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Traumatic Brain Injury is the most frequent cause of death and disability worldwide. It can be the result of a motor vehicle accident, fall, assault or sporting accidents.

Traumatic Brain Injury or TBI is an injury to the brain caused by a blow to the head or other external force, which causes rapid movement of the brain inside the skull. As a result the brain may be torn, stretched, penetrated, bruised or become swollen.

Possible effects of TBI

The effects of a Traumatic Brain Injury and the degree of recovery that can be expected will depend on the location and severity of the injury, as well as how successful the rehabilitation process is. Common cognitive effects can include:

• Memory problems
• Fatigue and slowed responses
• Poor concentration and attention
• Irritability, anger and susceptibility to stress
• Inappropriate behaviour and poor social skills
• Self-centredness, dependency and lack of insight
• Poor problem-solving, initiative and motivation
• Depression and lack of emotional control
• Impulsivity.

Common physical effects can include: 

• Loss of taste and smell
• Dizziness and balance problems
• Epilepsy and seizures
• Fatigue
• Headaches and chronic pain
• Visual problems
• Paralysis or movement disorders.

Assessing the severity of a TBI

The severity can range from a mild brain injury (often called concussion) to severe or catastrophic brain injury. Two reliable indicators of severity include how long the person is in a coma and the length of time in post-traumatic amnesia.

Another widely used indicator is the Glasgow Coma Scale (GCS). This scale measures a person's level of consciousness on a scale of 3-15, with 3 being the lowest level of consciousness. Scoring is based on verbal, motor and eye-opening reactions to stimuli. Generally, a score of 13 or above on the GCS is considered a mild brain injury or concussion, 9-12 as moderate and 8 or below severe.

Diagnosis & treatment of TBI

Initial diagnosis and treatment usually occurs in the Accident & Emergency ward of a hospital. This stage generally focuses on assessing and stabilizing the person's condition. Once the person is assessed as not being in immediate medical danger a complete neurological evaluation is performed to rule out conditions requiring neurosurgery, such as hematomas, certain skull fractures, and high intra-cranial pressure.

Different imaging tests may be used in diagnosis including:

• Computed tomography (CT) scans which provide a three dimensional view of the brain o detect abnormalities
• Magnetic resonance imaging (MRI) which uses electromagnetic radio waves to produce either 3-D or 2-D images of the brain
• X-radiation (composed of X-rays) is a form of radiation used as a diagnostic tool that reveals damage to structures of the brain
• Inter-cranial pressure (ICP) monitor implanted inside the skull to monitor changes in intracranial pressure.

Recovery from a TBI

It is difficult to predict accurately how far a person will recover after a brain injury. Some people may find that life eventually returns to normal with only a few lingering problems, while others suffering a severe brain injury will face many lifelong disabilities. 

The brain does have a limited ability to heal itself with usually the biggest improvements seen in the first year. Rehabilitation seeks to make the most of this period when the brain is recovering, and the effort put into rehabilitation has a very large bearing on the degree of recovery. Some of the best recoveries are from determined people with a positive attitude who continue to apply rehabilitation techniques long after the formal process has finished. 

Closed & open head injuries

A TBI can be described as being a closed or open brain injury. An open head injury results from the head hitting an object, or an object piercing the skull and brain tissue (open or penetrating head injury).

A closed head injury occurs without the skull being broken or penetrated, so the brain has not been exposed. An example of a closed head injury is when the rapid movement of the head backward and forward (acceleration-deceleration movement) causes the brain to move inside the skull and slam against its hard inner bone.

Focal & diffuse brain injury

A Traumatic Brain Injury can be focal or diffuse, meaning damage may be isolated to one specific area of the brain, or widespread in the case of diffuse injuries. Both types of injury can occur together.

Focal damage involves damage to specific areas of brain tissue. Types of focal injuries include contusions (bruised brain tissue), which often occurs under the sight of impact, lacerations (torn brain tissue), and or hematoma (a collection of blood inside or around the brain), which can be the result of hemorrhaging and can lead to increased pressure on the brain.

Diffuse damage involves damage to axons, the brain's microscopic communication pathways, which extend from brain cells. Damage occurs when the axons are stretched or severed.

A TBI often results in secondary injuries, which arise due to the brain's reaction to the first injury. These include brain swelling and hemorrhaging. Swelling puts pressure on brain tissue, which can restrict oxygen supply to other parts of the brain leading to cell death. Treatment is focused on controlling the secondary effects of a brain injury to prevent further damage.