by Katharina Cangl
Causes
You are driving at 90 mph in the rain when you suddenly hit a tree. The impact from your car colliding with the object causes you to jolt forward and put your head through the windshield.
You now have a blunt Traumatic Brain Injury (TBI), which is caused by a jolt or hit to the head that is hard enough to make your brain move or twist inside your skull.
Alternatively, when an object such as a bullet or knife penetrates the skull and enters the brain, it can also result in brain injury. In either case, time is of the essence for survival.
Symptoms
Initially, after the impact, you lose consciousness.
You come to in the ambulance, which was called by witnesses of the accident, but something is off. You can't see or hear properly, and you feel very aggressive. When you attempt to say something to the paramedics tending to you, you notice that you are having trouble forming words.
These symptoms are common for TBI and are the result of chemical changes in the brain caused by injury to the blood vessels and damage to the brain.
Diagnosis
Before you are taken to the nearest hospital, first responders assess your ability to follow directions, such as moving your limbs and eyes as instructed. They also check your coherence of speech.
All the information they gather from the evaluation is scored on the Glasgow Coma Scale, which goes from three to 15. The higher you score, the less severe your injury is, and the better your outcome will likely be.
Once your ambulance arrives at the hospital, you are put through a series of imaging tests so the doctors can determine the next steps in your treatment.
A CT scan, which employs X-rays to generate a detailed image of the brain, is first. Here, fractures, bleeding (hemorrhage), blood clots (hematomas), bruising (contusions), and swelling of brain tissue are detected.
Once your condition stabilizes, an MRI may be performed. Physicians use this test to look at the blood flow to certain areas of your brain.
Finally, brain swelling causes a dangerous pressure buildup in the skull. To keep watch on this, an intracranial pressure monitor will be inserted through your skull.
Additionally, it is crucial that the medical professionals treating you find out as much about the injury as possible. Witnesses will have to answer questions like, but not limited to, "how did the injury happen?" "Did the person become unconscious and if so, for how long?" as well as "Where was the head struck?"
Initial treatment
The tests show that you have a skull fracture and a brain bleed. This means that you require emergency surgery, where a part of your skull is removed, to allow the doctors to control the hemorrhage. This procedure is called a craniotomy.
After TBI, patients may also suffer from hematomas in the brain, which are caused by profuse bleeding in or outside of the brain, resulting in blood clots. Another problem that TBI patients face is the previously mentioned pressure buildup in the skull, which in the worst case, can lead to brain death.
These issues would also need to be addressed with a craniotomy. In TBI patients, it is common that the brain swelling doesn’t go down immediately after surgery. In this case, a window is opened in the skull to give the brain room to swell. This procedure is referred to as a craniectomy.
Your surgery is successful, but you are not out of the woods. People who had a severe brain injury are at risk for seizures in the first week after the injury, which is why you are given anti-seizure drugs.
You are also put into a medically induced coma because that way your brain needs less oxygen to function. This is important, as your blood vessels are compressed by the swelling in your brain and can therefore not supply the brain cells with enough oxygen.
Finally, you are supplied with diuretics, which are drugs that increase urine output and reduce the amount of fluid in tissues, such as your brain, ultimately reducing swelling.
Rehabilitation
In the first few days following your accident, you remain in a coma, where your eyes are closed continuously, and you are unresponsive.
As swelling decreases and blood flow in your brain improves, you enter the stage of unresponsive wakefulness. You can now breathe on your own, and you even have wake-sleep cycles. Additionally, during this stage, you make small movements, none of which are intentional.
Once the swelling in your brain goes down, surgeons reimplant the piece of your skull which they removed previously. This procedure is called a cranioplasty.
In time, you enter the minimally conscious state, in which you are partially conscious and aware of where certain sounds and visual cues are coming from. You can respond to questions and show emotion; however, all of this is very inconsistent. Once you are able to answer simple questions correctly or identify at least two different objects, you are considered out of this state.
Even though you are now well on the road to recovery, the minimally conscious state is followed by a period of confusion and disorientation. You become agitated easily and are very sensitive to light and noise. This is scary for you and your loved ones because it is extremely out of character; however, you are lucky. Other TBI patients experience hallucinations during this period, and they can’t differentiate between what is real and what isn’t. Regardless of what your symptoms are, this stage of recovery lasts a few days to a few weeks.
It’s a bumpy road, but you make it through the initial stages of recovery. Now it is time to focus on regaining as much mental and physical function as possible. You do this by working with a physical therapist, occupational therapist, language therapist, and recreational therapist. Additionally, you receive help from a physiatrist, who oversees the rehabilitation process, and a neuropsychologist, who assesses your mental state and shows you how to cope with your trauma and manage bad behavior that resulted from it. Finally, a rehabilitation nurse is in charge of planning when you should be discharged from the hospital and rehabilitation center, as well as caring for you while you recover.
All of your and the medical staff's hard work pays off, and you see lots of improvement in the first six months after your injury.
As more time passes, you notice that you aren’t recovering as fast anymore. This is normal because the biggest progress in TBI patients is usually seen in the first six months post-injury.
Long-Term Impact
Fast forward to two years after your traumatic brain injury. You can now move without help, as well as bathe and dress yourself. You are lucky because 30 percent of TBI survivors require assistance in these areas even two years after their injury.
You have trouble focusing and thinking fast.
Just like 50 percent of TBI patients, you go back to driving, and like 30 percent of TBI survivors, you return to work with the help of a vocational counsellor.
Unfortunately, you are afflicted with major depression, caused by the brain injury, the trauma you have endured, and the impact it had on your life. This is common among TBI patients, with 25 percent sharing your fate.
Sources
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https://physicsworld.com/a/advanced-algorithm-predicts-outcome-for-patients-with-severe-brain-injury/ Assessed and Endorsed by the MedReport Medical Review Board