A Review on Traumatic Brain Injury, Diagnosis and Its Treatment
Vijay Kumar Kurna*
Department of Biochemistry, Chaitanya PG College, Kakatiya University, Warangal, Telangana, India
- *Corresponding Author:
- Kurna VK
Department of Biochemistry,
Chaitanya PG College
Warangal, Telangana, India
E-mail: [email protected]
Received date: 02/08/2016; Accepted date: 05/08/2016; Published date: 12/08/2016
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Traumatic brain injury is one of the major problems of brain tissue damage, which results, loss of memory, amnesia or may also lead to brain death. One of the major effected country, United States were most of the young people are reported with the brain injury, mainly because of the accidents. This review will mainly focus on current situation on TBI in major countries, its present day research on diagnosis and its treatment.
Traumatic brain injury, Head
injury, Electroencephalography, Amnesia,
Traumatic brain injury (TBI) is a severe damage to brain resulting from external force which leads to damage to brain tissue
[1-3]. It occurs when the skull is stabbed by an object. It is a major public health problem and a leading cause of death worldwide
mainly in children and young adults, males sustain TBI more than females. Consistently, around 1.5 million influenced individuals
kick the bucket and a few millions get crisis treatment [4-8]. The vast majority of the weight (90%) is in middle and income nations.
Motor vehicular accident is leading cause of head injury worldwide. World health organization‘s world health day in 2004
was dedicated to road safety . The level of attention to road safety underscores the global burden of road traffic injuries and the
need for public health concern towards reducing this epidemic [10,11].
In United States (US), the incidence of head injury at the Emergency Department was recently reported to be 394 per
100,000 people, male: female ratio was 1.8:1 and mortality rate 19.3 per100, 000 people. The leading causes of TBI in US were
reported as fall (28%), motor vehicular traffic accident (20%) and assault (11%) [12-16]. The highest incidence of motor vehicular
traffic accident was found in the 15-19 year group, while fall was the leading aetiology in the 0-4 and >75 year groups. The traffic
safety law and preventive measures in the US has reduced road traffic accident whereas fall is on the increase at the extremes of
ages. Every year in the month of March, Brain Injury Association of America (BIAA) will conduct a campaigning on brain awareness
month and the theme for 2015 to 2017 campaigning is Not Alone [16-20].
Another study done in the United Kingdom (UK) population on the attendance rate of head injury at an Emergency Department
showed that head injury constituted 3.4% of the total attendance and the incidence was 453 per 100,000 . Nearly 11% were
moderate to severe head injury, implying that mild head injury (89.1%) was the most common type. Males were found to be at a
higher risk for moderate to severe head injury than females. Thus, even in the regulated systems of the developed countries, head
injury is still of special public health concern.
TBI is a major public health problem worldwide, any measure that would reduce mortality or morbidity associated with this
injury even slightly could translate into very significant benefit in human and economic term [22-27].
Clinical identification includes such as headache or neck pain, vomiting, confusion or disorientation, amnesia, loss of
consciousness, other neurological abnormalities such as focal neurological signs, seizure or intra cranial lesion [28-30].
Symptoms are dependent on the type of Injury to brain (diffuse or focal) and the part affected. Symptoms may also dependent
on the injury's severity [31,32]. There are a number of criteria for assessing severity of injury these include, the Glasgow Coma Scale
Score, loss of consciousness or coma and post traumatic or retrograde amnesia.
Cranial CT is the preferred method of assessment on admission to determine structural damage and to detect (developing)
intracranial haematomas [33-38]. Some studies have successfully identified risk factors for intracranial lesions, such as vomiting,
age, duration of amnesia, the type of injury, neurological deficit, and anticoagulant therapy.
In the past, much attention was focused on radiographs of the skull to triage indications for CT, but these are no longer
thought to be useful. Fractures of the skull can be seen adequately on CT in the bone-window setting, and three-dimensional
reconstructions with volume rendering techniques provide a far superior insight into complex fractures [39-45].
