Complications of traumatic brain injury

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Traumatic brain injury (TBI, physical trauma to the brain) can lead to various complications, health effects that are not TBI alone but a result of it. The risk of complications increases with the severity of trauma; But even mild traumatic brain injury can lead to defects that interfere with social interactions, work, and everyday life. TBI can cause a variety of problems including physical, cognitive, emotional, and behavioral complications.

Symptoms that may occur after concussion - a minor form of traumatic brain injury - are referred to as post-concussion syndrome.

Video Complications of traumatic brain injury

Effects on the unconscious

In general, there are six conditions of abnormal awareness that can result from TBI:

• Stupor is a partial or near-complete state of unconsciousness in which the patient is lethargic, immobile, and has a reduced response to stimuli.
• Coma is a state in which the patient is completely unconscious and can not be aroused even with strong stimuli.
• Persistent vegetative conditions are conditions in which the patient is awake unaware and unaware of their surroundings and the cerebral cortex is not functioning. The vegetative state can result from injuries that spread to the cerebral hemispheres of the brain without damaging the lower brain and brainstem. The vegetative state is considered permanent if it lasts for 12 months after TBI or 3 months after causing other than trauma.
• A minimal consciousness is a condition in which the patient experiences a decreased level of arousal and may appear, on the surface, in a persistent vegetative state but capable of demonstrating the ability to actively process information.
• Locked-in syndrome is a condition in which the patient is awake and awake, but can not move or communicate due to total body paralysis. Voluntary or flashing eye movement control can be avoided, allowing the detection of consciousness and allowing the establishment of functional communication.
• Brain death is the irreversible loss of measurable brain function, with loss of integrated activity among different brain areas. Breathing and heart function should be maintained with aids.

Impaired consciousness affects large numbers of people with severe TBI; of those with severe TBI discharged from the hospital, 10-15 are in a vegetative state, and of this number only half are conscious within one to three years.

Maps Complications of traumatic brain injury

Cognitive deficits

Most patients with severe TBI who restore consciousness suffer from cognitive defects, including loss of many high-level mental skills. Cognitive deficits that may follow TBI include attention disorder; disturbing insights, ratings, and thoughts; reducing processing speed; distractibility; and deficits in executive functions such as abstract reasoning, planning, problem solving, and multitasking. Memory loss, the most common cognitive impairment among head injured persons, occurs in 20-79% of people with closed head trauma, depending on severity. Post-traumatic amnesia (PTA), a confusing state with memory impairment, is characterized by a loss of specific memory or a partial inability to form or store new ones.

Alzheimer's disease (AD) is a progressive neurodegenerative disease characterized by dementia, memory loss, and worsening cognitive abilities. Research shows the relationship between head injury early in adulthood and later development of AD; the more severe the head injury, the greater the risk of developing AD. Some evidence suggests that head injuries may interact with other factors to trigger the disease and may accelerate the onset of disease in already-at-risk individuals. For example, head injured individuals who have a special form of apolipoprotein E protein (apoE4, a natural protein that helps transport cholesterol through the bloodstream) fall into this increased risk category.

Patients with moderate to severe TBI have more problems with cognitive deficits than mild TBI, but some mild TBI may have additional effects. About one in five career boxers is affected by chronic traumatic brain injury (CTBI), which causes cognitive, behavioral, and physical disorders. Dementia pugilistica, also called chronic traumatic encephalopathy, is a severe form of CTBI. Caused by repeated blows to the head over a long period, these conditions primarily affect the boxer's career and have recently been associated with other contact sports including American football and ice hockey as well as military service (see Ann McKee). It generally manifests as dementia, or decreased mental ability, memory problems, and parkinsonism (tremor and lack of coordination). Symptoms start anywhere between 6 and 40 years after the start of boxing career, with an average onset of about 16 years.

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Communication issues

Language and communication problems are common defects in TBI patients. Some may experience aphasia, difficulty in understanding and producing spoken and written language; or they may have difficulty with more subtle aspects of communication, such as body language and emotion, non-verbal signals. Some may have problems with intonation or inflection, called prosodic dysfunction. Problems with spoken language can occur if parts of the brain that control speech muscles break down. In this disorder, called dysarthria, patients can think of appropriate language, but can not easily pronounce words because they can not use the muscles needed to form words and produce sound. Speeches are often slow, lisp, and chaotic.

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Sensory deficit

TBI patients may have sensory problems, especially problems with vision; they may not be able to register what they see or may be slow to recognize the object. Also, TBI patients often have difficulty with eye-hand coordination, causing them to appear clumsy or unstable. Other sensory deficits include hearing, olfactory, tasting, or touching problems. Tinnitus, ringing or roaring to the ear, can occur. A person with damage to a part of the brain that processes taste or smell can feel a bitter taste or a persistent stench. Damage to the part of the brain that controls the sense of touch can cause a TBI patient to develop persistent skin tingling, itching, or pain. This condition is rare and difficult to treat.

