Severe Traumatic Brain Injury

Severe traumatic brain trauma can be associated with a severe fall, a sports injury, violence to the brain or a motor vehicle accident. A severe traumatic brain injury can be associated with a skull fracture, penetration to the brain or to no fracture or damage to the skull whatsoever. The brain is situated within a collection of cerebrospinal fluid and can be damaged through the rattling around the brain within the skull. The spot at which the brain is damaged near where the skull was struck is called the "coup" injury. When the brain bounces off the opposite side of the skull from the level of the injury, it is called the "contra-coup" injury. Sometimes the contra-coup injury is more severe and debilitating than the original coup injury. In such cases, there may be no damage to the skull itself and this type of injury is common in rapidly decelerating injuries.

Severe traumatic brain injuries can result in permanent brain damage that can be minor or severe. In a moderate brain injury, there is loss of consciousness that lasts from 20 minutes to about six hours. The Glasgow coma scale ranges from 9 to 12 at the time of first testing. A severe traumatic brain injury means there is a loss of consciousness past six hours with a Glasgow coma scale at the time of first assessment of between 3 and 8.

There is usually a strong impact of a severe brain trauma on the body. The degree of impact depends upon how severe the initial trauma to the brain is, how completely you recover, which functions of the brain are affected and the areas of function which are unaffected by the traumatic brain function. If there are good resources for rehabilitation, the traumatic brain injury has a lesser degree of impact than if there are few resources for rehabilitation.

Severe traumatic brain injury can affect the movement and sensation of the arms and legs, paralysis of a part of the face and speech. It can also affect more subtle things in the brain such as concentration, attention, memory, ease of distractibility, perseveration, impulsiveness and "executive functions". There can be permanent confusion and problems with the speed of processing information.

Speech is often affected with severe traumatic brain injury. The sufferer may not understand the spoken word and may have slurred speech or halting speech. You can speak very slowly or too fast. There can be problems in reading and in writing (dysgraphia). There can be visual problems, too, associated with partial or complete loss of vision and things like double vision or difficulty judging distances. Intolerance to light is also possible. Hearing and smell can be affected as well.

The Glasgow Coma scale determines the level of coma and brain injury a person has with traumatic brain injury. It is a fifteen point scale that looks at verbal response, motor response and eye opening. These are scored and are given a final added score. The lower the score, the greater is the degree of brain trauma. A lower score also means that the individual has a poorer prognosis. A Glasgow Coma Scale value of 3-8 indicates the high likelihood of coma with no meaningful response and no voluntary movements. A vegetative state involves a Glasgow Coma scale of less than three. If this state lasts longer than a month, it is known as a persistent vegetative state. In the most extreme cases, there can be no brain function and the patient may meet the criteria for brain death.

The diagnosis of severe brain injury can be done through the physical and neurological exam as well as through the use of MRI scans or CT scans showing darkening in areas of the brain where the brain has liquefied. Blood can be seen in parts of the brain as well. SPECT scans and PET scans can show areas of brain functioning juxtasupposed with areas of the brain that have no functioning.

Treatment of severe traumatic brain injury means supporting breathing if this is in danger. It means using medications like mannitol to reduce the swelling of the brain. Steroids are used to reduce brains swelling and medications are used to prevent seizures. As soon as the patient is stable, physical, occupational and speech therapy are used to try and regain those functions lost in the injury. Recovery can sometimes take years of therapy to regain function to a maximal level.