MRI studies are occasionally done in the acute phase of TBI because more time consuming and do not certainly provide any
further information for clinical results. However, MRI can be more useful if a strong injury with a wooden object is suspected [46-52].
Angiography might be utilized to identify vein pathology when danger elements, for example, infiltrating head injury are
included. Functional imaging can quantify cerebral blood stream or digestion system, surmising neuronal movement in particular
locales and conceivably foreseeing result. Electroencephalography and transcranial Doppler may likewise be utilized [53-55].
Management of TBI
The vast majority of patients presenting to emergency room with head injury fall under mild TBI (GCS score of 13-15) these
patients are awake, may have amnesia, there may be a brief history of loss of consciousness [55-58]. Other signs of mild TBI include
headache, nausea, vomiting, lack of motor coordination, dizziness, difficulty balancing, blurred vision, fatigue and changes in
sleep patterns. Mental and emotional symptoms include mood or behavioural changes, confusion and memory disorders. Mild
TBI symptoms may also be present in moderate and severe injuries [59-63].
Most patients go on to make uneventful recoveries, albeit with subtle neurological sequelae. However, about 3% of patients
unexpectedly deteriorate and can become neurologically devastated if the decline in their mental status is not noticed early .
Management of patients with minimal sign includes admission for observation for 12 to 24 h after resuscitation .
For moderate risk group with initial signs such as vomiting, post traumatic amnesia or signs of basilar or depressed skull
fracture, the recommended procedure includes extended close monitoring, cranial CT scan and neurological consultation [66-69].
However in those patients presenting with serious initial symptoms such as depressed or decreasing level of consciousness,
neurological signs or penetrating injuries, a neurological consultation, in combined with an emergency cranial CT scan is
recommended as patients may require surgical evacuation [70-75].
The management of these patients is described in five stages, (1) cardiopulmonary stabilization, (2) general examination,
(3) neurological examination, (4) diagnostic procedure, (5) surgical intervention.
A crucial part of the management of severe TBI is in the Intensive care unit which involves a comprehensive and assessment
outlined in the Advance Trauma and Life support. Patients should be stabilized before being transferred to intensive care unit.
Secondary injury is anything that occurs to augment the primary injury; the prevention of this is predominantly where intensive
therapy is aimed [76-79].
Apnea, atelectasis, aspiration, and acute respiratory distress syndrome are often associated with severe head injury;
prolonged apnea may often be the cause of immediate death at the scene of accident . All severely head injured patients
should be intubated, in the process of establishing an airway the mouth and nasal passages must be cleared of all foreign body,
secretion, blood or vomitus [81-86]. Emergency tracheostomy may be done in patients with severe maxillofacial injury in whom
intubation may be precluded because of severe soft tissue swelling and distortion of airway anatomy [87-90].
During cardiopulmonary stabilization, the clinician conducts a rapid general examination looking for other associated injuries,
like head and neck injuries, chest injury, abdominal pelvis and spinal cord injury [91-93]. Diagnostic X rays after cardiopulmonary
stabilization include cervical spine, chest, skull, pelvis and extremities [94-96].
Traditionally a staircase approach to increasing intracranial pressure include achieving mild hypocapnia by ventilating
patients to a PaCo2 between 3.5-4.0 kpa, use of mannitol and CSF drainage, followed by hypnotic coma with barbiturate or
propofol to prevent coning. This approach should be tailored to individual patho physiology [97-99].
Management of patients with TBI in intensive care unit includes monitoring, monitoring of the oxygen saturation in the
cerebral venous blood using fiberoptic technology which allows continuous assessment .
There is need to continue research methodology and a better understanding of the molecular mechanisms contributing to
brain injury, for effective pharmacological neuro protection.
