A traumatic brain injury (TBI) is an injury to the brain caused by a trauma to the head resulting from an external force. This can lead to temporary or permanent impairment of brain function. The severity of a traumatic brain injury can vary greatly, with injuries to the bones, scalp and meningeal membranes (meninges) differing from actual brain injuries. Treatment options for patients range from conservative therapeutic measures to surgical interventions.

Schädel-Hirn-Trauma

Overview

The brain is generally well protected by the skull. Nevertheless, severe force applied to the head can lead to brain damage.

There are two possible causes of injury to the head region:

Direct damage to the brain as a result of physical force: Doctors refer to an injury to the top of the skull which exposes the inside of the skull as an open traumatic brain injury. Severe direct traumatic brain injuries can cause permanent damage. With such injuries, the risk of infection for the brain and the surrounding structures increases.

Indirect damage to the brain as a result of physical force: This includes bleeding and oedema, for example. The extent of indirect damage to the brain can often be reduced if suitable therapeutic measures are initiated at an early stage.

Severity of traumatic brain injury

The severity of a traumatic brain injury can be determined by the score achieved on the Glasgow Coma Scale (GCS). The Glasgow Coma Scale is a system for classifying impaired consciousness and brain function following a traumatic brain injury. It was developed by neurosurgeons Graham Teasdale and Bryan J. Jennett at the University of Glasgow in 1974.

Depending on the severity of brain damage, a variety of symptoms can occur. Severe traumatic brain injury can be life-threatening and is one of the commonest causes of severe neurological impairments.

Particularly severe cases of traumatic brain injury require an intensive rehabilitation programme. It may be necessary for patients to re-learn basic functions such as walking or speaking. Long-term effects in the form of neurological deficits often occur in patients following a severe traumatic brain injury.

Overview of traumatic brain injury severity

The following overview summarises the three severity levels for traumatic brain injury based on the GCS score, the typical injury and the treatment.

Grade

GCS score

Injury

Treatment

Grade 1 TBI

13–15 score

Concussion (commotio cerebri); usually no permanent structural brain damage

Monitoring for 48–72 hours to rule out cervical spine/facial skull fractures and intracranial bleeding; usually no special treatment required

Grade 2 TBI

9–12 score

Cerebral contusion (contusio cerebri); injury to brain tissue, usually caused by direct force

Inpatient monitoring with imaging checks; medicinal and intensive care measures depending on the findings

Grade 3 TBI

3–8 score

Cerebral compression (compressio cerebri); due to increased intracranial pressure (cerebral haemorrhage, cerebral oedema) or direct-impact injuries

Intensive care treatment, often artificial coma; if necessary, neurosurgical interventions (removal of bleeding, decompressive craniectomy); measurement of brain pressure using a probe

GCS = Glasgow Coma Scale. CS = cervical spine.

Causes of traumatic brain injury

Road traffic accidents, workplace accidents, domestic accidents and sports accidents are the most common causes of traumatic brain injury. Less common causes are falls as well as blows to the head and gunshot injuries.

Symptoms of traumatic brain injury by degree of severity

Traumatic brain injuries have different symptoms depending on the severity and type of injury incurred. The following overview shows which symptoms can occur with traumatic brain injuries, depending on their severity.

Grade

Symptoms

Grade 1 TBI

Concussion. Possible symptoms:

  • Brief loss of consciousness (usually just a few seconds to minutes)
  • Light-headedness upon waking
  • Nausea
  • Vomiting
  • Dizziness
  • Impaired vision
  • Memory loss about the event (retrograde or anterograde amnesia)

Grade 2 TBI

Symptoms similar to grade 1, but primary unconsciousness lasts longer than 15 minutes.

Grade 3 TBI

Symptoms similar to grades 1 and 2, but primary loss of consciousness lasts for days or even weeks. In the case of severe TBI, the following are also possible:

  • Speech impairment
  • Sensory impairment
  • Paralysis
  • Epileptic seizures

Symptoms can occur immediately after the injury or develop over several hours or days.

External injuries

The following can occur for any grade:

  • Bleeding from head injuries
  • Swelling
  • Blood or cerebral fluid leaking from the nose or ear canal

How is traumatic brain injury diagnosed?

Various clarifications are carried out to determine the severity of the brain damage. First, a neurological examination is required. Especially in the case of unconscious patients, radiological examinations are also carried out, such as:

  • computed tomography of the brain
  • MRI scan of the brain.

These procedures enable the extent of the injury to be determined quickly and reliably.

Treatment 

Minor injuries

An injury to the head of a patient does not necessarily have to be accompanied by bleeding or neurological damage. Nevertheless, medical clarification should be carried out even for seemingly harmless injuries.

No special treatment is required for mild traumatic brain injuries. Nevertheless, patients are monitored for a period of 48 to 72 hours, depending on the findings and individual risk factors, before they are finally discharged home.

Concussion is the mildest form of TBI. You can find further information on the treatment of concussion here.

Serious injuries

In the case of severe traumatic brain injury, patients are often kept in an artificial coma to protect their brain. If patients develop severe brain injuries with cerebral haemorrhage, neurosurgical haemorrhage removal is usually required. In some cases, parts of the cranial bone must also be removed and the brain kept exposed for some time to counteract the life-threatening increase in pressure in the brain.

Serious injuries can also be accompanied by increased cerebral pressure. If elevated cerebral pressure is suspected, pressure sensors are used to measure the pressure, which provide important information for the treatment and monitoring of patients. Depending on the cause and situation, various medication and intensive care measures are also used.

Prevention

It is not always possible to prevent traumatic brain injury, but the risk of developing a TBI can be significantly reduced by taking appropriate protective measures. Wearing a helmet while cycling, motorcycling or doing winter sports can prevent head injuries and prevent the serious consequences of TBI. Using a seat belt in the car as well as ensuring a safe environment also help to prevent accidents and falls.

FAQ

How can a traumatic brain injury be prevented?

In some cases, a traumatic brain injury can be prevented by wearing seat belts or a helmet, for example. Particularly when doing exercise or sport and travelling by road, protective measures help reduce the risk of serious consequences, including neurological disorders, bleeding or severe headaches.

Do people with traumatic brain injury have memory problems?

Yes, memory problems can occur with traumatic brain injury. Particularly after suffering severe injuries, memory and concentration problems can occur. These symptoms may improve over time and are treated if necessary.

What are the possible consequences of traumatic brain injury?

The type of traumatic brain injury depends on the severity of the injury. Common symptoms include headaches, dizziness and difficulty concentrating. In the case of severe traumatic brain injury, neurological impairments or permanent impairments may also occur.

What are long-term effects of traumatic brain injury?

Long-term effects of traumatic brain injury can also appear after acute treatment. These include memory problems, fatigue, problems concentrating or impaired mobility. Targeted therapy and rehabilitation can aid recovery in such cases.

When can patients return to doing exercise or sport after a traumatic brain injury?

After a traumatic brain injury, patients should return to exercise and sport gradually, depending on their symptoms. The level of exertion can only be gradually increased once symptoms such as headaches or dizziness have subsided. Returning to doing sport and exercise should always be discussed with a doctor in order to avoid risks and to correctly assess the level of exertion on an individual basis.

How long are you on sick leave with traumatic brain injury?

The duration of sick leave after a traumatic brain injury depends on the severity and the individual symptoms. In the case of a grade 1 traumatic brain injury, the recovery time is often shorter, while more serious injuries may require a longer recovery period.

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