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Traumatic Brain Injury

What Is Traumatic Brain Injury?

Traumatic Brain Injury (TBI) occurs when a severe jolt or blow to the head leads to brain damage. It can also result when an object, such as a bullet or shrapnel, pierces the brain.

TBIs are commonly caused by sports injuries, falls, acts of violence, and collisions involving drivers or bikers. Symptoms can appear immediately after the incident or gradually emerge in the days that follow. A concussion, which is a type of TBI, results from a hit to the head or body that causes rapid movement of the head and brain. Typically, a person should seek medical attention after a severe blow to the head, especially if it seems to have altered the person’s behavior.

Injuries are categorized as mild, moderate, or severe based on how long the person was disoriented and unconscious, as well as on brain scan results. Different people with TBIs can experience symptoms that differ in nature and degree. They may experience headaches, nausea, disorientation, drowsiness, trouble sleeping, slurred speech, or loss of consciousness. They may also struggle with concentration, memory, decision making, impulse control, or depression. In the sensory domain, they may hear ringing in their ears, have vision impairments, or be especially sensitive to light and sound.

TBIs are quite common. About 2.87 million emergency department visits, hospitalizations, and deaths were attributed to TBIs in the United States in 2014, according to the Centers for Disease Control and Prevention. That number increased by 53 percent between 2006 and 2014.

Can a Head Injury Change Behavior?

Head injuries do have the capacity to alter behavior, and those changes depend on the severity and number of injuries. Short-term changes include feeling dizzy, confused, and exhausted. An injured person could have a headache, nausea, blurred vision, ringing in the ears, and sensitivity to light and sound.

Most people recover smoothly within a few weeks and show no permanent harm. But in some cases, lasting changes occur. People who suffer a TBI may lose the ability to concentrate as intently as they did previously, which may manifest at work, in conversations, or in household tasks. They may struggle to remember events or facts. Personality may shift as well: One may become more irritable, angry, or impulsive, or less able to exercise self-control. TBI sufferers may struggle with depression and anxiety, as well as sleep disturbances.

Repeated concussions can lead to Chronic Traumatic Encephalopathy (CTE), a neurodegenerative disorder that may be linked to severe changes in memory and impulse control, anxiety and depression, and suicidal thoughts or behavior. Many prominent athletes have posthumously been diagnosed with CTE—which has triggered a global discussion about the science, ethics, and commercialization of football and other contact sports.

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How Is a Head Injury Treated?

It's important to seek medical attention for any head injury, even if there are no immediately apparent symptoms. (Brain swelling may take hours or longer to manifest.)

Mild TBIs, which include concussions, are treated with rest and over-the-counter medication for headaches. The person can then gradually resume physical and mental tasks in accordance with a doctor's guidance, so as not to overwork the brain or prevent a full recovery.

Moderate and severe injuries are treated with a combination of medication, surgery, and rehabilitative therapies. Patients are first stabilized to prevent further injury, which may include controlling blood pressure and ensuring proper blood flow to the brain. Surgery may be necessary to repair a fracture in the skull, remove blood clots, or drain excess fluid from the brain. Medications may be prescribed to prevent blood clots (anticoagulants), stop seizures (anticonvulsants), or address anxiety and depression (antianxiety and antidepressant medications).

Patients may engage in a variety of therapies. Physical therapy can help one regain strength and movement, occupational therapy can restore the ability to carry out daily tasks, speech therapy can improve communication, and cognitive therapy can hone memory and concentration.

How a Head Injury Changes the Brain

A sudden jolt can send the delicate brain crashing into the hard skull that surrounds it. This can cause the brain tissue to bruise or swell where it collided with bone.

It can also strain a part of neurons called axons, which facilitate communication between brain cells. The force can stretch and rip axons apart, leading them to release chemical toxins that kill other brain cells.

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