Traumatic Brain Injury

TBIs (traumatic brain injuries) are a major cause of death and disability in the U.S. You can get a TBI from a hard bump or jolt to your head or if you’re hit with something that penetrates your skull. TBIs may have short-term or long-term medical issues. There are treatments for TBI. More importantly, there are ways to prevent them from happening.

Overview

What is a TBI (traumatic brain injury)?

A traumatic brain injury (TBI) is a serious medical issue that affects how your brain works. You can get a TBI from a hard bump or jolt to your head or if you’re hit with something that penetrates your skull. Traumatic brain injuries are a major cause of death and disability in the U.S. They can cause short-term and long-term medical issues that can affect every part of your life. There are treatments for TBI. More importantly, there are ways to prevent them from happening.

Are TBIs common?

Traumatic brain injury affects thousands of people in the U.S. every year. In 2020, more than 214,000 people needed in-patient care for a TBI. More than 69,000 people died from issues involving traumatic brain injury.

Types of traumatic brain injuries

Traumatic brain injuries may be penetrating or non-penetrating (blunt):

• Penetrating TBI: A penetrating TBI is when something pierces your skull, enters your brain tissue and damages a part of your brain. Healthcare providers may call these open TBIs. Penetrating TBIs may happen if you’re hit in the head by a sharp object, like shrapnel, a bullet or a knife.
• Blunt TBI: A non-penetrating TBI is when something hits your head hard enough that your brain bounces or twists around inside your skull. Providers may use the terms closed head TBI or blunt TBI for this kind of TBI. Non-penetrating TBIs may happen if you’re in a vehicle accident, take a fall, are hit in the head, injured in an explosion or are injured while playing sports.

Further, healthcare providers classify traumatic brain injuries as being mild, moderate and severe. They may use the term concussion when talking about mild TBI. They typically group moderate and severe TBI together.

• Mild TBI: More than 75% of all TBIs are mild. But even mild TBIs may cause significant and long-term issues. People with a mild traumatic brain injury may have trouble returning to their daily routines, including being able to work.
• Moderate and severe TBI: Most people with a moderate or severe traumatic brain injury can develop significant and long-term health issues.

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Symptoms and Causes

What are the symptoms of a TBI (traumatic brain injury)?

If you have a traumatic brain injury, it means you were hit in the head hard enough to make your brain bounce around or twist inside your skull. When that happens, you can damage your brain and injure blood vessels in your brain. A TBI creates chemical changes in your brain so your brain cells don’t function as they should.

Traumatic brain injury symptoms vary depending on whether a TBI is mild or moderate and/or severe. But all TBIs may cause symptoms, including physical issues, trouble thinking or remembering, and social or emotional issues. Children and adults have similar symptoms. TBI symptoms in babies are issues eating or nursing. They may cry inconsolably, meaning nothing you do to comfort them helps them stop crying.

Mild TBI symptoms

Mild TBI symptoms vary. They can develop right away, a few days or even a week after you were hurt. You may not always make the connection between bumping your head hard and not feeling well. Symptoms also change as your brain recovers from injury.

Symptoms may include physical issues, issues with thinking and remembering, social and emotional issues, and sleeping issues.

Physical issues

Common symptoms include:

• Nausea and vomiting.
• Dizziness or balance issues.
• Headaches.
• Noticing that light bothers your eyes.
• Fatigue.
• Vision issues like blurred vision.

Thinking or remembering issues

If you have mild TBI, you may experience symptoms like:

• Confusion.
• Difficulty concentrating.
• Difficulty thinking clearly.
• Short-term memory loss.
• Feeling “slowed down,” like you’re moving in slow motion.
• Grogginess.

Social or emotional issues

Mild TBI may affect your sleep. You may also have trouble falling asleep, sleeping less than usual or sleeping more than usual.

Moderate or severe TBI symptoms

Like mild TBI, symptoms of a moderate or severe TBI may change over time.

Physical issues

Physical issues can be serious, including:

• Losing consciousness (passing out). A moderate TBI causes unconsciousness that lasts more than 30 minutes but fewer than 24 hours. In a severe TBI, you’re unconscious for more than 24 hours.
• Coma.
• Weakness in your arms and legs.
• Issues with balance and coordination.
• Hearing or vision issues.
• Changes in sensory perception, like touch.

Thinking or remembering

Moderate or severe TBI can cause symptoms like:

• Confusion.
• Difficulty concentrating.
• Difficulty thinking clearly.
• Short-term memory loss.
• Trouble communicating.
• Grogginess.

Social or emotional issues

Having moderate or severe TBI can cause the following symptoms:

• Anxiety.
• Nervousness.
• Irritability.
• Sadness.
• Depression.
• Anger.
• Aggressiveness.
• Difficulty managing behavior.
• Being more impulsive than usual.

What are complications of traumatic brain injuries?

Mild, moderate and severe TBIs cause different complications.

If you have a mild TBI and you don’t give your brain time to heal, you have an increased risk for second-impact syndrome, a life-threatening condition that happens when your brain suddenly swells and your brain tissue is displaced.

Moderate or severe TBIs have long-term consequences, including:

• Brain bleed.
• Seizures.
• Permanent brain damage and disability.
• Shorter life expectancy.

Moderate or severe TBIs increase your risk of developing the following issues:

• Alzheimer’s disease.
• Anxiety.
• Chronic traumatic encephalopathy.
• Depression.
• Movement disorders.
• Post-traumatic stress disorder.

