Traumatic Brain Injury

Up to 270,000 people suffer craniocerebral trauma in Germany every year. 80 percent of patients are treated as inpatients in hospitals. Depending on the severity of the trauma, there can be transient functional disorders with a brief loss of consciousness (commotio cerebri/brain concussion) to severe disorders with the need for intensive medical treatment and surgical therapy.

A craniocerebral trauma (also TBI) is a term used to describe injuries to the head, skull, and brain caused by an external force. The injuries can occur individually or in combination – in any case, however, the brain is affected. Because of the risk of brain hemorrhage or other complications, observation in the hospital is recommended for every patient with a traumatic brain injury.

Craniocerebral trauma is divided into three different degrees of severity using the so-called Glasgow Coma Scale:

• Mild: GCS 13-15
• Moderate: GCS 9-12
• Severe: GCS 3-8

A further distinction is made between

• Non-penetrating TBI and
• Penetrating TBI (open TBI): Perforation of the scalp, skull bones, and rupture of the dura mater.

Symptoms

The following symptoms may indicate a traumatic brain injury. It is important to note that some of the symptoms mentioned may develop well after the trauma. This is called latency or latent period (time between the occurrence of the trauma and the symptom).

• Loss of consciousness
• Headache
• Dizziness and loss of balance
• Squinting
• Pupillary divergence (pupils of different sizes)
• Convulsions or other neurological deficits
• Nausea and vomiting
• Memory lapses (amnesia)
• Visual hallucinations (photopsies)

The pupil difference (anisocoria) and increasing disturbances of consciousness must be regarded as special warning signs, as they can be indications of a haemorrhage within the skull.

Causes

In principle, any external force can be the cause of a craniocerebral trauma. It can be direct violence, for example by blows to the head, but it can also be traffic accidents or falls.

In young patients, traffic accidents are the most common cause of a traumatic brain injury; in older people over 70, it is falls. Work-related accidents also often result in such injuries. Sports accidents (skiing) are also frequently the cause.

Therapy

In case of a suspected craniocerebral trauma, it is very important to bring the affected person to a suitable clinic as soon as possible. Here, the type of injury must first be determined, from which the therapeutic measures result.

The treatment in the early phase of a severely affected patient has first and foremost the goal of preserving the patient’s life as well as preventing the occurrence of secondary damage as far as possible. So-called secondary damage can occur due to poor cerebral perfusion or due to the “jamming” of swelling brain parts in pre-formed bone cavities or connective tissue structures of the skull. Such secondary damage can further worsen the patient’s condition.

In the case of severe brain injuries, acute care is followed by transfer to an early rehabilitation department of a special clinic. The patients require intensive monitoring, which is why intensive monitoring is carried out around the clock in the early rehabilitation department of Kliniken Schmieder. If vital functions are disturbed, the doctors can intervene immediately. Patients whose limitations are less pronounced can also be transferred directly from acute care to further rehabilitation.

The patient’s further treatment depends on the damage to the brain. Medical rehabilitation plays a decisive role for patients who have suffered a traumatic brain injury. Only through targeted, often long-lasting rehabilitation measures is successful reintegration into the family, social environment and, if necessary, the job possible. The aim of the rehabilitation measures is the partial or complete regression of the neurological deficits.