Traumatic brain injury (non-congenital brain injury)

Traumatic Brain Injury (TBI), also known as non-congenital brain injury, is an injury to the brain caused by an external force. Possible causes related to traumatic brain injury, which in the medical world is also referred to as intracranial injury, include falls, car and bicycle accidents, and violence. Traumatic brain injury can lead to physical, psychological, cognitive, emotional and behavioural symptoms. With a view to possible recovery it is essential that patients are correctly diagnosed sooner rather than later, in which case, full or partial recovery can be expected. Severe traumatic brain injury, however, can also lead to functional or permanent damage. This risk is reduced if the correct diagnosis is made within the shortest possible time frame.

Leading cause of death

Traumatic brain injury is the leading cause of death and permanent disability worldwide, especially in children and young adults. It is relatively more common in men than in women. The elderly are considered a high-risk group as a result of falls. Other high-risk groups are the military, the police (partly as a result of gun recoil) and the fire brigade (partly due to losing control of high-pressure hoses).

Severity depending on impact and acceleration

The severity of traumatic brain injury depends on two factors. Besides the impact of the external force, the degree of acceleration or deceleration also determines the severity of the injury. In the event of impact with an external force, such as contact with the pavement upon falling, the impact of the fall is greater if the person is running or cycling. This then results in more serious brain trauma than if the same person were to fall when standing still. In other words, traumatic brain injury is damage to the brain tissue as a result of a mechanical force, which may or may not be accelerated.

The brain is like a soft-boiled egg

In addition to the injury that occurs at the time of contact with the external force (such as contact with the pavement or an elbow jab), various processes that may occur after the moment of contact can exacerbate the severity of the brain injury. Examples of those processes are a change in blood circulation in the brain and a change in pressure within the skull. Imagine the impact this can have on your brain. After all, the brain consists of 60% unsaturated fatty acids and so the brain is a large gelatine mass, as it were. It’s like a very soft-boiled egg. It's easy to imagine that the brain, when met with an external force, will move suddenly and violently in the cranial region, which can result in serious damage.

Acquired, non-acquired, closed and open brain injury

Traumatic brain injury, which is also referred to as brain damage, actually comes in two forms, namely acquired and non-acquired brain injury. Acquired brain injury applies in the event of an accident, for instance, whereas a brain haemorrhage or brain infection (such as meningitis) is a non-acquired brain injury. Another classification distinguishes between open and closed brain injuries. In the case of a closed brain injury, also known as non-penetrating brain injury, the brain is not affected by the external force. Open brain injury, also called penetrating brain injury, on the other hand, involves an external force that pierces the skull and damages the cerebral membrane and the brain tissue connected to it. The Functional Neurology Institute's treatment of traumatic brain injury focuses on closed brain injury. 

Importance of rapid diagnosis

A rapid diagnostic test and a detailed anamnesis are essential for determining, at the earliest possible time after the trauma, whether you have suffered mild or severe brain injury. An anamnesis is what you as a patient can tell the healthcare provider about what happened before the brain trauma and the relevant circumstances. Our professional specialist asks specific questions to compile this anamnesis, or case history. We notice that in daily practice the consequences of brain trauma are often greatly underestimated and that people are advised to simply take it easy for a few days. As a consequence, other serious complaints may arise at a later stage resulting from the brain trauma. So the risk of serious brain injury increases if you delay getting a diagnosis.

Local and diffuse injury

Damaged brain tissue can be local or diffuse (general) by nature. In the former case, the brain damage occurs in a specific area of the brain. In the latter case, the brain damage is more spread out. The former is the most common. Local injury mainly occurs in the orbitofrontal cortex (the front of the brain) and the temporal cortex (the side of the brain). Both brain areas are involved in social behaviour, emotional regulation, and judgement and decision making. Cerebral contusion, or brain bruising, is a form of focal injury. In this instance and contrary to cerebral haemorrhage, no blood flows into the brain tissue. 

