Beyond the bump: unravelling traumatic brain injuries

A traumatic brain injury (TBI) is one of the most serious and complex injuries sustained by the human body, often with profound and long-term effects on an individual’s physical, emotional, behavioural and cognitive abilities. 

What is a traumatic brain injury?

A TBI results from an external force which causes structural and physical damage to the brain. 

The primary injury refers to the immediate damage to the brain tissue which is caused directly by the event. Whereas secondary injuries result from the cascade of cellular and molecular processes triggered by the initial injury and develop from hours to weeks following the initial TBI. 

Typically, the injury can be penetrating, where an object pierces the skull and damages the brain, or non-penetrating which occurs when the external force is large enough to shake the brain within the skull causing coup- contrecoup damage. 

Diagnosis and severity

The severity of a TBI is classified as either mild (aka concussion), moderate, or severe, using a variety of indices. Whilst more than 75% of TBIs are mild, even these individuals can suffer long-term consequences from post-concussion syndrome. 

Here are two commonly used measures to initially classify severity: 

• The Glasgow Coma Scale (GCS) is an initial neurological examination which assesses severity based on the patient’s ability to open their eyes, move, and respond verbally. It is a strong indicator of whether an injury is mild (GCS 13-15), moderate (GCS 9-12) or severe (≤8). 

  
  

• Following the injury and any period of unconsciousness, when a patient has trouble with their memory and is confused, they are said to have post-traumatic amnesia (PTA). This is another measure of injury severity and lasts up to 30 30 minutes in mild TBI, between 30 minutes and 24 hours in moderate TBI, and over 24 hours in severe TBI. 

  
  

Imaging tests including CT scans and MRIs are used to detect brain bleeds, swelling or any other damage. These tests are essential upon arrival to the hospital, especially in moderate and severe cases to understand the full extent of the injury.

Leading causes of TBI

Common causes of TBI are a result of: 

• Falls (most common in young children and older adults) 

• Vehicle collisions (road traffic accidents- RTAs)

• Inter-personal violence 

• Sports injuries 

• Explosive blasts 

Interestingly, the rate of TBI is 1.5 times more common in men than women. 

General symptoms

The symptoms and outcome of a TBI depend on the severity and location of the injury. They differ from person to person based on a range of factors which include pre-injury sociodemographic vulnerabilities including age, sex and level of education, as well as premorbid mental illnesses. There are also post-injury factors such as access to rehabilitation and psychosocial support which influence recovery. 

Due to this, nobody will have the same experience of a TBI, however there are some effects which are more common than others which are described:

Mild TBI: 

• Physical symptoms: headaches, dizziness, nausea, and blurred vision.

• Cognitive symptoms: confusion, trouble concentrating, difficulty with memory or disorientation. 

• Emotional symptoms: mood swings, irritability, depression or anxiety. 

  
  

Moderate-to-severe TBI:

• Behavioural symptoms: aggression, personality change, disinhibition, impulsiveness. 

• Cognitive symptoms: difficulties with attention and concentration, decision making, memory, executive dysfunction, information processing, motivation, language, reasoning, self-awareness. 

• Physical symptoms: headaches, seizures, speech problems, fatigue, weakness or paralysis. 

  
  

Many of these symptoms are ‘hidden’ and can often impact functional outcomes for an individual, such as their capacity for employment and daily living (i.e., washing, cooking, cleaning etc.).  

The long-term effects of TBI can vary, with some returning to normal functioning. However, others might experience lifelong disabilities and require adjustments in their daily lives. 

For more information and support, there are some great resources on the Headway website, a leading charity which supports individuals after brain injury. 

Written by Alice Jayne Greenan