- Rogatzki MJ and Baker JS. Traumatic brain injury in sport with special focus on biomarkers of concussion injury.J Neurol Neurophysiol. 2016;7:383
- Huang SH and Zhou YH. Why molecular biomarkers of traumatic brain injury may never work: Effects of glymphatic pathway dysfunction.J Trauma Treat. 2016;5: 309.
- Bruns J and Hauser WA. The epidemiology of traumatic brain injury: A review. Epilepsia. 2003;44:2-10.
- Everhart DE, et al.The emerging importance of evaluation of pre-injury sleep characteristics among adolescents with traumatic brain injury.Int J Neurorehabilitation Eng. 2016;3:210
- Kaputa D and EnderleJD. An ultrasound based eye tracking system.J Biomed Eng Med Devic. 2016;1:108.
- Peden Margie. Injury: A leading cause of the global burden of disease. Geneva: WHO; 2002.
- Huang W.Healing from within the Wonder of Tai Chi.Int J Phys Med Rehabil. 2016;4:e110.
- Hofman K, et al. Addressing the growing burden of trauma and injury in low and middle-income countries. Am J Public Health. 2005;95:13-17.
- Tobe EH.Geriatric traumatic brain injury: Relationship to dementia and neurodegenerative disease.J Gerontol Geriatr Res. 2016;5:292.
- Thurman D and Janet G. Trends in hospitalization associated with traumatic brain injury. Journal of American Medical Association. 1999;282:954–957.
- Khallaf FG and Kehinde EO.The effect of serum from acute traumatic brain or spinal cord injury patients on the growth of human bone marrow-derived mesenchymal stem cells.J Trauma Treat. 2016;5:299.
- Sankar G and Jaya K.The psychological problems and existentialist view of the great two Americans Ernest Hemingway and F Scot Fitzgerald: A Glimpses.Arts Social Sci J. 2016;7:165.
- Archer T.Physical exercise and its impact on psychology.Clin Exp Psychol. 2016;2:e104.
- Sankar G. The cognitive insight and Jungian philosophy after the post-colonial era in American writer Ernest Hemingway.Arts Social Sci J. 2016;7:156.
- Moscote-Salazar LR and SatyartheeGD.Moving forward: The role of neuromonitoring in pediatric traumatic brain injury and targeted therapy.Clin Pediatr. 2016;1:e103.
- Zink BJ. Traumatic brain injury outcome: Concepts for emergency care. Annals of Emergency Medicine. 2001;37:318–32.
- Moscote-Salazar LR and Satyarthee GD. A sensible approach to pediatric mild traumatic brain injury: New roads and new vistas.Clin Pediatr. 2016;1:e104
- Atcherson SR and Mina Steele CL.Auditory processing deficits following sport-related or motor vehicle accident injuries.Brain Disord Ther. 2016;5:204.
- Wiseman-Hakes C, et al. A profile of sleep architecture and sleep disorders in adults with chronic traumatic brain injury.J Sleep Disord Ther. 2015;5:224.
- Olivera A, et al.Combination treatment of natural compounds and integrative therapies for mild traumatic brain injury.Brain Disord Ther. 2015;4:198.
- Maas AI, et al. Moderate and severe traumatic brain injury in adults. Lancet Neurology. 2008;7:728–41.
- Van Wyck DW, et al.Penetrating traumatic brain injury: A review of current evaluation and management concepts.J Neurol Neurophysiol. 2015;6:336.
- Li Y, et al.Traumatic brain injury−management principles of raised intracranial pressure and the emergence of hypertonic saline.J Neurol Neurophysiol. 2015;6:331.
- Morrison M, et al. A biosensing approach for detecting and managing head injuries in American football.J Biosens Bioelectron. 2015;6: 189
- Radha MJ, et al. Case report of secondary narcolepsy presenting as self-inflicted genital injury.J Clin Case Rep. 2015;S3:005.
- Huang YL, et al. Susceptibility-weighted MRI in mild traumatic brain injury: the importance of cerebral microbleeds.J Neurol Neurophysiol. 2015;6:321.