Symptoms related to traumatic brain injury

Symptoms depend on the form of the traumatic brain injury (diffuse or focal), the severity of the injury, and the part of the brain where the injury occurs. Symptoms related to a mild brain injury include headache, nausea, the urge to vomit, loss of balance, loss of coordination, light-headedness, double vision, eyestrain, ringing in ears, unpleasant taste in the mouth, fatigue, lethargy, changes in sleep pattern, mood swings, confusion, memory loss, reduced ability to concentrate, restlessness, becoming quickly agitated, as well as difficulty focusing and thinking. 

Symptoms in children

In babies and small children, traumatic brain injury is generally caused by falls and physical violence. The shaken baby syndrome falls under the latter category and is an example of diffuse injury. The symptoms related to traumatic brain injury in babies and small children include persistent crying, inability to be consoled, being non-adventurous, limited interest, unusual or easy irritability, and change in eating or nursing habits. 

Direct contact or impact injury

Traumatic brain injury can even occur without direct contact with an external force, but with significant acceleration or deceleration. An example of this kind of injury is whiplash. Direct contact with an external force is called direct contact injury or impact injury. This often leads to focal injury, while the movement of the brain in the skull in turn leads to diffuse injury. 

Coup injury and contrecoup injury

Brain injury can occur directly under the point of contact with the external force, but it can also occur on the exact opposite side of the brain. This is also referred to as coup injury and contrecoup injury respectively. A coup injury is when a moving object hits a motionless head. A blow to the head, for instance, is a coup injury. Contrecoup injury, on the other hand, occurs when a moving head hits a stationary object, like in a car accident. Focal brain injury is also called primary brain injury, whilst diffuse brain injury is also known as secondary brain injury.

Patient deterioration after hospitalisation

A significant proportion of those who die as a result of brain trauma do not pass away immediately, but rather days or weeks after the trauma. 40% of those who do not die, deteriorate after hospitalisation. This deterioration in the condition of hospitalised brain injury patients is caused by a combination of factors that arise as a result of secondary brain injury. These include damage to the blood-brain barrier, which is a protective layer over the brain. Other factors are inflammatory reactions within the brain, the release of toxic free radicals, as well as an excessive release of the neurotransmitter glutamate. Furthermore, the brain cells absorb more calcium and sodium and reduced functioning occurs of the mitochondria, which provide the cells with energy. In addition, there is the chance of oxygen deficiency as well as poor blood circulation. Finally, fluid can build up inside the brain, resulting in swelling of the brain. This, in turn, leads to increased brain pressure within the skull, which exacerbates all other symptoms. 

3 to 5 days of bed rest immediately after trauma

Because in many instances the coup and contrecoup complaints do not manifest themselves in the first few days after the trauma, the impact of a brain trauma is often severely underestimated. We frequently notice that patients return to work too soon, thus potentially aggravating their injury. We recommend bed rest for at least 3 to 5 days after a brain trauma and then a CT scan.

Quickly making a proper diagnosis

Proper diagnosis is therefore crucial in the event of a brain injury in order to maximise the chances of recovery. We therefore always recommend an extensive neurological examination. A CT (computed tomography) scan provides accurate results relatively quickly. If a CT scan has not been done and (other) complaints occur 5 to 7 days after the trauma, it is prudent to have an MRI (magnetic resonance imaging) scan done. A possible alternative to an MRI scan is angiography, to determine whether there are any ruptured blood vessels. A functional MRI is suitable for determining brain blood flow, metabolism and brain activity in specific brain regions. One to two weeks after the occurrence of brain trauma, a quantitative EEG or a QEEG is very effective in determining atypical brain functioning. Neuropsychological tests are useful for testing cognitive ability. 

Protective effect of Omega 3 supplements

Research conducted by neurosurgeon Julian Bailes of West Virginia University indicates that high-quality Omega 3 supplements, such as XO-7, are highly protective against the occurrence of biochemical brain damage after brain trauma has arisen. 

Extensive expertise and experience

The Functional Neurology Institute boasts extensive expertise and experience in the treatment of traumatic brain injury. Read here the compelling stories of some of our patients suffering from traumatic brain injury.