Traumatic brain injury: a blow with far-reaching consequences
Every year, thousands of people in Switzerland sustain a moderate to severe traumatic brain injury (TBI). “The consequences for those affected can be severe,” says neurologist Nicole Naumann.
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Be it a hard blow to the head, a fall or a road traffic accident, a trauma brain injury can happen unexpectedly – and in the worst case can have far-reaching consequences.
Each year in Switzerland, over 20,000 people are treated for traumatic brain injuries, with around 5,000 of these experiencing serious long-term complications. “The consequences of a traumatic brain injury are often invisible and have both physical and psychological effects,” says Dr Nicole Naumann, neurologist at Basel University Hospital and member of the board of FRAGILE Suisse.
Causes
Common causes of traumatic brain injuries include road traffic accidents, falls at home and sports injuries.
Among those particularly at risk are cyclists who don’t wear a helmet; older people, who are more likely to suffer a fall; and people who do extreme sports. Shaken baby syndrome is a type of inflicted traumatic brain injury that happens when a baby is violently shaken.
Mild TBI: more than just dizziness
Mild traumatic brain injuries, also known as concussion, are the most common form. Symptoms can include headaches, dizziness, nausea and vomiting. People with a mild traumatic brain injury may experience reduced consciousness, a brief loss of consciousness and/or gaps in their memory. “Even a mild TBI requires medical attention,” warns Dr Naumann.
Moderate traumatic brain injury: take warning signs seriously
With a moderate TBI, the symptoms are more intense. Patients may be unconscious for several hours and they are more likely to experience neurological deficits including speech or memory disorders, paralysis or visual impairments. “This type of trauma requires close monitoring in hospital, as there is a higher risk of bleeding on the brain and swelling,” explains Dr Naumann.
Severe traumatic brain injury: life-threatening
Severe traumatic brain injury is characterised by prolonged unconsciousness, which can last from several hours to days.
Bleeding or swelling in the brain can be life-threatening. “Neurosurgery is often required to reduce the pressure on the brain and prevent further damage,” says Dr Naumann.
Severe TBIs are more likely to lead to sustained damage that can affect the life of patients and their loved ones in the long term.
Complications
Long-term complications include motor disorders such as paralysis or difficulty coordinating movements, speech and visual impairments or paralysis of cranial nerves. Naumann reports that problems with memory and concentration are also common.
In some cases, TBIs can cause post-traumatic epilepsy, which can occur years after the accident.
Possible psychological effects
In addition to the physical effects of a traumatic brain injury, there can also be serious mental and emotional effects. “Many patients report increased irritability, reduced impulse control, emotional instability or depressive moods,” says Dr Naumann. Emotional or mental health issues are difficult to recognise from the outside, but they are hard on those affected and their relatives.
Cognitive skills can also be affected, making it difficult to return to normal daily life and work. In many cases, neuropsychological therapy may be necessary to compensate for cognitive deficits.
Supportive measures such as psychological therapy can also help to handle and overcome the emotional and psychological consequences. Post-traumatic stress disorders are also common, particularly if the TBI was caused by a violent attack.
Diagnosis and treatment
A traumatic brain injury is usually diagnosed by talking to the patient and relatives as well as conducting a clinical examination and imaging procedures. A CAT scan is particularly helpful to quickly diagnose traumatic bleeding in the brain or skull fractures, while MRI is often used later to identify smaller but clinically relevant injuries that are often not visible from the CT scan.
After an accident that may have caused a traumatic brain injury, it is important that patients are monitored closely.
The treatment depends on the severity of the injury. Mild TBIs usually only require a brief period of monitoring, while moderate to severe injuries often require intensive medical care. In severe cases, surgery may be required to open the skull to relieve pressure on the brain or remove bleeding.
Preventing TBIs
The good news is that many TBIs can be prevented through effective precautionary measures, such as wearing a helmet while cycling, skiing or riding a motorbike. Particularly for older people, safety measures at home can help reduce the risk of a fall and any associated traumatic brain injury.
About the expert
Dr Nicole Naumann is the head of department and neurologist for asim assessment at Basel University Hospital, She is a certified medical assessor, SGV medical officer and pain specialist. She is also a member of the board of FRAGILE Suisse, the Swiss patient organisation that supports people with brain injuries and their relatives.