Traumatic brain injury (TBI)
There is a large number of people who encounter complications after an accident either from a fall or a knock. some ignore the problem especially if its minor and others get a wrong diagnosis especially if they go to small clinics. it is important to understand what traumatic brain injury is so that one can get the right treatment or diagnosis. A traumatic brain injury is as a result of blow/Jolt to that happens to the head. This blow penetrates and injures the normal working of the brain. It is only the blows that have a great impact that causes TBI or otherwise not all the blows cause it. These injuries can result to wounds that are severe and mild which makes it the ranges of the disorder. Mild makes the damage be mental status change and consciousness while the severe is provides extended unconsciousness period and amnesia after injury. Majority occurrence of TBIs which appears each year is conscious besides other form of traumatic brain injury (Faul , Xu , Wald & Coronado, 2010).
Brain damage is the main cause of disability and impacts livelihoods and lives of almost 2 million persons in America annually. In the past, there was a conviction that the window for brain damage recovery was one year at most per damage. Any damage to the brain prior to maturation raises the danger of long term cognitive issues. For young children specifically, the long term impacts might not even be clear until they get to the development stage (Faul , Xu , Wald & Coronado, 2010).
There are injuries which are more common in certain kinds of brain damage. Various injuries to the diverse parts and lobes offer one different symptoms. A number of the most life changing hardships that can occur in an individual’s life are traumatic brain damage. Different from normal wounds which have the likelihood of healing fully within a short time; brain injuries usually have long term and, life-altering impacts that affect one’s life style and sometimes, personality too. Even though the brain is covered by three protective layers and then covered by the skull, it still can encounter damage (Faul, Xu, Wald & Coronado, 2010).
Types of TBI
Concussion is the traumatic damage of the soft tissue, typically the mind, it always occurs as a consequence of a violent blow, quivering, or spinning. A brain concussion can cause instantaneous but momentary destruction of brain functions, for example thinking, vision, stability, as well as awareness.
Diffuse axonal injury
Diffuse axonal injury is a type of brain injury which is being caused by shearing services which takes place in between diverse parts of the brain on account of rotational hastening. The body callosum and the brainstem are frequently affected. It is the most vital types of brain damage that can take place because of non-missile head injury, and it might be very complex to diagnose post mortem unless the pathologist is aware of what he is looking for. Rising knowledge with fatal non-missile head injury in a person has allowed the discovery of three grades of diffuse axonal injury.
Hemorrhage ( epidura hemorrhage,
Hemorrhage is described as the escape of blood from a ruptured vessel; this can take place either outside or inside (Zasler, N. D., Katz, D. I., & Zafonte, R. D. (2007). Contusion is damage to tissues with skin staining and with no skin breakage, this is also known as bruise (Levenson, J. L. 2007) . Blood from the broken vessels accumulates in close tissues leading to pain, bulge, and softness. It always heal without special cure, although cold compresses may diminish bleeding if applied right away after the injury, and thus may lessen swelling, as well as soreness.
Causes of TBI
TBI has much of the causes seen as in falls, vehicle accident and violence. Falls are seen when people fall from high buildings or structures, those who are running as well as those walking. Vehicles accidents are much common when reckless drivers are involved when they are drunk, tired, ignorance, testing cars without skills and driving cars when they have problems as examples (CDC, 2003).
Violence attacks are seen in ethnicity that results to people fighting among themselves. People are hit on their heads with bland or sharp objects. Some are cut completely to the inside but survive the pain and injury. Traumatic brain injury is damage to the brain brought about by the head being shaken violently or hit by something (CDC, 2003). This damage can affect how the injured person moves, acts, and thinks. There are two main kinds of TBI and they include closed head damage and penetrating injuries. Closed head damage refers to an injury which is brought about by a blow like during an accident when the person’s head hits against a dashboard or windshield. Penetrating injuries on the other hand are injuries which occur when an objects gets inside the brain and brings about injuries to certain parts of the brain. This localized or focal, damage takes place along the path the object used to get to the brain. Symptoms differ in depending on the brain regions that are injured (CDC, 2003).
There are also two different forms of brain damage: primary and secondary damage. The primary damage is an injury that is whole during the impact and might include skull fracture, lacerations, bruises, blood clots, and nerve damage. Secondary damage on the other hand, is noticed after trauma and might include epilepsy, edema, hematoma, and fever, high or low pressure, lung changes among others (CDC, 2003).
