Patient education: Moderate to severe traumatic brain injury (The Basics)

What is a traumatic brain injury? — A traumatic brain injury, or "TBI," is a head injury that causes damage to the brain. This can happen when:

●A person is hit in the head with something.

●A person falls or hits their head on a surface.

●Something goes through the skull and into the brain, for example, from a gunshot or explosion.

The most common causes of TBI are falls, sports injuries, and car and bike accidents.

TBIs can range from mild to severe. When a TBI is mild, it is called a "concussion." Moderate and severe TBIs are more serious. They can cause coma or even death. When a person survives a moderate or severe TBI, they can have long-lasting disabilities and need a lot of care.

What are the symptoms of moderate to severe TBI? — Symptoms can be similar to those of a mild TBI (concussion). But they are often more severe and last longer. They can include:

●Headache

●Confusion

●Dizziness

●Blurred vision

●Memory loss

A person with a moderate or severe TBI might also have problems like:

●Symptoms related to a skull fracture, such as bruising of the face or blood or clear fluid draining from the nose or ear

●Nausea or vomiting that does not get better

●Losing consciousness for more than a few minutes

●Not being able to wake up

●Weakness

●Trouble walking or talking

●Seizures

With a severe TBI, the person might be unconscious for some time. A "coma" is when a person is in this state for a few weeks, and does not respond or react to sound or touch. Sometimes, people come out of a coma and begin to improve. Other times, people remain unconscious or develop brain death. Brain death is when the brain can no longer function and damage cannot be reversed.

Is there a test for moderate to severe TBI? — Yes. When a person has a bad head injury, doctors will do an exam. They will test the person's ability to:

●Follow instructions, and move their arms and legs

●Respond to touch or pain

●Speak clearly

●Think clearly

Based on the results of the exam, a TBI is called mild, moderate, or severe. For example, a person with a severe TBI might not be able to respond to words or touch.

Doctors will also order an imaging test of the brain, such as a CT or MRI scan. These tests create pictures of the skull and brain. They can find problems like bleeding and swelling of the brain.

How is moderate to severe TBI treated? — A moderate or severe TBI is usually first treated by emergency responders or in the emergency department. As soon as possible after an injury, the medical staff will:

●Make sure that the person can breathe, and put in a breathing tube if needed

●Give fluids to control blood pressure, if needed

●Protect the person's spine to avoid further injury

●Check for injuries to other parts of the body

●Give medicine to lower the risk of bleeding in the brain, if needed

●Do emergency surgery to treat bleeding, blood clots, swelling, or a skull fracture, if needed

Whenever possible, further treatment should happen in a hospital or trauma center with experience caring for people with brain injury. Most people will need to stay in the intensive care unit, or "ICU." There, they will be closely monitored. Treatment depends on how severe the injury is, and might include:

●Procedures to remove extra fluid from around the brain

●Medicines to keep the person sedated while they heal

●Pain medicines

●Giving fluids by "IV" (a thin tube that goes into a vein)

●Using a "ventilator," or breathing machine

●Medicines to help prevent problems like seizures, blood clots, or bleeding

●A feeding tube to give the person nutrients

How long the person needs to stay in the ICU depends on their injury. Different people need different types of treatment and support.

What will life be like after a moderate or severe TBI? — This depends on the person's situation and how serious their injury was. Many people get some of their abilities back over time, but it can take months to years.

After a TBI, many people need "rehabilitation." This is sometimes called "rehab." In many cases, the person with TBI will go directly to a rehab center after leaving the hospital. Other times, they might be able to get rehab services at home. The plan will depend on the person's needs as well as things like their insurance plan and how much support they have at home.

In rehab, there are many different medical professionals who specialize in helping people who have had a TBI. They can work with the person to try to regain some of their abilities and improve their quality of life. They can also give support to help the person cope with problems caused by their injury.

Rehab might involve things like:

●Physical therapy to help improve strength and movement

●Occupational therapy to help with daily activities

●Speech therapy

●Mental health support

Caring for someone with a TBI can be challenging. If you are a caregiver and you need help, talk to the person's doctor or nurse. They can work with you to get support.

When should I call the doctor? — If you are caring for someone who had a TBI, there are certain problems you need to watch for.

Get help right away if the person:

●Has a seizure, or jerking of their arms or legs they cannot control

●Has a sudden and persistent change in behavior

●Suddenly starts having more trouble with things like moving, talking, thinking, vision, or balancing

If the person already has trouble communicating, it can be hard to tell if there has been a change in their health. If you are concerned about the person but cannot reach the doctor or nurse, seek emergency help (in the US and Canada, call 9-1-1).

More on this topic

Patient education: Skull fractures (The Basics)
Patient education: Concussion in adults (The Basics)
Patient education: Concussion in children and teens (The Basics)
Patient education: Postconcussion syndrome (The Basics)
Patient education: Head injury in adults (The Basics)
Patient education: Head injury in children and teens (The Basics)
Patient education: Head injury in babies and children under 2 years (The Basics)
Patient education: Headaches in adults (The Basics)
Patient education: Headaches in children (The Basics)
Patient education: Seizures (The Basics)
Patient education: Coma (The Basics)

Patient education: Head injury in children and adolescents (Beyond the Basics)
Patient education: Headache causes and diagnosis in adults (Beyond the Basics)
Patient education: Headache in children (Beyond the Basics)
Patient education: Seizures in adults (Beyond the Basics)
Patient education: Seizures in children (Beyond the Basics)