playground activities, basketball, and soccer.
While in the military, the leading causes of TBI arise from gunshots, fragments from an explosion, blasts, falls, motor vehicle crashes, and assaults.

Symptoms and course of illnes after TBI

A broad array of neuropsychiatric symptoms may follow TBI of all severities.
Common physical symptoms include:

• headache
• fatigue
• sleep disturbance
• vertigo or dizziness
• sensitivity to light and/or sound, and anosmia

Cognitive disturbances potentially range from level of arousal and attention through higher-order executive functions and social intelligence. Problems with complex attention, executive functioning, learning, memory, and speed of processing are common.
Emotional disturbances often include:

• irritability
• depression
• anxiety
• affective lability
• decreased frustration tolerance

Behavioral disturbances or personality changes may involve:

• aggression
• disinhibition
• impulsivity
• apathy

Since infants and young children with brain injuries, usually, are not able to communicate headaches, sensory problems, confusion and similar symptoms- during medical disability evaluation of a child, symptomes may vary and are observed as the following:

• Change in eating or nursing habits
• Unusual or easy irritability
• Persistent crying and inability to be consoled
• Change in ability to pay attention
• Change in sleep habits
• Seizures
• Sad or depressed mood
• Drowsiness
• Loss of interest in favorite toys or activities

Treatment

Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible. Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize an individual with TBI and focus on preventing further injury. Primary concerns include insuring proper oxygen supply to the brain and the rest of the body, maintaining adequate blood flow, and controlling blood pressure. Treatment is tailored after combining the history of the injury, clinical examination, alongside with blood tests and imaging tests during medical disability evaluation. Moderately to severely injured patients receive rehabilitation that involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support.