How is the TBI detected?
The attending doctors’ first priority is to calm the patient on the patient’s arrival to the hospital. This is done by conducting a physical examination and making an initial diagnosis. Once the patient is stabilized, the doctor is therefore required to carry out additional tests for further diagnosis of the patient’s condition. When factors such as a patient’s critical signs, breathing patterns as well as visible exterior injuries shows the chance of a concussion , doctors may be required to assess brain damage by using X-rays, computed tomography (CT) scans or magnetic resonance imaging (MRI) scans. In addition to brain scans, doctors assess the extent of the brain damage using neurological evaluations, which comprise numerous simple questions that establish a patient’s level of consciousness.
The most usually used scales to classify levels of patients’ consciousness are the Glasgow Coma Scale and the Rancho Los Amigos Scale. The Glasgow Coma Scale is a fifteen point scale which measures opening of the eye while the Rancho Los Amigos Scale categorizes patients into eight levels of consciousness. There is also the use of PET scan which uses computed tomography to envisage tracers of radioactive substances which are being introduced into the brain by breathing. PET can measure such brain functions as cerebral metabolism, blood flow and volume, oxygen use in the brain as well as the formation of neurotransmitters.
The doctors are able to determine the extent of the traumatic brain injury and provide a diagnosis once doctors are done with physical and neurological evaluations,.( Levenson, J. L. 2007). Many patients with mild traumatic brain injury do not display symptoms until weeks after the incident. Mild symptoms such as headaches and insomnia may be overlooked by the patient In some instances. Patients with this kind of brain injury who seek medical consideration are evaluated physically (Levenson, J. L. (2007). Patients who sustain moderate to severe brain injuries may show unconsciousness or severe cognitive injury. it is more perceptible through physical examinations, doctors can instantly note a severe bleeding. A closed head injury in contrast, can be hard to recognize and may need extensive physical and neurological examinations
The injury is also detected by the CT scan machine which is a computer tomography and MRI which is magnetic resonance imaging. These machines are able to see inside the brain and also help the physicians know the places affected much in the head brain (Stevens, 2004).
Signs of TBI
Every three types of TBI depict various symptoms that one should be aware of. Placid TBI, also called concussion, is harder to diagnose both in military battlefield and civilian life. With placid TBI persons, they can recover fully in a few hours or even minutes; a small percent have signs that might carry on for months or even years. Signs of mild TBI consist of dizziness, headache, and problem with concentration, vomiting, irritability, and memory issues. Temperate TBI comprises of a group of patients that are in between severe and mild spectrum. These persons have the most inconsistency in the medical presentation picture (Stevens, 2004).
There is normally loss of consciousness, confusion, and physical or mental deficits which can be present for a couple of months or even for a long time. Critical TBI normally result from substantial closed brain injury, as in an accident or penetrating wounds, where there might be significant residual discrepancies of brain function. Depending on the damage, a serious TBI could affect sensory, speech, cognitive and vision deficits together with difficulties with memory, attention, impulsiveness, and concentration.These symptoms help the medics to establish the kind of treatment they are going to administer to the patient for better results. This is because different symptoms allow them to know which specific sections of the brain are damaged (Stevens, 2004).
Effects of TBI
TBI causes to the host physical, social cognitive, behavioral and emotional effects. This results to a disability that is permanent or results to death.
Most deaths in the world today are caused by this damage of the brain. It is evident that deaths are mild in teenagers and children among others. Most males sustain the injury more frequently as compared to the females ( Stevens, 2004).
Prevention of TBI
TBI prevention in many ways that seeks to prevent any interruption or touch or injury made to the head. Technology as a resend revolution can help in protection of such injuries by introducing seatbelts and motorcycle or sports helmet. Safety educations to the schools of driving and common schools which are elementary and secondary besides the tertiary should have programs that help students understand the dangers. Since they are the very same people who will buy vehicles they get equipped with knowledge at their disposals (Nicholas & Cowley, 2008).
Subsequently, prevention in the traffic rules and laws enforcement that seeks to protect the innocent and jail the guilty to clean up on the accidents is paramount. Since the traffic rules cuts across on the people who are involved in driving, it is able to seclude and remove those who go against the laws which cause accidents. The un roadworthy vehicles are also removed so as to clean up on the road system (Nicholas & Cowley, 2008).
