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  • Patients who are injured while working or in a car accident are often afraid to seek medical care because of insurances issues and legal concerns.
  • Sometimes after an injury, patients are waiting weeks to be seen for their immediate injuries, and while waiting develop secondary injuries, which can be disabling. And by the time patients see a Neurologist because of delays, it is often too late to prevent long term neurologic damage.

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Types and Treatments of Traumatic Brain Injuries

Types and Treatments of Traumatic Brain Injuries

In the United States, approximately 2.8 million people suffer a traumatic brain injury (TBI) every year, and 14.3% are the result of car accidents. The symptoms of traumatic brain injuries vary from a brief change in the mental state to death, depending on the severity of the injury. There are surgical and nonsurgical treatment options for a traumatic brain injury, but a diagnosis is the first step. 

What is a Traumatic Brain Injury?

A TBI is a sudden trauma to the head that causes a disruption in the normal function of the brain. Doctors break it down into two stages: primary and secondary injuries. 

Primary and Secondary Injuries

The primary injury occurs at the moment of impact during a head injury and affects either all or part of the brain. In a car accident, the primary injury may include bleeding or bruising caused by an object striking the head. An abrupt stop at high speed could be enough to cause a TBI. The secondary injury, or delayed trauma, follows the primary impact and occurs when the brain swells and causes pressure on the skull. The second phase of a TBI is often more damaging than the primary injury. 

TBI Classifications

Doctors measure the severity of a TBI by how long the person suffers a change of mental status or loss of consciousness. They gauge mental status change using the Glasgow Coma Scale, a points system that tests eye-opening response, motor response, and verbal response.

A mild, moderate, or severe TBI can present in different periods of loss of consciousness. The measurements of each are:

  • Mild: 30 minutes or less
  • Moderate: 30 minutes to 6 hours
  • Severe: six hours or more

Roughly 75% of TBIs are mild. A mild TBI may temporarily affect the brain cells without causing permanent damage. A severe traumatic brain injury may cause long-term complications or even death. 

What are the Types of Traumatic Brain Injuries?

What are the Types of Traumatic Brain Injuries

Doctors typically identify TBIs as closed or open injuries. An open injury occurs when a break in the skull leaves the brain exposed. Closed injuries do not damage the skull. Treatment for traumatic brain injuries varies based on the eight main types that can occur. 

1. Concussion

A concussion occurs when an object strikes the head with a strong force, causing the brain to collide with the skull. Concussions also have varying degrees of severity and can cause long-term complications, especially if left untreated. Symptoms that persist beyond a month are usually indicative of post-concussion syndrome, which is a treatable condition. Concussions are the most common type of TBI diagnosed by an auto accident doctor.

Concussion

2. Contusion

Contusions are a form of bruising or mild bleeding. In the event of head injuries resulting in TBI, a contusion typically accompanies a concussion, and when it does not heal on its own, it may become a hematoma. The severity of a contusion on the brain depends on its location and size.

3. Coup-Contrecoup Brain Injury

As the French words coup, meaning blow, and contrecoup, meaning counterblow, imply, a coup-contrecoup brain injury is actually two separate injuries. These are most common in car accidents where a person’s head hits a hard surface, such as the steering wheel or window, and the brain collides with the skull at the place of impact before bouncing back and hitting the other side of the skull. The coup injury is the initial injury from the point of impact, and the rebound causes the contrecoup injury. 

4. Diffuse Axonal Injury

A diffuse axonal injury (DAI) occurs when a violent shake or twist of the brain causes cerebral tissue to slide back and forth until the axons, or connecting fibers, tear. Medical professionals refer to these tears as axonal shearing, and it can result in a loss of brain function. The severity of a DAI depends on the size and location of the tears. Larger, more numerous tears result in more serious effects. DAIs are among the most serious traumatic brain injuries. 

5. Intracranial Hematomas

An intracranial hematoma is the collection of blood outside of the blood vessels. These sometimes take days or weeks to develop and are potentially deadly if left untreated.

The most common types of hematomas are:

  • Intracerebral hematoma, which occurs in the brain
  • Epidural hematoma, which occurs between the brain and skull
  • Subdural hematoma, which occurs between the brain and the thin layer surrounding it

A hematoma usually shows up in the medical imaging an auto accident doctor orders following a collision. 

6. Penetrating Brain Injury 

A penetrating brain injury occurs when an object penetrates the skull and brain. These are less common in auto accidents, but people who have suffered penetrating head wounds have a higher likelihood of developing epilepsy and needing long-term treatment for traumatic brain injuries. 

7. Hemorrhage

Uncontrolled bleeding in or around the brain is brain hemorrhage. The two types are subarachnoid hemorrhages, which occur outside of the brain in the surrounding area, and intracerebral hemorrhages, which occur inside the brain.

8. Recurrent Traumatic Brain Injury

Second impact syndrome, or recurrent traumatic brain injury, occurs when a person suffers two brain injuries within a short period of time. The second injury typically causes more damage and is sometimes overlooked if the person did not lose consciousness after the second.