- Sixta SL, et al. Hypocoagulability in traumatic brain injury as measured by traditional means and thrombelastography.J Neurol Neurophysiol. 2015;6:316.
- de Menezes KKP.Physical therapy rehabilitation after traumatic brain injury.J Neurol Neurophysiol. 2015;6:311.
- Adiga US. Significance of random blood sugar in traumatic brain injury.JCNB. 2012;3:103-110.
- Rostami E, et al.Time-dependent changes in serum level of protein biomarkers after focal traumatic brain injury.Int J Neurorehabilitation Eng. 2015;2:168.
- Litovchenkoa T. et al. Combination of medical and physical therapy in management of post-traumatic headaches and sleep disturbances in patients with post-concussion syndrome.J Sleep Disord Ther. 2015;S1:005.
- Lanof JN, et al. Analysis of electroencephalogram resting state in diffuse axonal injury? A pilot study.Int J Neurorehabilitation Eng. 2015;2:158.
- de Aguiar GB, et al. Direct post-traumatic carotid cavernous fistula treated by endovascular intervention.Trauma Treat. 2014;4:103.
- O’Neil-Pirozzi TM, et al.Immediate memory and electro physiologic effects of prefrontal cortex transcranial direct current stimulation on a chronic traumatic brain injury survivor: A case report.Int J Phys Med Rehabil. 2015;3:278.
- Massenzo T and Pidcoe PE. Investigating the impact of visual biofeedback on postural control via informative dynamic balance training in healthy individuals.Int J Phys Med Rehabil. 2015;3:275.
- Blais MC and Boisvert JM.Coping with traumatic brain injury: How do post-acute TBI couples compare with those from the general population on psychological and marital adjustment?Int J Phys Med Rehabil. 2015;3:270.
- Hernández TD, et al. Acupressure as a model for complementary and alternative medicine (cam) treatment following acquired brain injury: Translating lessons from the laboratory.Int J Phys Med Rehabil. 2015;3:269.
- Rieger SM.Personality and behavior changes subsequent to traumatic brain injury: A review of the literature.Int J Emerg Ment Health. 2015;17:196.
- Catano A, et al. Occupational reintegration in patients with traumatic brain injury.Int J Neurorehabilitation Eng. 2015;2:150.
- Marmarou A, et al. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg. 1991;75:159–166.
- Nahas NME.Recovery of a patient from a seemingly vegetative state.J Trauma Treat. 2015; 4: 233.
- SecadesJJ.Citicoline for the treatment of head injury: A systematic review and meta-analysis of controlled clinical trials.J Trauma Treat. 2014;4:227.
- Wong FS and Lo AC.Collagen-based scaffolds for cell therapies in the injured brain.J Stem Cell Res Ther. 2015;5:267.
- Collicot PE and Hughes I. Training in advanced trauma life support. JAMA, 1980;243:1156-1159.
- Lepping RJ et al. Effectiveness of semantic encoding strategy training after traumatic brain injury is correlated with frontal brain activation change.Int J Phys Med Rehabil. 2015;3:254.
- Kumar A, et al. Neuroprotective effects of Aframomum melegueta extract after experimental traumatic brain injury.Nat Prod Chem Res. 2015;3:167.
- Tabish SA and Syed N.Recent advances and future trends in traumatic brain injury. Emergency Medicine. 2015;5:229.
- Kuenzler M, et al. Mortality and outcome of severe traumatic brain injury in a Swiss level one trauma center. Emergency Medicine. 2015;5:226.
- Thomas DJB. Physician heal thyself.Int J Phys Med Rehabil. 2014,2:244.
- Soltani Z, et al.Can soy diet be protective in severe and diffuse traumatic brain injury?J Neurol Neurophysiol. 2014;5:249.
- McDonnell E and Kolakowsky-Hayner SA.Post traumatic epilepsy: A review of triggers and potential treatments after brain injury.Int J Neurorehabilitation Eng. 2014;1:115.