Pathophysiology of traumatic brain injury
The understanding of the pathophysiology following traumatic head harm is essential for sufficient and patient-directed treatment. As the prime insult, which stands for the direct perfunctory damage, cannot be influenced therapeutically, objective of the management is the restriction of the secondary harm. It is predisposed by alterations in flow of cerebral blood, destruction of autoregulation of cerebroscular, dysfunction of cerebral metabolism, and insufficient cerebral oxygenation. Moreover, damage of excitoxic cell and inflammation might lead to necrotic and apoptotic cell death. Comprehension of multidimensional flow of secondary head injury gives distinguished therapeutic alternatives (Nicholas & Cowley, 2008).
The initial stages of cerebral damage following the TBI are featured by primary tissue damage and destructed regulation of metabolism and CBF. This pattern brings about lactic acid accumulation because of anaerobic glycolysis, amplified membrane permeability, and successive Oedema formation. Because of the fact that anaerobic metabolism is insufficient to uphold cellular energy levels, the ATP-stores run down and collapse of energy-reliant membrane ion pumps takes place. The other stage of pathophysiological flow is featured by incurable membrane depolarization alongside excessive discharge of excitatory neurotransmitters, and other elements (Nicholas & Cowley, 2008).
TBI brings together reflex stress to head tissue with a disparity between metabolism and CBF, oedema formation, excitotoxicity, and apoptotic and inflammatory processes. Up till now, the volatility of the person’s pathophysiology needs monitoring of the damaged brain so as to customize the treatment in accordance with the unique status of the injured person (Nicholas & Cowley, 2008).
Treatment of TBI
Treatment of this injury begins with emergency treatment. People with severe injuries are taken to the intensive care unit (ICU) so that they can be given special treatment that results to a stable condition of the body including the head. There recovery welcomes other treatments for other parts of the body i.e. performing the neurosurgical (CDC, 2003).
Treatment is with the immunity of the recovery period of ailing patient. Little can possibly be done to achieve the reverse damage that has come initially by trauma. Rehabilitation becomes the main treatment for chronic and sub acute stages of one who is recovering (CDC, 2003). A clinical guideline is one of the proposals given with an aim of directing and managing decisions made in relation to TBI treatment. This has been well defined by the authoritative evidence that is currently on board.
Endotracheal intubation and mechanical ventilation are used to ensure that there is proper oxygen supply s well as provision of secure airway. Hypotension which contains a devastating outcome in TBI can be prevented by the use of intravenous fluids to maintain a normal blood pressure. Blood pressure may be reserved at an unnaturally high level under controlled circumstances by concoction of norepinephrine or similar drugs. This help in maintaining cerebraperfusion. The temperature of the body is vigilantly synchronized since increased temperature raises the metabolic needs of the brain, potentially grudging it of nutrients. Seizures are noted to be common. While they can be treated using benzodiazepines, these drugs are expected to be used carefully because they can discourage breathing and lower blood pressure.
There is the use of anti-depressant Medications, they are thought to work by affecting the levels of the brain’s natural chemical messengers known as neurotransmitters, and adjusting the brain’s response to them for examples; citalopram, amitriptyline, paroxetine as well as sertraline. Pain management medications are also used to manage pain stemming from TBI, and the symptoms and effects connected to the injury. The following are the example, acetaminophen, ibuprofen, and naproxen sodium. In addition, there is motor System Medications; these medications operate on the motor system to influence the chemical balance in the brain in an effort to control bodily movement. For examples baclofen, tizanidine or cyclobenzaprine. Finally, there is Memory and Cognition Medications, This medications operate to hunk enzymes in the brain,( Zasler, N. D., Katz, D. I., & Zafonte, R. D. 2007). These drugs are used for treating dementia, such as that found with Alzheimer’s disease. Others are used to treat attention deficits and hyperactivity.
Also, Brain oxygen monitor (Licox) is positioned through a tiny hole in the skull and positioned within the brain tissue. It measures the level of oxygen plus temperature within the brain. When using the LICOX, the practitioner drills a distinct burr hole and places an intracranial bolt. Each prod is then inserted to its port in the LICOX housing system. The positioning of the probe is based on the patient’s condition as well as the goals of the psychoanalysis and a assessment of a computed tomography (CT) scan. For example, the probes may be located close to a cerebral lesion if oxygen monitoring therapy is to be made. probes can be placed on the opposite hemisphere to enable measurement of global oxygenation if it is tricky to place the probes on the side of the injury, (Zasler, N. D., Katz, D. I., & Zafonte, R. D. 2007). a sterile dressing is applied over the bolt site after placing the probes, the probe cables are then connected to the monitor.
