Traumatic brain injury

Preventing possible consequences

If external force is exerted on the head, for example in a fall or accident, this can lead to a traumatic brain injury. Some of the patients with a traumatic brain injury do not require medical treatment. However, this is often necessary, sometimes even essential for survival. Inpatient monitoring and, if necessary, further diagnostics are necessary, since symptoms, such as impaired consciousness, may only appear after a certain time delay.Qualified consultants and therapists work at Schoen Clinic to treat traumatic brain injuries. We use the latest therapies to help save lives, prevent the occurrence of long-term effects and restore physical and mental functions. 

Causes & symptoms

What is traumatic brain injury?

A traumatic brain injury involves injury to the cranial bone and/or brain. This can be caused either by direct external force on the head or by abrupt acceleration and deceleration of the head and cervical spine, as in road traffic accidents. 
In principle, a distinction is made between open and closed traumatic brain injury:  In contrast to a closed traumatic brain injury, an open traumatic brain injury causes injury to the cranial bone as well as tearing the outer meninges, i.e. the connective tissue layer surrounding the brain. The inside of the skull thus comes into contact with the outside world. This, in turn, means a high risk of infection.

What leads to a traumatic brain injury?

While road traffic accidents are the most frequent cause of traumatic brain injury in young patients up to the age of 30, falls are the most common cause in those over 70. Further causes are accidents at home, work and sports accidents, as well as perforating injuries (e.g. gunshot wounds) and blunt force (e.g. a blow). In about 30 per cent of patients, several regions of the body are injured simultaneously (for example, chest and abdominal cavity), at least one of which or the combination is life threatening.

Traumatic brain injury: Symptoms that may occur

A traumatic brain injury is already classified as minor, light, moderate or severe at the accident site. This is performed by assessing the state of consciousness. Motor response, linguistic response and eye opening are decisive criteria here. 
Depending on the nature and intensity of the forces exerted, different damage patterns are possible: They can affect the cranial bone, brain, meninges and the blood vessels of the brain.
In principle, a distinction is made between symptoms:
  • defined, limited damage, such as fractures, contusions of the brain and bleeding.
  • non-defined, diffuse damage. This refers to injuries to nerve fibres inside the brain

Diagnostics

Diagnosis: How we diagnose traumatic brain injury

If the patient is responsive, we enquire about previous illnesses, medication and the sequence of events in the accident during the consultation.
The focus of the examination then initially lies on recording the state of consciousness as well as on respiration, blood pressure and circulation. It is also necessary to determine accompanying injuries. If it can be assumed that the cervical spine is also involved, the first measure we take is to immobilise the spine.  The neurological examination of cranial nerve function, strength development, sensitivity, muscle reflexes and coordination examines possible symptoms of physical deficits. In addition, a laboratory examination is also undertaken concerning blood clotting, blood count, blood gases, liver and kidney values, blood sugar, and possibly blood alcohol level and blood group typing.

Imaging techniques to give certainty

Various imaging procedures lead to an exact diagnosis: 
  • X-rays An X-ray examination of the skull and cervical spine allows bone breaks (fractures) to be detected. Even in patients with minor traumatic brain injury, fractures of the skull are found in about 10% of cases.
  • Computer tomography (CT)Sectional images of the brain and bones allow bleeding to be detected and differentiated. The pressure from bleeding on the brain can also be evaluated and thus the necessity of a surgical intervention can be quickly assessed. Brain oedemas, enlarged cerebrospinal fluid spaces, complicating strokes or skull fractures as consequences of traumatic brain injury become visible in this way. The decision concerning whether we also perform a CT for a minor traumatic brain injury depends on risk factors such as age (> 65 years), the intake of anticoagulant drugs or an unclear accident mechanism. A more severe traumatic brain injury may require multiple CTs.
  • Magnetic resonance imaging (MRI)MRI generates sectional images using strong magnetic fields. This also allows more subtle injuries of the nerves (diffuse axonal injury) to be detected. MRI also enables a more precise assessment of the brain stem, and circulatory disorders and tears in the walls of blood vessels can also be detected.
  • NeurosonographyThis ultrasound procedure makes it possible to detect vascular tears and convulsive constriction of blood-carrying vessels.
  • Electroencephalography (EEG)EEG is a method for measuring the electrical activity of the brain. Epileptic activity patterns are recorded. An epileptic seizure can be the result of traumatic brain damage, but it can also be the cause of impaired consciousness. In addition, EEG has certain prognostic significance in severe traumatic brain injury.
  • Evoked potentialsThis examination technique is used to check the integrity of the optic, acoustic and sensitive nerve tracts. The time between the triggering of the stimulus and the reaction is measured. The longer the patient’s reaction time, the more severe the extent of the traumatic brain injury