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Emotional and behavioral issues

TBI can cause emotional or behavioral problems and personality changes. Emotional symptoms that can follow TBI include emotional instability, depression, anxiety, hypomania, mania, apathy, irritability, and anger. TBI appears to predispose a person to psychiatric disorders including obsessive compulsive disorder, alcohol or substance abuse or substance dependence, dysthymia, clinical depression, bipolar disorder, phobias, panic disorder, and schizophrenia. About a quarter of people with TBI suffer from clinical depression, and about 9% suffer from mania. The prevalence of all psychiatric illnesses was 49% in moderate to severe TBI and 34% in mild TBI within one year of injury, compared with 18% control. People with TBI continue to be at greater risk for psychiatric problems than others even years after the injury. Problems that can last up to two years after an injury include irritability, suicidal ideation, insomnia, and loss of ability to experience the fun of a previously enjoyable experience.

Symptoms of behavior that can follow TBI include disinhibition, inability to control anger, impulsivity, lack of initiative, inappropriate sexual activity, and personality changes. Different behavior problems are characteristic of the location of the injury; for example, frontal lobe injuries often result in disinhibition and inappropriate or childish behavior, and temporal lobe injuries often cause irritation and aggression.

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Physical complications

Pain, especially headaches, is a common complication after TBI. Being unconscious and lying still for a long time can cause a blood clot to form (deep venous thrombosis), which can cause pulmonary embolism. Other serious complications for an unconscious patient, coma, or in a vegetative state include pressure sores, pneumonia or other infections, and progressive multiple organ failure.

The risk of post-traumatic seizures increases with the severity of the trauma (picture on the right) and is especially increased with certain types of brain trauma such as cerebral contusions or hematoma. As many as 50% of people with head injury will develop seizures. People with early seizures, those occurring within weeks of injury, have an increased risk of post-traumatic epilepsy (recurrent seizures occur more than a week after initial trauma) even though seizures may appear a decade or more after initial injury and common type of seizures may also change over time. Generally, medical professionals use anticonvulsant drugs to treat seizures in TBI patients within the first week of injury only and after that only if seizures persist.

Neurostorms can occur after severe TBI. The lower Glasgow Coma Score (GCS), the higher the chances of Neurostorming. Neurostorms occur when the Patient Autonomic Nervous System (ANS), Central Nervous System (CNS), Sympathetic Nervous System (SNS), and ParaSimpatis Nervous System (PSNS) become severely compromised https://www.brainline.org/story/neurostorm- century -part-1-3-medical-terminology. This in turn may create the following potentially life-threatening symptoms: increased IntraCranial Pressure (ICP), tachycardia, tremor, seizures, fever, increased blood pressure, increased cerebral spinal fluid (CSF), and diaphoresis https://www.brainline. org/story/neurostorm-century-part-1-3-medical-terminology. A wide variety of drugs can be used to help reduce or control episodes of Neurostorm https://www.brainline.org/story/neurostorm-century-part-3-3-new-way-life.

Parkinson's disease and other motor problems as a result of TBI are rare but can occur. Parkinson's disease, chronic and progressive disorders, can develop many years after TBI as a result of basal ganglia damage. Other movement disorders that can develop after TBI include tremor, ataxia (uncoordinated muscle movement), and myoclonus (muscle contraction as shock).

Skull fractures can tear meninges, membranes that cover the brain, causing cerebrospinal fluid leak (CSF). A tear between the dura and the arachnoid membrane, called the CSF fistula, may cause CSF to leak out of the subarachnoid space into the subdural space; this is called subdural hygroma. CSF can also leak from the nose and ears. These tears can also allow bacteria to enter the cavity, potentially causing infections such as meningitis. Pneumocephalus occurs when air enters the intracranial cavity and is trapped in the subarachnoid space. Infection in the intracranial cavity is a dangerous complication of TBI. They can occur outside the dura mater, under the dura, under arachnoid (meningitis), or within the brain itself (abscess). Most of these injuries develop within a few weeks of early trauma and result from skull fractures or penetrating injuries. Standard treatments involve antibiotics and sometimes surgery to remove infected tissue.

Injury to the base of the skull can damage nerves that appear directly from the brain (cranial nerves). Damage to the cranial nerve may cause:

• Facial muscle paralysis
• Damage to the nerve responsible for eye movement, which may cause double vision
• Damage to the olfactory nerves
• Loss of vision
• Loss of facial sensation
• Swallowing problem

Hydrocephalus, post-traumatic ventricular enlargement, occurs when CSF accumulates in the brain, resulting in cerebral ventricular dilatation and increased ICT. This condition may develop during the acute stage of TBI or may not appear until later. Generally occurs in the first year of injury and is characterized by worsening neurological outcomes, impaired consciousness, behavioral changes, ataxia (lack of coordination or balance), incontinence, or signs of increased ICT.

Damage to the head or brain usually causes damage to the blood vessel system, which provides blood to the brain cells. The body can repair small blood vessels, but greater damage can lead to serious complications. Damage to one of the main arteries leading to the brain can cause a stroke, either through bleeding from the artery or through the formation of blood clots in the injury site, blocking blood flow to the brain. Blood clots can also develop in other parts of the head. Other types of vascular complications include vasospasm, in which the blood vessels narrow and restrict blood flow, and the formation of aneurysms, where the sides of blood vessels weaken and out balloons.

Liquid and hormonal imbalances can also complicate treatment. Hormonal problems can occur due to dysfunction of the pituitary gland, thyroid gland, and other glands throughout the body. Two TBI hormonal complications are inappropriate syndromes of antidiuretic hormone and hypothyroidism.

Another common problem is spasticity. In this situation, certain muscles of the body are tight or hypertonic because they can not be completely relaxed.

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References

Source of the article : Wikipedia