Cranioencephalic Trauma (TBI): Symptoms, Causes, Treatments

The traumatic brain injury ( TBI ) or Traumatic brain inujury ( TBI ) is an impact in the brain which occurs due to an external force that can lead to decreased or altered level of consciousness, which in turn causes a decrease of cognitive and / or physical abilities (Portellano, 2005).

In other words, a TBI is any traumatism that occurs in the head, either superficial level affecting the scalp or  more serious, affected the skull and brain tissue (Ferrés Cuñado, 2016).

In addition, cranioencephalic trauma is one of the most common types of acquired brain damage. Specifically, in Spain and in other industrialized countries  , TBI is the leading cause of death in young adults (Jodar Vicente, 2013).

Injuries can occur when the head hits or is struck suddenly and violently with an object or surface, or when an object  pierces the cranial vault and accesses nerve tissue (National Institute of Neurological Disorders and Stroke, 2016).

Cranioencephalic Trauma

Among the most common causes of TBI are traffic accidents, falls, accidents at work or violent attacks (Jodar  Vicente, 2013).

The signs and symptoms of traumatic brain injuries can vary in a continuum from mild, moderate or severe ,  depending on the extent of damage and nerve damage (National Institute of Neurological Disorders and Stroke, 2016).

Cranioencephalic trauma

Therefore, the severity can vary from a light bruise or bruise, to severe bruising in brain areas. Specifically, the most common injuries  include: contusions, cranial fractures or scalp wounds (Reed-Guy, 2015).

The consequences and treatment of traumatic brain injuries vary enormously among different cases, since they depend both on the cause of  the injury and the severity of the injury (Reed-Guy, 2015).

Characteristics of traumatic brain injury

traumatic brain injury ( TBI ) or traumatic brain injury occurs when an external mechanical force  causes damage and injury at the brain level (Mayo Clinic, 2014).

When an object violently hits the skull, a wide variety of medical conditions can appear: headache, confusion, dizziness,  dizziness, blurred vision, fatigue, sleep, loss of consciousness and other neurological and cognitive symptoms (National Institute of Neurological Disorders and  Stroke, 2016).

Due mainly to the structural configuration of the skull, the TCE will cause damage both in the affected areas , that is,  those that receive the impact, and in others further awayas a result of the blow-counterattack effect (Pelegrín, Muñoz-Céspedez and  Quemada , 1997, Portellano, 2005).

On the other hand, traumatic brain injuries can be divided into two main groups:

Open TCE

In open cranioencephalic traumas, the skull suffers a fracture or penetration. In these cases, it is possible that the damage reaches the brain tissue  or fragments of bones are embedded (Ardila and Roselli, 2007).

Normally, people suffering from this type of traumatic brain injury usually lose consciousness and clinical symptoms are usually  associated with focal neurological damage (Ardila and Roselli, 2007).

In addition, when the encephalic mass is exposed to the outside, the risk of contracting an infection will increase “(Portellano, 2005).

TCE closed

In closed head injuries, brain injuries occur as a result of the mechanical effects of the traumatic event (Ardila  & Otrosky, 2012).

In this case, the skull does not suffer a fracture and a concussion or contusion of the encephalic mass occurs (Ardila & Otrosky, 2012) and generally  produces more diffuse neurological and cognitive effects (Portellano, 2005). 

Statistics

Traumatic brain injuries represent an important public health problem due to their frequency in the general population and the consequences  or consequences associated with them (Esper et al., 2010).

In the United States, approximately 230,000 people each year are hospitalized in emergency medical services with serious traumatic brain injuries  , while approximately another million people experience minor or traumatic incidents (Cleveland Clinic, 2014).

Of the serious cases, more than 99,000 people will suffer major sequels, so they may remain in a state of chronic disability  (Cleveland Clinic, 2014).

In the case of Spain, there are around 200 cases of traumatic accidents per 100,000 inhabitants each year. Within this high figure,  most cases (80%) will be considered mild, while 10% will be serious and another 10% moderate (Hospitals Nisa, 2016).

In addition, traumatic brain injuries are two or three times more frequent in men than in women, while the most affected age group is the  period from 15 to 24 years of age. However, after 60 years the risk also increases (Cleveland Clinic, 2014).

symptom

The most characteristic signs and symptoms in traumatic brain injuries are physical injuries to the head :

  • Scalp.
  • Skull.
  • Brain tissue

In addition, brain or nerve tissue damage may occur at the time of impact or develop later. Some of the physical injuries  resulting from traumatic brain injury are (Portellano, 2005):

  • Superficial bleeding on the scalp.
  • Bruise on the surface of the scalp.
  • Accumulation of blood in intracranial and intracerebral areas.
  • Interruption of blood flow and oxygen in intracerebral areas.
  • Development of blood clots.
  • Cranial fracture with possible collapse of bony regions.
  • Fracture of the meningeal layers.
  • Concussion or cerebral concussion: violent shock of the brain against the walls of the skull due to external trauma.
  • Laceration and / or tearing of brain tissue.
  • Cerebral edema (accumulation of fluid in brain areas).
  • Intracranial hypertension (increase in blood pressure).
  • Brain infection, hydrocephalus, convulsive episodes, etc.

In addition to these signs that are evident at the time of impact or trauma, traumatic brain injuries can have important  physical or neurological consequences. Although the clinical course is quite heterogeneous, a set of symptoms have been identified that appear  frequently immediately after the traumatic event or a few days later.

