An in-depth guide to traumatic brain injuries

Traumatic brain injuries are very serious injuries that can cause numerous symptoms and complications. In his latest article, renowned consultant psychiatrist Dr Samr Dawood explains the symptoms.

What can cause traumatic brain injuries?

Traumatic brain injuries comprise any type of injury to the brain or skull if it causes brain damage. It occurs after a sudden application of a physical force of considerable magnitude to the head.

Sometimes a violent flexion and extension of the neck or blast explosions can cause trauma to the brain. Head injuries may be either open or closed. An open head injury occurs when something penetrates or fractures the skull, while a closed head injury describes injuries that do not penetrate the skull.

Traumatic brain injury (TBI) is known as a “silent epidemic” because of a lack of knowledge about it and its delayed symptoms of memory and cognitive problems. The incidence is approximately 341 per 100,000 in developing countries. TBIs occur mainly due to traffic accidents, falls, and violence. All age groups are affected, but the rates are higher in men than in women. The causes vary as per the age groups.

What are the symptoms of traumatic brain injuries?

The brain damage can be focal like contusions, lacerations, haemorrhages, or generalized microscopic axonal injury. The symptoms will depend on the severity of the injury. In severe cases, critical neurological symptoms, death, and coma can occur while in less severe injuries patients might suffer from acute delirium and post-concussion syndrome.

In its mildest form, there is only a brief period of stunned disorientation and amnesia during which the person appears outwardly normal.  Upon resolving the acute symptoms, people typically will have trouble concentrating, are inattentive, and are easily distracted. Also, they might have trouble memorising things.

Patients might develop what we call post-concussion syndrome. Post-concussion syndrome symptoms include headache, dizziness, and various cognitive and emotional changes. The headache may be severe, chronic, or paroxysmal, either steady or throbbing in character, and exacerbated by stress, loud noises, and coughing. Dizziness and light-headedness can occur, as well as true vertigo. Other symptoms include fatigue, photophobia, sensitivity to noises, excessive sweating, and unwarranted startling.

In most cases, gradual improvement is seen over the first few weeks or the first few months. Post-concussion syndrome and long-term sequelae of brain injury are of interest to psychiatrists.

How are traumatic brain injuries diagnosed?

The history of the physical trauma, neurological examination, psychiatric assessment and a brain CT scan or brain MRI as well as other types of investigations are the golden standards in the initial diagnosis.

At the outset, the depth of the coma is usually measured in emergency and intensive care settings using a scale called the Glasgow coma scale.

In the chronic phases of the illness, psychiatric assessment, and neurological examination in addition to several scales and measures are used to identify, record, and measure the chronic symptoms and the progress of the patient.

What are the psychiatric sequelae of traumatic brain injury?

Data from various studies indicate a wide variation in the incidence and prevalence of psychiatric disorders after TBI, but they are higher as compared with the general population

The most common psychiatric diagnoses at follow-up were major depression, insomnia, alcohol abuse or dependence, other types of addictions, PTSD, panic disorder, specific phobia, and psychotic disorders.

A personality change can occur as well, often being characterized by disinhibition, impulsivity, irritability, violent behaviour and outburst of anger, and depressive symptoms. Additionally, attention deficit hyperactivity disorder is a well-documented phenomenon after TBI, with a rate of 20% among those with neurotrauma compared with 4.5% in the general population.

Furthermore, certain physical symptoms such as headache, dizziness, fatigue, unpleasant sensations, and pain, as well as cognitive symptoms like difficulty in concentration and performing mental tasks, impairment of memory, and reduced tolerance to stress are frequently treated by psychiatrists.

These illnesses can persist for months or even years post-injury and affect crucial aspects of everyday life, including independence, interpersonal relationships, employment, and community integration. From the standpoint of labour performance, they may not be able to regain their previous level of capabilities.

Is it possible to fully recover from a traumatic brain injury?

Yes, there is a high possibility of full recovery. TBI recovery is heavily dependent on the rehabilitation process. If a survivor does not receive proper treatment promptly, it can increase the risk of complications and long-term suffering.

Medications can be used in treatment as well as other types of physical, psychological, and social interventions. Experts recommend that people with a suspected concussion not return to activities that are associated with a higher risk of another concussion while still showing concussion symptoms. They should void physically demanding activities (e.g., heavy housecleaning, weightlifting/working out) or require a lot of concentration (e.g., balancing your checkbox). They should avoid contact-based sports, which could lead to a second concussion. Also, they should get plenty of sleep at night, and rest during the day.

Alcohol and other drugs may slow recovery and put the patient at risk for further injury. Medical advice is always needed to estimate the need for rest and to construct a stepped-care approach. If the symptoms persist and become chronic, then it is crucial to understand the social and vocational limitations to help in designing a care plan that addresses the need for special adjustments at work and in everyday life activities.

It is important to recognize how difficult it is for the person to adjust to the massive life-changing consequences of a significant brain injury. The person may have to cope with a wide range of difficulties like; loss of occupation, loss of training and education opportunities, loss of role, changes in family and social relationships, loss of leisure activities, financial difficulties, outbursts of anger, changes in the ability to sit, stand, and move limbs, impairments in memory, problems with fatigue and motivation, communication impairments, suffering from different types of pain, and uncertainty and anxiety about their future.

Rehabilitation should be regarded as a continuum, which will depend on the person’s ongoing difficulties. Supporting the person to develop ways of compensating for their difficulties and preventing secondary complications are very important targets.

Can a traumatic brain injury from a long time ago suddenly start to cause problems?

Some of the symptoms of TBI may appear right away, while others may not be noticed or remain subtle for months or years after the injury. The risks of secondary psychiatric disorders such as depression and psychosis, as well as other illnesses like epilepsy, early-onset Alzheimer’s, or early-onset Parkinson’s disease, could occur years after the injury and can continue for decades after the damage.

Substance abuse, lifestyle, genetic, repetitive subclinical brain injury, and environmental factors may increase these conditions’ risks. One study found that psychosis after TBIs could occur with a mean latency of 54.7 months after a head injury, and usually with a gradual onset and a subacute or chronic course. Another study found the onset of depression occurred either in the first year in approximately the third of their sample or more than 10 years postinjury in the remaining two-thirds. Despite the directionality of psychiatric conditions and TBI being challenging to determine, however a plethora of studies indicated a higher percentage of these conditions in the TBI population in comparison to the general public.       

Can I get fully compensated after suffering from TIB in an accident?

No one can be truly compensated for the devastating effects of a brain or head injury, but professionals can help victims to obtain the right treatment and compensation. Medical experts can help patients to identify their illnesses, the sequelae of their injuries, and the degree of their impairments.

Without a proper medical assessment, they cannot identify their problems. Professionals can also advise patients on the treatments available, and how to handle the life-changing consequences. They also can support patients in getting their legal rights as well.

Dr Samr Dawood is a highly-revered consultant psychiatrist based in central London. If you would like to book an appointment with Dr Dawood you can do so today via his Top Doctors profile.