TBIs

Traumatic brain injury (TBI) refers to brain dysfunction caused by an external mechanical force. Common causes include falls, motor vehicle crashes, assaults, and sports injuries. TBIs range in severity from mild concussions to severe brain injury and can result in temporary or permanent impairment.

Pathophysiology involves primary injury at the time of impact and secondary injury from processes such as hypoxia, ischemia, swelling, and inflammation that can worsen damage. Mechanisms include focal contusions, hematomas, and diffuse axonal injury, which may occur together.

Classification generally follows severity: mild TBI (often called a concussion) with brief loss of consciousness or confusion, or none at all; moderate to severe TBI with longer impairment or coma. Symptoms are heterogeneous and may include headache, dizziness, nausea, confusion, amnesia, cognitive or behavioral changes, sleep disturbance, and, in children, irritability or fatigue.

Diagnosis relies on clinical assessment and imaging. The Glasgow Coma Scale is used to gauge initial level of consciousness. CT scans are commonly employed acutely to detect intracranial hemorrhage or mass effect; MRI may reveal injuries not seen on CT. Neuropsychological testing can help evaluate cognitive effects. Management emphasizes stabilization, prevention of hypoxia and hypotension, and monitoring for rising intracranial pressure. Mild TBIs often require rest and a gradual return to activity, while moderate to severe cases may need surgery to evacuate hematomas and intensive rehabilitation, including physical, occupational, and speech therapy.

Prognosis varies with severity, age, and comorbid conditions. Most individuals with mild TBI recover within days to weeks, but some experience persistent symptoms or cognitive and emotional changes. Repeated TBIs increase the risk of longer-term problems, including chronic traumatic encephalopathy. Prevention includes helmet use, fall prevention, seat belts, safe driving, and protective measures in sports.