Neurocritical Care

NCC Q&A - Traumatic Brain Injury

What is a traumatic brain injury (TBI)?
Traumatic brain injury lies on a spectrum from mild to severe.  A concussion is a form of mild traumatic brain injury in which the patient has no evidence on imaging of brain injury but may/may not have lost consciousness, have headache and memory problems.  Severe brain injuries can cause patients to be in a coma (not responsive to stimulation.) 

Are there different types of TBI?
There are multiple types of TBI.  Often the type of injury depends on the mechanism.  Blunt trauma (getting hit in the head) often causes a different type of injury than a car accident or fall.  Patients can have contusions, which are bruises on the brain.  They can also have collections of blood (hematoma) above or below the protective lining (dura) of the brain.  There are also shear/stretch types of injury where the nerves in the brain get stretched, torn and sometimes bleed.  The way a patient acts with their injury depends on the location and the extent of the injury.

How are patients treated when they have a TBI?
Patients with mild injuries may be sent home and follow up with their doctor.  More severe injuries require admission to the hospital for close monitoring of the patient’s neurologic exam.  Sometimes with a severe injury, patients require surgery to remove a blood clot or to remove part of the skull to help manage swelling.  If there is concern for significant swelling of the brain based on imaging (CAT scan), patients may have a monitor placed to help follow the brain pressures so they can be treated if they are too high.  Just like high blood pressure, high brain pressure can be dangerous.

How long does it take to recover from a TBI?
The time frame  for recovery depends on the severity of the injury.  For severe TBI, it can take months to years to know the extent of recovery.  This does not mean all the time is spent in the hospital but time required for skilled care and rehabilitation.  Patients with severe injuries sometimes require long term assistance with breathing (tracheostomy) and a feeding tub placed within the stomach.  Sometimes an injury is so severe, either large parts of the brain injured or very important structures damaged, that patients are not able to have a functional recovery.  Functional recovery is often defined as being able to interact with others and the ability to care for oneself.