Diagnosis and Tests

How are traumatic brain injuries diagnosed?

If you have a mild TBI, your healthcare provider will examine you and ask about your symptoms. They’ll also want to learn more about what caused the injury. They may do the following tests:

• Neurological evaluation.
• Imaging tests. A CT scan or MRI checks for brain bleeding and swelling.
• Blood tests.

If you have a moderate or severe traumatic brain injury, your provider likely will do blood tests and a CT scan so they can decide on immediate medical treatment.

Management and Treatment

What are treatments for a traumatic brain injury?

There are different treatments for mild and moderate/severe TBI. Specific treatments vary depending on your situation.

Treatment for mild TBI

If you have a mild traumatic brain injury, healthcare providers may recommend:

• Rest.
• Over-the-counter nonNSAID pain relievers.
• Regular checkups over the next few weeks to watch for new symptoms or worsening symptoms.

Treatment for a moderate or severe TBI

A moderate or severe traumatic brain injury is a medical emergency. Healthcare providers may do surgery to:

• Relieve pressure inside your skull.
• Remove any debris inside your skull from a penetrating TBI, where something breaks through your skull and into your brain tissue.
• Remove blood clots.
• Repair fractures in your skull.
• Place monitors in your brain to measure pressure and oxygenation.

Providers may prescribe medications, including:

• Prescription pain medicines.
• Antiseizure medications.
• Medication to prevent venous thromboembolism.
• Stimulants to increase alertness.
• Antidepressants.
• Anxiolytics for anxiety.

Once you recover from surgery, you’ll probably begin rehabilitation treatment. The goal of rehabilitation is to improve your ability to handle daily activities and help you manage challenges like communication or mental health issues. You may receive:

• Physical therapy.
• Occupational therapy.
• Speech therapy.
• Respiratory therapy.
• Psychological therapy to help with any emotional or mental health issues.

Prevention

Can TBIs be prevented?

You may not be able to avoid all the things that can cause a traumatic brain injury. But there are steps you can take to protect your head and reduce your risk of TBI. Here are some suggestions:

• Reduce your risk of falling. If you’re age 65 or older, you have an increased risk of falling. Consider steps like installing stair handrails to help navigate stairs. Create clear and safe paths throughout your home by removing rugs, long electrical cords or small pieces of furniture that could make you trip and fall.
• Play it safe. Wear protective gear if you participate in contact sports or ride bicycles and motorcycles.
• Buckle up. Wear your seatbelt and make sure your passengers wear theirs. If you travel with babies and toddlers, make sure they always ride in car seats or boosters.

Outlook / Prognosis

Can you fully recover from a TBI?

That depends on your situation. All traumatic brain injuries can create challenges. In some cases, a traumatic brain injury can have long-lasting consequences. If you have a TBI, ask your provider what you can expect.

Living With

I have a mild traumatic brain injury. How do I take care of myself?

Most people with mild traumatic brain injury feel better after a few days of rest. If you have mild TBI, you can take care of yourself by:

• Avoiding activities that put your head and brain at risk for another injury.
• If you have headaches, ask your healthcare provider about over-the-counter pain relievers you can use, and when you should use them.
• Getting extra rest. It takes time for your brain to heal. If you have trouble sleeping, talk to your provider about steps you can take to get a good night’s sleep.

When should people with a TBI go to the emergency room?

If you have a TBI, get help right away if you have:

• Headaches that don’t go away or get worse.
• Vomiting that doesn’t stop.
• Slurred speech.

If you’re caring for someone with a TBI, you should seek immediate care if:

• They’ve lost consciousness and you can’t rouse them.
• They’re having convulsions.
• You notice the pupil (center) of one of their eyes is much larger than the pupil in their other eye.

One of my loved ones has a moderate to severe TBI. How can I help them?

If you care for someone with a traumatic brain injury, you may want support and guidance on how to help them rebuild their lives. Here are some suggestions:

• Learn how TBI affects them. If you know what to expect, it may help you do more as your loved one copes with challenges.
• Encourage them to participate in therapy.
• Do what you can to help them get enough rest.
• Take care of yourself. It can be stressful and exhausting to care for someone with severe TBI. Ask your loved one’s providers about services and programs that will let you take breaks.
• Join a support group. Connecting with people who understand what you’re going through may help you feel less alone.

What questions should I ask my healthcare provider?

If you have a mild traumatic brain injury, you may want to ask your provider the following questions:

• What kind of TBI do I have?
• Will I need surgery or therapy?
• When will I feel better?
• When can I go back to work or school?

If you care for someone with a severe TBI, you may want to ask:

• What are the treatment options?
• What kind of rehabilitation will they need?
• What are the chances they’ll recover?
• How can I help them cope with this condition?

A note from Cleveland Clinic

At its worst, a TBI, or traumatic brain injury, can be life-threatening. But even mild TBIs can change your life. Traumatic brain injuries happen when you hit your head or are hit in the head. They can cause short- or long-term problems that may affect every part of your life. A TBI may change how you think, act, feel and learn. It can affect your ability to work and build relationships.

Many things can cause TBIs, from accidental falls and vehicle accidents to interpersonal violence. There’s no guarantee you’ll avoid everything that may cause a TBI. But you can take steps to reduce your risk. If you’re worried you could be at risk for a TBI, ask a healthcare provider for information about protecting yourself — and your brain — from a traumatic brain injury.