Focal vs. Diffuse TBIs

Focal vs Diffuse TBIs

TBIs fit into two subtypes: focal brain injury and diffuse brain injury. The difference between the two is location. Focal injuries occur in a single location, while diffuse injuries are more widespread. Coup-contrecoup, contusions, and intracranial hemorrhage are focal brain injuries. Symptoms typically present as behavioral changes, such as anger, social inappropriateness, visual changes, and speech difficulties.

Diffuse injuries are more common. Concussions and diffuse axonal injuries are examples. When serious, these injuries present a higher risk of temporary or permanent widespread brain damage, sometimes resulting in coma or death in the most severe cases. 

What are the Symptoms of a Traumatic Brain Injury?

An auto accident doctor looks for a wide range of symptoms that manifest physically and psychologically. For a better understanding of the severity scale, look at the types of symptoms by mild and moderate to severe TBI. 

Symptoms of Mild TBI

Symptoms of Mild TBI

Common physical symptoms of mild TBI may include:

  • Headache or dizziness
  • Difficulty speaking
  • Drowsiness or fatigue
  • Loss of balance
  • Nausea or vomiting

Common cognitive and behavioral symptoms include:

  • Difficulty sleeping or sleeping more often than usual
  • Sensitivity to light or sound
  • Mood swings
  • Sensory changes, such as ringing in the ears, blurred vision, changes in smelling ability, or a bad taste in the mouth
  • Disorientation or confusion
  • Struggling with memory or concentration
  • Loss of consciousness lasting up to a few minutes
  • Depressed or anxiety

The number of symptoms that present varies by the injury’s level of severity.

What are the Types of Traumatic Brain Injuries

Symptoms of Moderate to Severe TBI

Treatment for traumatic brain injuries starts with symptom assessment, and moderate to severe TBIs may include any of the symptoms mentioned for a mild TBI as well as these physical symptoms:

  • Loss of consciousness ranging from several minutes or hours to coma or other disordered consciousness
  • Headache that worsens and never goes away
  • Clear fluids leaking from the nose or ears
  • Seizures
  • Numbness or weakness in extremities
  • Loss of coordination
  • Consistent nausea or vomiting
  • Dilation of the pupils in one or both eyes

There are mental symptoms to watch for as well:

  • Extreme confusion
  • Any unusual behavior, such as combativeness or agitation
  • Inability to wake from sleep
  • Slurred speech

Some symptoms may take hours or days to appear. The US Centers for Disease Control and Prevention (CDC) lists several of the moderate to severe symptoms as danger signs in adults and children. Additionally, infants or toddlers may present as inconsolable and will not nurse or eat.

Some other symptoms to look for in children are:

  • Unusual irritability
  • Sadness or loss of interest in their favorite toys or activities
  • Deviation from normal sleep habits

The most at-risk demographics for traumatic brain injuries include males, children from newborn to 4 years old, young adults from ages 15 to 24, and adults age 60 and older. 

How is a Traumatic Brain Injury Diagnosed?

How is a Traumatic Brain Injury Diagnosed

An auto accident doctor or neurologist has a few ways to reach a diagnosis before discussing treatment for traumatic brain injuries. The first step is to ask questions about the nature of the car accident and the symptoms the patient experienced.

Some common questions include:

  • Was there a loss of consciousness, and if so, how long was the person unconscious?
  • How forceful was the impact that caused the injury?
  • Where was the head struck?
  • Was the person’s body severely jarred by the impact?

The next step may include a neurological exam to assess the autonomic nervous system, mental status, coordination, balance, reflexes, cranial nerves, and ability to feel sensations. 

Most doctors will order imaging tests for a potential TBI. The tests include a computerized tomography (CT) or magnetic resonance imaging (MRI) scan. Doctors typically order the CT scan first. It collects details of the brain using multiple X-rays and provides a visual of any hematomas, hemorrhages, contusions, or swelling of the tissue. An MRI is more powerful than a CT scan. It uses radio waves and a magnetic field to create a computer-generated image of the brain.

What are the Treatment Options for a Mild Traumatic Brain Injury?

What are the Treatment Options for a Mild Traumatic Brain Injury

Treatment for a mild TBI depends on the symptoms that the person experiences. For pain, an auto accident doctor may prescribe pain relievers or sleep aids to help with difficulty sleeping.

The primary treatment is rest and a steady practice of self-management. Mild TBIs usually heal quickly, but some people deal with symptoms for an extended period. Doctors often recommend healthy lifestyle changes, including drinking plenty of water, eating a well-balanced diet, and getting enough sleep. 

What are the Treatment Options for Moderate to Severe Traumatic Brain Injuries?

Moderate to severe TBIs have several possible treatments, both surgical and nonsurgical. The most common treatment is the use of prescription medications. More severe TBIs often call for emergency treatments and rehabilitative therapy.