It is obligatory to ensure accurate placement of the LICOX catheters in order to obtain reliable data. Generally, the catheters are placed on the right-hand side of the frontal lobe since placing them on the left-hand side of the frontal lobe may cause injury of the brain’s speech center. However, a CT scan can be employ to locate the damaged area so that the LICOX catheter may be inserted into the penumbra of the injury. the system starts recording and displaying temperature measurements and the local cerebral oxygen after duration of about 10 to 120 minutes. Recording is done after stabilization of the brain tissues from the micro-trauma of probe insertion. A vebtriculostomy may be needed for cerebrospinal fluid drainage in some patients.
There is also the use of Mechanical Ventilator; a number of patients may need a ventilator to help them in breathing. The ventilator is coupled to the patient by the endotracheal tube. The tube is positioned into the mouth of the patient and down into the trachea. The tube enables the machine to press on air into and out of the lungs, thus helping the patient breathe.
Furthermore, Early extraventricular drainage of CSF is occasionally of great significant in controlling brain edema if there is a doubt that the ventricles will gradually lessen in size for the reason that edema cannot be cannulated from a burr hole.
Medications used to treat TBI’
TBI is treated through the use of Diuretics. These drugs reduce the amount of fluid found in tissues as well as increasing urine production (Levenson, J. L. 2007). . Diuretics are given intravenously to persons suffering from traumatic brain injury. It reduces pressure within the brain. There is also the use of Anti-seizure drugs. People who have had a reasonable to severe traumatic brain injury are at risk of having seizures during the first week after their injury. An anti-seizure drug can be given in the first week to evade any extra brain damage that may be caused by a seizure. Additional anti-seizure treatments are only used in occurrence of seizures.
There are coma-inducing drugs which sometimes doctors uses to put people into temporary comas for the reason that exhausted brain requirements less oxygen to supply of to function. This is especially helpful when blood vessels, squashed by improved pressure in the brain, are not in apposition to deliver the usual amount of nutrients and oxygen to brain cells. There is also the use of Anti-convulsant Medications; they are used to hold back the fast and extreme dismissal of neurons that begin a seizure. Anti-convulsants may occasionally thwart the spread of a seizure inside the brain and offer fortification against any possible excitotoxic effects that may result in brain damaging. (Flanagan, S. R., Zaretsky, H. H., & Moroz, A. 2011).
Comorbidities of traumatic brain injury
It is noted that Sometimes, health complications takes place immediately after TBI. These complications are not types of TBI, but are divergent medical problems that occur as a result of the injury. Even though complications are unusual, the risk increases due to the sternness of the trauma. These are some of the complications of TBI; instant seizures, hydrocephalus also known as post-traumatic ventricular growth, CSF leaks, infections, vascular injuries, cranial nerve injuries, throbbing, bed sores, numerous failure of organ system in comatose patients, and polytrauma thus trauma to other parts of the body besides the brain (Tsao, J. W. 2012) . About 25 percent of persons suffering from brain contusions or hematomas and about 50 percent of patients suffering from penetrating head injuries will develop instant seizures. This is a seizure which occurs within the first 24 hours of the injury. It is noted that these instant seizures increase the risk of early seizures. It is distinct as seizures taking place within 1 week after injury but do not seem to be linked to the development of post-traumatic epilepsy (recurrent seizures occurring more than 1 week after the initial trauma).
Normally, therapeutic professionals use anticonvulsant medications to cure seizures in TBI patients but only if the seizures persevere. Hydrocephalus or post-traumatic ventricular enlargement takes place when CSF accumulates in the brain hence resulting in dilation of the cerebral ventricles thus cavities in the brain filled with CSF and an increase in ICP (Erdman, J. W. 2011). This condition can develop through the sensitive stage of TBI or may not appear until later. Generally it takes place within the first year of the injury, additionally is characterized by deterioration neurological result, impaired consciousness, changes in behavior, ataxia also known as lack of synchronization or poise, incontinence, or symbols of eminent ICP. The condition might grow as a result of meningitis, , intracranial hematoma, subarachnoid hemorrhage (Tsao, J. W. 2012).