- Bixenmann B, et al.Retinal and balance changes based on concussion history: A study of division 1 football players.Int J Phys Med Rehabil. 2014;2:234.
- Middleton J, et al. A clinical perspective on the need for psychosocial care guidelines in spinal cord injury rehabilitation.Int J Phys Med Rehabil. 2014;2:226.
- Galeote A, et al.Neurological rehabilitation after severe traumatic brain injury, new tools new hopes: The hippotherapy approach.J Neurol Neurophysiol. 2014;5:231.
- Murphy TE, et al.Trends in fall-related traumatic brain injury among older persons in Connecticut from 2000-2007.J Gerontol Geriatric Res. 2014;3:168.
- Clark JF, et al. Aggressive rehabilitation pathway targeting concussion symptoms: Illustration with a case study.Brain Disord Ther. 2014;3:131.
- Ashraf MU, et al. Citicholine: Current role in ishemic stroke and future perspectives.J Neurol Disord. 2014;2:165.
- Piel J. Case of migraine psychosis with traumatic brain injury.J Psychiatry. 2014;17:113.
- Hotz G, et al.The importance of orientation in evaluating recovery in pediatric traumatic brain injury.Int J Phys Med Rehabil. 2014;S5:004.
- Han X, et al.The development of posttraumatic stress disorder after mild traumatic brain injury in civilian populations: A meta-analysis.J Sleep Disord Ther. 2014;3:164.
- Sadaka F.Traumatic brain injury and preinjury antiplatelet use: is platelet transfusion helpful?J Blood Disord Transfus. 2014;5:e113.
- Zhao Q and Luo JJ. Epilepsy in elderly.Brain Disord Ther. 2014;3:115.
- Reneer DV, et al. Extent of cerebrovascular disruption following blast exposure is influenced by the duration of the positive phase in addition to peak overpressure.J Neurol Neurophysiol. 2014;5:188.
- Marion W, et al. The use of moderate therapeutic hypothermia for patients with severe head injuries. J Neurosurg 1993;79:354-362.
- Johansson B and Ronnback L.Evaluation of the mental fatigue scale and its relation to cognitive and emotional functioning after traumatic brain injury or stroke.Int J Phys Med Rehabil 2013;2:182.
- Sundman MH, et al.Examining the relationship between head trauma and neurodegenerative disease: A review of epidemiology, pathology and neuroimaging techniques.J Alzheimers Dis Parkinsonism. 2014;4:137.
- MollayevaT.Study of sleep patterns might advance our knowledge on alertness in traumatic brain injury.J Sleep Disord Ther. 2014;3:152.
- Stochetti N, et al. Hypoxemia and arterial hypotension at the accident scene in head injury. J Trauma 1996;40:764–767.
- Maller JJ and Reglade-Meslin C.Longitudinal hippocampal and fornix changes after traumatic brain injury: Observations from traditional structural magnetic resonance imaging.J Neurol Neurophysiol. 2014;5:185.
- Chung P and Khan F.Traumatic brain injury (TBI): Overview of diagnosis and treatment.J Neurol Neurophysiol. 2014;5:182.
- Corradini PL and Persinger MA.Standardized low resolution electromagnetic tomography (s_loreta) is a sensitive indicator of protracted neuropsychological impairments following? mild? (Concussive) traumatic brain injury.J Neurol Neurophysiol. 2013;4:176.
- Young GB.Traumatic brain injury.J Neurol Neurophysiol. 2013;4:174.
- Selcuk O, et al.(2013)Mild traumatic brain injury.J Neurol Neurophysiol 2013;4:172.
- van den Berghe G, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359-1367.
- Mollayeva T, et al. Sleep apnea in traumatic brain injury: Understanding its impact on executive function.J Sleep Disord Ther. 2013;2:129.
- Schober ME, et al. Isoflurane Exposure did not adversely affect recognition memory or decrease hippocampal brain derived neurotrophic factor expression in the 17 day old rat pup.J Anesth Clin Res 2013;4:362.