Medications

Doctors often prescribe medications to alleviate symptoms of moderate to severe TBIs. Some common medications include:

  • Muscle relaxants to reduce the occurrence of muscle spasms that cause pain and discomfort
  • Anti-anxiety medication or antidepressants to help with mood swings 
  • Anticoagulants to help prevent blood clots
  • Stimulants to aid issues with attentiveness or difficulty staying awake. 

Patients who deal with several symptoms may take a combination of these medications for a short term. 

Rehabilitative Therapies

There are a number of reasons patients may need rehabilitation as part of long-term treatment for traumatic brain injuries. An auto accident doctor or neurologist may recommend rehab for physical and emotional support, as well as to improve overall function. Rehab also aids in the prevention of common medical complications associated with a TBI. Examples include blood clots, dropping blood pressure, reproductive and sexual function issues, muscle spasm and weakness, bladder and bowel issues, difficulty breathing and respiratory disease, pressure ulcers, and general pain. 

There are several different types of rehab therapy:

  • Cognitive therapy improves judgment, memory, learning capabilities, perception, attention, and planning.
  • Sensory retraining is a form of cognitive behavioral therapy that uses sensory stimulation activities, such as acupuncture and electrical stimulation, to help patients regain sensory awareness.
  • Physical therapy restores strength, coordination, motor skills, and flexibility.
  • Vocational counseling helps patients deal with any workplace challenges that may arise so they may return to work or find more accommodating work.
  • Occupational therapy helps patients who have lost the ability to perform everyday tasks, such as brushing their teeth, getting dressed, or taking a shower.
  • Psychological counseling helps with overall emotional wellbeing and provides the tools to cope with relationships.
  • Speech therapy improves communication skills and diction. It also treats cognitive deficits and communication disorders, such as aphasia. Severe TBIs may also lead to a need for communication devices, and speech therapy provides the necessary training to operate the equipment.
  • Constraint-induced movement therapy helps patients avoid learned non-use following a TBI. Learned non-use is when patients get into the habit of avoiding using affected muscles, which can prevent their recovery.

Cognitive therapy is the most common approach to rehabilitation after a TBI. 

Brain Injury - Surgical Treatments

Surgical Treatments

Surgical intervention for the treatment of traumatic brain injuries is occasionally unavoidable. Skull fractures, intracerebral hemorrhages, and hematomas may require surgery, and most of them require very different types of operations. For example:

  • craniotomy with open surgery is a possible treatment for large hematomas. It entails the removal of a section of the skull to allow access to the brain. The surgeon then drains the hematoma to reduce intracranial pressure and repairs the broken blood vessel. 
  • Smaller hematomas usually respond to an aspiration procedure. The surgeon drills a small hole, or burr hole, into the skull and places rubber tubes into the hole to allow the blood from the hematoma to drain. This is less invasive than a craniotomy.
  • decompressive craniectomy treats intracranial pressure when medication is not successful. It also involves the removal of a portion of the skull, allowing the brain room to expand without further damage. This procedure also allows the removal of skull fractures to prevent penetration of brain tissue. 

The decompressive craniectomy is often an emergency procedure, and doctors always attempt to aspirate before resorting to more invasive surgery.

General Recovery Timeline for Traumatic Brain Injuries

All TBIs and recovery experiences are unique. Some patients move through treatments and rehabilitation quickly while others need extra time. Several factors, including age and treatment availability, play a role in the recovery process. The following general timeline may help patients understand what to expect from recovery after a severe TBI caused by a car accident. 

Early Recovery (0-2 Months After Injury)

The first two months of recovery includes three possible stages:

  1. A coma is a deep state of unconsciousness when the person is unresponsive to stimulants and appears asleep.
  2. A vegetative state is where the person may seem conscious because the eyes open and close, but it is just an autonomic response.
  3. The person presents minimal consciousness with a reduced and inconsistent reaction to stimulation.

As alertness returns, recovery speeds up quickly. There is no actual set timeframe for regaining consciousness because severity plays a major role in the process. In general, most coma patients remain unconscious for weeks. 

Faster Recovery State (3-6 Months)

The brain experiences a heightened state of plasticity in the first six months. Most patients respond best to treatment for traumatic brain injuries during this time. An auto accident doctor is familiar with assessing the needs of patients that suffered a TBI from a collision and may recommend several types of treatment. 

Continued Improvement (6 months-2 years)

Six months and beyond is a period of healing. Mobility usually returns within the first six months, and speech and cognitive abilities usually improve after a year. By the two-year mark, most patients see major improvements in motor function and cognitive ability. 

Best Neurologist in New York

Diagnosing and developing a treatment plan for traumatic brain injuries is often a complex process that requires the skills and expertise of neurologists. Visit the Neuro Injury Care Institute for a neurologic evaluation by a board-certified neurologist. We accept workers’ compensation, no-fault, PIP, and other insurance plans. Our goal is to prevent secondary injury and long-term disability.

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