It can be treated by shunting and exhausting of CSF in addition to any other suitable treatment for the root cause of the condition. Skull fractures can destroy the membranes that wrap the brain, leading to leaking of CSF. A rip in between the dura and the arachnoid membranes, well known as CSF fistula, can lead to CSF leakage out of the subarachnoid gap into the subdural gap, this is known as 15 a subdural hygroma. CSF can also leak from the nose and the ear. These tears that enable CSF out of the brain cavity may let air and bacteria into the cavity hence causing infections for example meningitis. Pneumocephalus takes place when air gets into the intracranial cavity and becomes fascinated in the subarachnoid space( Zasler, N. D., Katz, D. I., & Zafonte, R. D. 2013) .
Infections inside the intracranial cavity are a hazardous impediment of TBI. They may take place outside the dura, underneath the dura, under the arachnoid or meningitis as well as within the space of the brain itself (abscess). the majority of these injuries develop within a few weeks of the initial trauma plus result from skull fractures or piercing injuries. Normal treatment involves antibiotics and occasionally some surgery to get rid of the infected tissue. Meningitis may be hazardous, with the potential to extend to the rest of the brain and nervous system. Whichever damage to the head or brain often results in some break to the vascular structure, which provides blood to the cells of the brain. The immune system available in the body can revamp damage to small blood vessels, but injury to larger vessels can cause severe complications.
Injury to one of the main arteries leading to the brain can lead to stroke, either due to bleeding from the artery (hemorrhagic stroke) or through the configuration of a clot at the site of injury, thrombosis, blocking blood flow to the brain (ischemic stroke). Blood clots can also develop in other parts of the head. This can be noticed in symptoms such as nuisance, queasiness, seizures, paralysis on one part of the body, and semi consciousness rising within several days. Thrombotic-ischemic strokes are treated with anticoagulants, though surgery is the most favored treatment for hemorrhagic stroke. Additional types of vascular injuries are; vasospasm and the development of aneurysms.
Research and development of TBI.
There has been no medication to stop the sequence of the secondary damage, but various pathological efforts shows opportunities to get treatment that changes the damage process. Neuroprotection ways to mitigate secondary damage has been the topic of great attention for the ability to slow down the injury that follows TBI(CDC, 2003).Development of technology has given doctors valuable medical information i.e. machine to monitor oxygenation attached to probe positioned in the brain. In this development it uses monitor ICP.
Research on the plan to clarify factors correlated to give outcomes of TBI and determine in the cases while performing CT scan and surgical processes have been innovated. This seeks to enhance on the studying, understanding and trying to come up with recommended solutions to the Injury.
Conclusion on TBI
It is noted that TBI including all levels of severity, is the main cause of death and life-long disability in some countries such as United States. Given the large payment of TBI and nonattendance, prevention is of paramount significant. Identification, intervention, and prevention of various risk factors provide an important opportunity to reduce TBI and its effects. Traumatic brain injury can do not only crucial deficits of glide motion or language, but also a number of potentially disabling psychiatric symptoms as well as syndromes. These comprise of temper and nervousness disorders, personality turbulence, antagonism; and, occasionally, phobia. TBI treatment is convoluted by cognitive deficits, lack of impetus, and lack of awareness of deficits. There is lack of controlled treatment trials for TBI. Pharmacological treatment might involve a broad range of medications, for example antidepressants, antipsychotics, bad temper stabilizers, and stimulants. Family and individual psychotherapy is predominantly important in assisting the patient and the family reunite themselves to the certainty of the behavioral changes in the patient post-TBI.
Community reintegration after severe TBI is powerfully inﬂuenced by social ability and behavioral self-regulation. These interrelated domains of performance are commonly impaired by TBI and compose a primary rehabilitative focal point for specialists in communication disorders. In both domains there is a substantiation base that supports intervention. Traumatic brain injury can be irresistible and stressful to both patients and their family members. Besides the emotional and social impact that accompanies TBI, it is in order to find out and deliver sensible attention to the physical needs of the patient. Prophylactic medications play an essential role in patients suffering from TBI; yet as of now various categories require definitive data to direct suitable therapeutic choices. Future studies are required to elucidate this important issue in the management of persons with this condition.
Centers for Disease Control and Prevention (CDC), (2003), National Center for Injury Prevention and Control. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Atlanta (GA): Centers for Disease Control and Prevention.