Traumatic brain injury (TBI) is considered to be damage to the substance of the brain and skull bones as a result of exposure to a traumatic factor (mechanical force). can be combined with damage to the soft tissues of the head and facial skeleton. If the damage affects only soft tissues or bones of the facial skeleton, then such an injury is not craniocerebral. There are several types of TBI, which differ from each other in the nature of damage to the brain substance and clinical signs. TBI can be successfully treated without any consequences for the patient, or it can leave behind a significant defect with which a person will have to live the rest of his life. You can learn about the types of TBIs, what are their consequences, how rehabilitation after TBI is carried out, as well as the types of generic TBIs, you can learn from this article.
Types of TBI
Traumatic brain injury can be open (accompanied by a violation of the integrity of the aponeurosis) or closed (the aponeurosis is not damaged) To understand the classification of TBI, it is required to clarify that aponeurosis- this is a wide tendon plate located between the skin and the periosteum, otherwise called tendon helmet.
TBI can be:
- open (if it is accompanied by damage to the soft tissues of the head with injury to the aponeurosis, or it is a fracture of the bones of the cranial vault with injury to the adjacent tissues, or it is a fracture of the skull base with leakage of cerebrospinal fluid). If, with an open TBI, the dura mater is also damaged, then such an injury is called penetrating, if this membrane remains intact, then the injury is non-penetrating;
- closed (when there is no damage to soft tissues, or they are damaged, but the aponeurosis is intact).
It is generally accepted to divide TBI into several types (clinical types of damage to the brain and skull bones):
- fracture of the bones of the skull;
- (does not have degrees of severity, contrary to the general opinion of the population). This is a transient dysfunction of the brain after exposure to a traumatic factor. With a concussion, changes occur at the molecular level;
- (mild, moderate, or severe). It's like a wound inside the brain;
- compression of the brain (by a foreign body, depressed fracture of the skull, hygroma (accumulation of cerebrospinal fluid in the membrane), accumulation of air in the cranial cavity);
- intracranial hemorrhage (subarachnoid hemorrhage, hemorrhage in the cerebral ventricles, intracerebral hemorrhage, epi- and subdural hematomas);
- diffuse axonal injury (DAP). With this type of TBI, the axons that connect the cerebral cortex with the stem structures are torn. This is a very serious injury with poor rehabilitation potential.
Concussion and mild contusion are mild TBIs, moderate cerebral contusion is moderate trauma, severe cerebral contusion and DAP are severe trauma. Compression of the brain, intracranial hemorrhage can be both moderate and severe (depending on the specific situation). It is possible that the patient has several types of TBI at the same time (for example, brain injury and SAH, skull fracture and hematoma).
Hematomas can be:
- epidural - formed as a result of fractures of the bones of the skull with rupture of the meningeal artery or its branches. In this case, blood accumulates between the skull bone and the outermost shell of the brain;
- subdural - occur when the connective veins of the subdural space rupture or the arteries and veins of the cerebral cortex rupture. At the same time, blood accumulates between the arachnoid and the dura mater of the brain;
- intracerebral - when there is a rupture of a blood vessel deep in the medulla.
Signs of TBI
TBI is an insidious injury. Of course, in most cases, its presence is easy to establish by a number of symptoms. However, sometimes the first signs may appear several days or even weeks after the injury.
The signs of TBI are usually:
- loss of consciousness or confusion. Most often this occurs at the time of TBI, but it can also occur remotely. Impaired consciousness some time after injury is characteristic of intracranial hematomas;
- headache;
- unsteadiness when walking;
- nausea and vomiting;
- blurred vision, double vision;
- noise in ears;
- weakness and numbness in one or more limbs;
- speech impairment;
- loss of memory for a certain period of time (most often for the period before the injury or immediately after);
- epileptic seizure;
- inappropriate behavior (agitation, disorientation, lethargy).
It should be understood that each individual symptom is by no means a mandatory sign of TBI. The presence of speech impairment without knowledge of the traumatic factor is unlikely to be a sign of TBI. And just nausea and vomiting without hitting the head or on the head can generally be associated with completely different diseases. Therefore, of course, the first sign of TBI is information about the traumatic factor. The rest of the symptoms must already be considered in the context of a possible TBI. Sometimes it happens that the person himself completely amnesifies the events associated with the trauma (that is, denies its fact), while there are no witnesses and there are no external injuries either. In such cases, it is not immediately possible to suspect TBI.
Consequences of TBI
For some time, even after a mild TBI, the patient may complain of headache, dizziness, distraction of attention, inability to concentrate Usually, by the term "consequences" of TBI, physicians mean those changes in health that are a consequence of trauma at least 12 months after TBI. Mild TBI, with proper treatment, adherence to all medical recommendations, most often disappears without a trace. It is rather difficult to predict how other degrees of TBI severity will end.
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