Traumatic Brain Injury

Traumatic brain injury can have wide-ranging physical and psychological effects. Some signs or symptoms may appear immediately after the traumatic event, while others may appear days or weeks later.

Mild traumatic brain injury
The signs and symptoms of mild traumatic brain injury may include:

Physical symptoms

• Headache
• Nausea or vomiting
• Fatigue or drowsiness
• Problems with speech
• Dizziness or loss of balance

Sensory symptoms

• Sensory problems, such as blurred vision, ringing in the ears, a bad taste in the mouth or changes in the ability to smell
• Sensitivity to light or sound
• Cognitive, behavioural or mental symptoms
• Loss of consciousness for a few seconds to a few minutes
• No loss of consciousness but a state of being dazed, confused or disoriented
• Memory or concentration problems
• Mood changes or mood swings
• Feeling depressed or anxious
• Difficulty sleeping
• Sleeping more than usual

Moderate to severe traumatic brain injuries
Moderate to severe traumatic brain injuries can include any signs and symptoms of mild injury and the symptoms below. These symptoms may appear within the first hours to days after a head injury:

Physical symptoms

• Loss of consciousness from several minutes to hours
• Persistent headache or headache that worsens
• Repeated vomiting or nausea
• Convulsions or seizures
• Dilation of one or both pupils of the eyes
• Clear fluids draining from the nose or ears
• Drowsiness
• Weakness or numbness in fingers and toes
• Loss of coordination
• Cognitive or mental symptoms
• Profound confusion
• Agitation or other unusual behaviour
• Slurred speech
• Coma and other disorders of consciousness

Traumatic brain injuries are usually caused by a blow or other traumatic injury to the head or body. The degree of damage can depend on several factors, including the nature of the injury and the force of impact.

Common events causing traumatic brain injury include the following:

• Falls
• Vehicle-related collisions
• Violence
• Sports injuries
• Explosive blasts and other combat injuries.

A medical exam is the first step to diagnose a potential brain injury. Assessment usually includes a neurological exam to evaluate thinking, motor function (movement), sensory function, coordination, eye movement, and reflexes.

Imaging tests, including CT and MRI scans, cannot detect all traumatic brain injuries but can discover bleeding that may require immediate medical or surgical attention.

Treatment is based on the severity of the injury. Mild traumatic brain injuries usually require no treatment other than rest and over-the-counter pain relief to treat a headache. However, a person with a mild traumatic brain injury must be monitored closely at home for any persistent, worsening or new symptoms.

Emergency care for moderate to severe traumatic brain injuries focuses on ensuring the patient has enough oxygen, and adequate blood supply, maintaining blood pressure, and preventing further damage to the head or neck.

People with severe injuries may also have other injuries that need to be addressed. Additional treatments in a hospital’s emergency room or intensive care unit will minimise secondary damage due to inflammation, bleeding or reduced oxygen supply to the brain.

Emergency surgery may be required to minimise additional damage to brain tissue, including:

• Removing clotted blood (haematomas)
• Repairing skull fractures
• Bleeding in the brain or pressure inside the skull

Postoperative care

• Keep the wound dry for five days. You can get wet in the shower, but pat the area dry rather than rub.
• Do not use shampoo for ten days postoperatively
• GP review for wound review and removal of staples on day seven.
• No driving for at least three months until review with Dr Shiva
• Monitor for any wound redness, discharge or fevers
• Monitor for new symptoms, including worsening headaches, upper or lower limb symptoms, speech or visual symptoms, seizures
• Six-week review with Dr Shiva