What is Traumatic Brain Injury?

Traumatic brain injury, also called TBI, occurs when an outside force injures the brain. This may happen after a fall, motor vehicle accident, sports injury, assault, blast injury, or penetrating head injury. TBI can range from a mild traumatic brain injury, often called a concussion, to a severe injury involving bleeding, swelling, skull fracture, or pressure on the brain.

A traumatic brain injury can affect thinking, memory, mood, balance, vision, speech, movement, sleep, and level of alertness. Some symptoms appear immediately, while others develop hours or days after the injury. Even when the initial injury seems mild, worsening symptoms should be evaluated promptly.

De Novo Brain & Spine evaluates adult patients with traumatic brain injury-related neurosurgical concerns, including subdural hematoma, epidural hematoma, intracerebral hemorrhage, brain swelling, skull fracture, hydrocephalus, post-traumatic neurological deficits, and the need for surgical treatment planning after emergency evaluation.

Common Signs and Symptoms

Traumatic brain injury symptoms depend on the severity of the injury, location of brain involvement, presence of bleeding or swelling, and whether the skull or blood vessels are affected.

Common signs and symptoms may include:

• Headache
• Nausea or vomiting
• Dizziness or balance problems
• Confusion or feeling dazed
• Brief loss of consciousness or decreased alertness
• Memory loss before or after the injury, called amnesia
• Trouble concentrating or slowed thinking
• Blurred vision, double vision, or sensitivity to light
• Ringing in the ears or sensitivity to sound
• Fatigue, drowsiness, or sleep changes
• Mood changes, irritability, anxiety, or depression symptoms
• Weakness, numbness, or tingling in the face, arm, or leg
• Trouble speaking, slurred speech, or difficulty understanding speech
• New-onset seizure
• Unequal pupils or trouble with eye movement in some cases
• Worsening headache, repeated vomiting, or increasing confusion after a head injury

Seek emergency medical care or call 911 for loss of consciousness, seizure, repeated vomiting, worsening headache, sudden weakness, sudden speech difficulty, severe confusion, unequal pupils, clear fluid from the nose or ears, severe drowsiness, or rapid neurological decline after head trauma.

What Causes This Condition?

Traumatic brain injury is caused by an external force that disrupts normal brain function. The injury may be caused by direct impact, rapid acceleration or deceleration, penetrating trauma, blast exposure, or a combination of these mechanisms.

Common causes and related factors may include:

• Falls
• Motor vehicle crashes
• Motorcycle, bicycle, or pedestrian accidents
• Sports-related head injury
• Assault or physical violence
• Blast injury or combat-related trauma
• Penetrating injury from an object or projectile
• Work-related or construction-related head trauma
• Skull fracture
• Bleeding around or within the brain, such as subdural hematoma, epidural hematoma, subarachnoid hemorrhage, or intracerebral hemorrhage
• Brain swelling, also called cerebral edema
• Diffuse axonal injury, which can occur when rapid motion damages brain connections

These causes or mechanisms do not determine severity by themselves. Treatment planning depends on the neurological examination, imaging findings, injury mechanism, bleeding or swelling, skull fracture, age, medication use, and overall health.

How It Is Diagnosed?

Traumatic brain injury is diagnosed through medical history, injury history, neurological examination, and imaging when appropriate. Because symptoms can change over time, follow-up evaluation may be important after head trauma.

Common diagnostic steps may include:

• Medical history and injury history to understand how the injury occurred, when symptoms began, and whether there was loss of consciousness, amnesia, seizure, vomiting, or worsening symptoms
• Neurological examination to evaluate alertness, orientation, speech, vision, eye movement, facial movement, strength, sensation, coordination, balance, reflexes, and memory
• Glasgow Coma Scale, also called GCS, to help describe level of consciousness after head injury
• CT scan of the head, often used in urgent settings to evaluate bleeding, skull fracture, swelling, mass effect, or other acute findings
• MRI of the brain in selected cases when more detailed evaluation of brain tissue, diffuse axonal injury, small hemorrhages, or persistent symptoms is needed
• CT angiography, also called CTA, in selected cases when vascular injury, aneurysm, dissection, or traumatic vessel injury is suspected
• Blood tests to evaluate bleeding risk, blood count, clotting function, medication effects, and other medical factors when appropriate
• Intracranial pressure monitoring in selected severe TBI cases when pressure inside the skull is a concern
• Repeat CT or MRI imaging when symptoms worsen, bleeding needs monitoring, or swelling may be changing
• Cognitive, vestibular, vision, or rehabilitation evaluation in selected patients with ongoing post-concussion or neurological symptoms

The goal of diagnosis is to determine the severity of injury, identify bleeding or swelling, assess neurological function, and decide whether observation, medication, rehabilitation, surgery, or urgent hospital care may be needed.

Treatment Options

Traumatic brain injury treatment depends on the severity of injury, symptoms, neurological examination, CT or MRI findings, bleeding, swelling, skull fracture, medication history, age, and overall health. Not every traumatic brain injury requires surgery, but some injuries require urgent treatment.

Treatment options may include:

• Observation and neurological monitoring for selected mild traumatic brain injuries or concussions when imaging and symptoms support safe monitoring
• Rest and gradual return to activity after concussion when guided by a healthcare professional
• Medication for symptom control, such as headache, nausea, sleep disturbance, or seizure management when clinically appropriate
• Anti-seizure medication in selected patients when seizures occur or when seizure prevention is medically indicated after certain injuries
• Reversal of blood-thinning medication when appropriate and medically indicated after traumatic bleeding
• Blood pressure, oxygen, and intracranial pressure management in moderate or severe TBI
• External ventricular drain, also called an EVD, when hydrocephalus or elevated intracranial pressure requires CSF drainage and pressure monitoring
• Craniotomy for hematoma evacuation when a traumatic blood clot causes pressure on the brain or neurological decline
• Surgical treatment of epidural hematoma, subdural hematoma, or intracerebral hemorrhage in selected cases based on size, location, symptoms, and imaging findings
• Decompressive craniectomy in selected severe TBI cases when brain swelling causes dangerous pressure
• Repair or management of depressed skull fracture when bone fragments, open injury, contamination, or pressure on the brain requires surgical evaluation
• Treatment of hydrocephalus when trauma disrupts normal cerebrospinal fluid flow
• Rehabilitation, including physical therapy, occupational therapy, speech therapy, vestibular therapy, cognitive therapy, and neuropsychological support when needed
• Follow-up care for post-concussion symptoms when headaches, dizziness, memory problems, mood changes, sleep issues, or concentration problems persist

Neurosurgical treatment may be considered when traumatic brain injury causes brain bleeding, skull fracture, pressure on the brain, hydrocephalus, neurological decline, or imaging findings that require surgical evaluation. The safest treatment plan depends on the injury pattern and the patient’s individual condition.