Specifically, depending on the severity of the traumatic injury we can distinguish various symptoms (Mayo Clinic, 2014):

Mild cranioencephalic trauma

Signs and symptoms related to mild head trauma may affect the physical, sensory and cognitive area.


a) Physical symptoms

  • Altered level of consciousness: loss of consciousness, daze, confusion, temporo-spatial disorientation, etc.
  • Headache.
  • Fatigue, tiredness or drowsiness
  • Dizziness, loss of balance.
  • Nausea, vomiting.

b) Sensory Symptoms

  • Blurred or double vision.
  • Auditory buzz
  • Luminous and auditory sensitivity.
  • Changes in the perception of tastes or smells.

c) Cognitive and neuropsychiatric symptoms

  • Problems of concentration and attention.
  • Memory deficits.
  • Moodiness.
  • Sensation of anxiety.

Mild-severe cranioencephalic trauma

In the case of the signs and symptoms related to the moderate-severe traumatic brain injury, they will mainly affect the physical and / or cognitive area  and may include all those related to the mild traumatic brain injury.

a) Physical symptoms

  • Altered level of consciousness: loss of consciousness, daze, confusion, temporo-spatial disorientation, etc.
  • Convulsive episodes
  • Pupillary dilation
  • Presence of liquid substance in oidium and / or nose.
  • Weakness and numbness of the upper and lower extremities.
  • Nausea and recurrent vomiting.

b) Cognitive and neuropsychiatric symptoms

  • State of deep confusion.
  • Agitation, aggressiveness.
  • Patterns of abnormal behaviors.
  • Linguistic deficits

Most frequent causes

There are numerous events or conditions that can cause traumatic damage to the brain.

The most common cause of traumatic brain injury are traffic accidents , accounting for approximately 50% of cases  (Cleveland Clinic, 2014). On the other hand, physical activity and some sports modalities can also cause accidents that  imply a TBI, it is considered the second most prevalent cause (Cleveland Clinic, 2014).

In addition, routine accidents and falls are another common cause, especially in people over  65 (Cleveland Clinic, 2014).

Other less frequent causes have also been identified, such as bullet wounds or the use of forceps during birth  (Ardila & Otrosky, 2012).

Systematically, the most common causes of TBI are (Mayo Clinic, 2015):

  • Traffic accidents : collisions between cars, motorcycles or bicycles is one of the most common causes of TCE.
  • Sports accidents : in relation to sports, injuries caused by accidents in football, boxing, baseball, skateboarding, hockey,  etc., can also be the cause of TCE.
  • Falls : the most frequent scenarios of TCE in the case of falls are the missteps in building stairs or ladders,  falls from the bed, slips during the shower or in the bathroom.
  • Violence : Many of the injuries involving TBI are caused by gunshot wounds, domestic violence, or child neglect.

Types of traumatic brain injuries

There are a wide variety of classification criteria for traumatic brain injuries: clinical factors, severity, injury produced, etiology,  etc.

a) According to the type of injury:

– Open TCE : when a cranial nerve takes place and the brain tissue is exposed to the outside (Jodar Vicente, 2013).

– TBI closed : when there is no open lesion and the damage occurs secondarily the traumatic event (Jodar Vicente,  2013).

b) According to the location of the lesion

– Brain cells: injuries directly affect brain tissue (Jodar Vicente, 2013).

– Cranial: the lesions affect the inside of the skull, but do not involve other secondary cerebral level (Jodar Vicente, 
2013).

– Epicranial: the lesions affect the outside of the skull (Jodar Vicente, 2013). Apart from these classifications, the most usual one in head injuries is the one that refers to the severity criterion:

  • Mild TBI : the patient is fully oriented and maintains alertness. There are usually no significant and permanent neurological deficits  . Despite this, at the time of the trauma there may be loss of consciousness and post-traumatic amnesia.
  • Moderate TBI : in the moderate TCE there is a decrease in the consciousness or alert novel and signs of neurological deficits may appear  .
  • Severe TBI : in the most severe type there is a serious decrease in the level of consciousness. The patient appears totally  isolated from the surrounding environment without responding to verbal commands or environmental stimulation. Severe TBIs are associated with both significant brain damage  and the development of important neurological consequences.

Diagnosis

The traumatic brain injuries are considered an urgent medical condition, so they are treated in medical services with special  priority.

The first diagnostic action used in TBI has to do with the determination of the level of awareness of the patient. The most commonly used scale  is the Glasgow Coma Scale (GCS), which offers an initial index of severity (Mayo Clinic, 2014).

On the other hand, all the information related to the traumatic event is collected: how it happened, where, initial symptoms, altered conscience, etc., (Mayo  Clinic, 2014).

In addition, some brain imaging techniques ( magnetic resonance or computed tomography ) are used to locate the possible presence of brain lesions  that require urgent medical intervention (Mayo Clinic, 2014).

Consequences or possible complications

Normally, brain trauma will cause different kinds of deficits: impaired memory, attention, concentration, decision  making, problem solving or even behavioral changes (Ardila and Rosselli, 2007).

The complications and sequelae will depend fundamentally on the severity of the traumatic event. In the mild type of TBI, they may present minimal sequelae  , however in the more serious, other more severe ones may appear: chronic coma, physical disability, deep cognitive deficits, etc. (Ardila and Roselli, 2007).

Treatments used

In any case, all those individuals who have just suffered a TBI should receive urgent medical attention.

The treatments used in the acute phase are aimed at controlling the immediate signs and symptoms of the traumatic event. It is essential to maintain  vital signs and control possible bleeding and fractures.

In addition to the use of pharmacological measures, in some cases it may be necessary to address medical complications through surgical procedures  to repair fractures, lacerations, bone incrustations, clot development, etc.

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In the sub-acute phase, all therapeutic interventions will be oriented towards recovering the patient’s level of consciousness and the affected cognitive and physical areas  .

 

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