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A traumatic brain injury (SHT for short) is an injury (trauma) to the skull bone that is associated with damage to the brain . This can result in bruises or fractures on the bony skull, trauma to the brain can cause impaired consciousness, dizziness and nausea.
The head injury is caused by an external influence
- either by an accident (for example a fall from a ladder or a
traffic accident) or by an aggressive act (for
example a punch in the head). Sports injuries are
another cause . Traumatic brain injury is most common in sports in
which the players are headbutted hard, such as boxing, soccer, and American
football.
How does a traumatic brain injury develop?
The brain is actually well protected: no other
organ is packed with such a dense bone and it is also surrounded by a liquid
(liquor, nerve water), which among other things has the task of cushioning the
organ and protecting it from pressure damage. Nevertheless, the brain is
very vulnerable: Of all the cells in the body, the cells of the brain are the
most sensitive to a lack of oxygen. And bleeding or swelling in the brain
can quickly lead to a lack of oxygen and permanently damage the nerve cells.
To understand exactly what happens in the event of
a traumatic brain injury, first a brief look at the anatomy :
If the head is hit hard, the brain is injured first at the point of impact
(e.g. on the forehead). Due to the force of the movement, the brain mass
then collides with the opposite side of the skull (e.g. the back of the head),
a contre-coup effect. The damage is often even more
severe on the opposite side than on the original site of the injury.
In addition, shear forces act on the brain tissue
as a result of the impact, whereby nerve tracts are mechanically irritated,
compressed, pulled or interrupted. Roughly speaking, we speak of shear
forces when two forces that are parallel to one another act in the opposite
direction and tissue layers move accordingly. This causes the typical
symptoms: loss of consciousness, which can last from a few seconds to several
days, dizziness, headache and memory disorders,
nausea and vomiting (see: Traumatic brain injury: Symptoms ).
In the worst case, blood vessels rupture,
causing bleeding in the brain .
When a bruise occurs,
the pressure inside the skull increases. This can cause a lack of oxygen
in the brain, which can lead to serious brain damage and death.
How common is a traumatic brain injury?
Traumatic brain trauma is one of the most common
types of head injuries. Around 270,000 people in Germany receive medical
treatment for head injuries every year. The majority of them have a slight
traumatic brain injury (91 percent), around 4 percent suffer a moderate and
around five percent a severe traumatic brain injury, reports the German Society
for Neurointensive and Emergency Medicine (DGNI). The latter, in
particular, can have serious or life-threatening consequences: Every year, more
than 4,000 patients who have suffered severe head injuries are given long-term
care, explains the German Society for Neurosurgery (DGNC). Up to 40
percent of patient who have suffered severe traumatic brain injury die from it.
Traumatic brain injury: diagnosis
The emergency doctor first checks breathing, pulse
and blood pressure and asks the patient himself (if he can be contacted) or
witnesses of the course of the accident what happened. It is often not
easy for the doctor to assess the severity of a head injury in a victim of an
accident or violence. A look into the brain is only possible with imaging
methods such as computed tomography (CT). However,
the doctor can check the patient's state of consciousness with an examination
and thus assess the severity of the traumatic brain injury. The doctor checks three characteristics :
- Eyes : is the injured person able to open his eyes? Does he
do this spontaneously, only after being spoken to or not at all?
- Language : Can the patient speak clearly and respond sensibly to
questions (such as his name and the current date) or can he only utter
individual sounds? Does the person concerned seem oriented or
confused when speaking?
- Motor
skills : does the person affected react to
painful stimuli? Can he move on request or is it not possible to do
so?
The better and more spontaneous the injured
person's reactions, the easier the traumatic brain injury is. For each
positive reaction, the doctor enters a number of points on a scale (the
so-called Glasgow Coma Scale or GCS Score ) . A
very high number of points (13 - 15 points) indicates a slight head injury, a
lower number (9 - 12 points), on the other hand, a moderate and a low number (3
- 8 points) a serious head injury.
To illustrate: 15 points mean that the patient is
fully conscious, 3 points indicate that the head injured person is in a deep
coma.
In the hospital, the doctor will check for any skeletal or soft tissue injuries . The
cervical spine in particular is often also affected in a traumatic brain
injury. It must be immobilized by a stable support (the so-called
immobilization collar) until it is finally clarified in the CT.
The doctor has the diagnosis made at the scene of
the accident as an indication of how serious the traumatic brain injury could
be. In order to get a precise picture of the injuries inside the head, he
can use various imaging methods:
• X-ray : On an
X-ray of the skull, broken bones (fractures) can be determined. They occur
not only in severe head injuries, skull fractures also occur in ten percent of
patients who have a slight traumatic brain injury.
• Computed tomography (CT) :
With the help of cross-sectional images of the brain and skull
serious damage, such as a crushed brain or
bleeding, becomes visible. Doctors can also determine the pressure of the
bleeding on the brain and thus assess whether an operation should be carried
out immediately. In addition, a skull CT also makes injuries to the upper
cervical spine visible.
• Magnetic resonance imaging
( MRI ) : Doctors do an MRI to detect damage to
the nerve processes (these transmit signals to other cells) and the brain stem
(controls blood pressure and heartbeat rate, controls breathing) as well as
circulatory disorders and tears in the event of a traumatic brain injury to be
recognized in the vessel walls. Even if the CT does not reveal any changes
in the head despite neurological disorders, an MRI is also performed.
In individual cases, further clarification using the following examination methods may be necessary:
- With an MR angiography (magnetic
resonance angiography), the doctor may discover a violation or narrowing
of a blood vessel.
- Special ultrasound examinations such
as neurosonography are used to detect vascular injuries that have occurred
outside the skull in the body.
- The electroencephalography (EEG)
is to measure a method to the electrical activity of the brain. It
can also be used to detect epilepsy-like disorders in the brain.
A blood test shows
whether there are abnormalities in the blood count, blood sugar , liver and kidney values and
whether the blood alcohol level is increased.
Only after all these examinations can the severity
of the traumatic brain injury be determined and the effects (see: Traumatic brain injury: Consequences ) assessed.