- Weigelt JA. Initial management of the trauma patient. Crit Care Clin. 1986; 2: 705-716.
- FriedlandDP. Improving the classification of traumatic brain injury: The mayo classification system for traumatic brain injury severity.J Spine. 2013;2:S4-005.
- Boris K, et al.Is routine brain CT scan, performed for early follow up in head trauma patients with gcs 14-15, always justified?J Trauma Treat. 2013;2:174.
- Aibiki M, et al.Effects of dexamethasone on pulmonary oxygenation impairments in therapeutic hypothermia for patients with traumatic brain injury.J Neurol Neurophysiol. 2013;4:164.
- Capo-Aponte JE, et al. Pupillary light reflex as an objective biomarker for early identification of blast-induced mTBI.J Spine. 2013;2:S4-004.
- Perkins J, et al. Case series illustrating the use of consistent rehabilitation outcome measures in traumatic brain injury.J Nov Physiother. 2013;3:177.
- Whitfield PC, et al. Bifrontal decompressive craniectomy in the management of posttraumatic intracranial hypertension. Br J Neurosurg. 2001;15:500-507.
- DeMuro JP and Hanna AF.Prophylaxis of deep venous thrombosis in trauma patients: A review.J Blood Disord Transfus. 2013;4:151.
- Luong KVQ and Nguyen LTH. Environmental factors in Alzheimer’s and Parkinson’s diseases.J Alzheimers Dis Parkinsonism. 2013;3:119.
- Bombien R and Rajput PS. A novel hydrazide lead compound to treat neurodegeneration: Ceetox? Safety and genotoxicity analysis.J Neurol Neurophysiol 2013;4:154.
- Electrophysiologic Evaluation of diffuse axonal injury after traumatic brain injury, Encephalitis.J Neurol Neurophysiol. 2013;4:157.
- Billek-SawhneyB.Translating massed practice principles to promote skill acquisition in a patient with brain injury.J Nov Physiother. 2013;3:154.
- Sinkiewicz M and HuangW. Osteopathic manipulative therapy on cervicogenic headache in veterans with mild traumatic brain injury - a case series.Int J Phys Med Rehabil. 2013;1:123.
- Weber M, et al. A brief and selective review of treatment approaches for sleep disturbance following traumatic brain injury.J Sleep Disord Ther. 2013;2:110.
- Haar CV, et al. The use of nicotinamide as a treatment for experimental traumatic brain injury and stroke: A review and evaluation.Clin Pharmacol Biopharm. 2013;S1:005.
- Paavola JM. Use of x-box kinect gaming console for rehabilitation of an individual with traumatic brain injury: A case report.J Nov Physiother. 2013;3:129.
- Roth RS and Spencer RJ.Iatrogenic risk in the management of mild traumatic brain injury among combat veterans: A case illustration and commentary.Int J Phys Med Rehabil. 2013;1:105.
- Current opinions on epidemiology, treatment and outcome after traumatic brain injury.J Trauma Treat. 2012;S1:001.
- Prehospital interventions in children with a severe traumatic brain injury.Emergency Medicine. 2012;2:129.
- Esposito TJ. Neurosurgeons, acute care surgeons or moms: Who should care for the head injured?J Trauma Treat. 2012;1:137.
- Kutzleb J. Evidence-based practice nursing interventions for improved functional and cognitive outcomes in the traumatic brain injury patient.J Nursing Care. 2012;1:110.
- Honeybul S. Decompressive craniectomy for severe traumatic brain injury: A review of its current status.J Neurol Neurophysiol. 2012;S9-001.
- AlexiouGA.Coagulopathy after traumatic brain injury.Emergency Medicine. 2012;2:e117.
- Watters N et al.Can a posttraumatic stress disorder be caused by a traumatic injury to a companion pet?J Trauma Treatment. 2012;1:117.