Overview
Traumatic brain injury is a leading cause of death and disability in young people. It can range from mild to severe and can have outcomes ranging from a full recovery to a life time of disability. It is often very distressing for the patient and their family and friends. Stricter regulations on speed limits and education regarding the use of preventative measures such as seat belts and helmets have reduced injuries but they still remains a very real problem for the affected individuals, their families and society as a whole.
Most brain injuries in the UK result from road accidents in which the head gets thrown forwards, backwards or is rotated. This can result in the brain 'pulling' on the nerve fibres and blood vessels causing them to be damaged or even torn. This is known as the primary injury as it happens at the time of the incident. Primary injuries can result in 'closed' injuries, such as described above, or 'open' injuries which are caused by a blow to the head or penetration by an object, consequently resulting in an open wound that exposes the skull, tissue surrounding the brain or the brain itself.
When the brain is damaged and bruised it can swell much like any other tissue in the body. However, as the brain is encased in the solid skull, it has no where to go. This can lead to pressure building up within the brain which blocks blood flow and compresses the brain which can be fatal. Other consequences are bleeding into the brain and blood loss from a scalp injury or other wound. Blood accumulating in the brain can lead to further pressure build up whilst blood loss reduces the amount of blood flowing through the rest of the body and subsequently less oxygen getting to the tissues, including the brain. Additionally, an open head wound allows pathogens to enter the brain and infection to occur which can also be fatal. All these are known as secondary injuries and can occur very quickly after the injury, may not occur at all or may occur days or weeks later.
When someone is diagnosed with a traumatic brain injury the treatment focuses on stabilising the patient and minimising any secondary insults to the brain. This can include stabilising the patient's vitals such as breathing and circulation, performing regular neurological examinations, taking brain scans and performing surgery if necessary.
After the acute phase of treatment (in the days or weeks after the injury), the focus is directed to rehabilitation in order to regain the most function and ensure the best quality of life after the injury.
