What Happens To The Brain After The Initial Injury?
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What Happens To The Brain After The Initial Injury?

Traumatic brain injury is damage to the brain from a blow to the head or jostling of the head. Some common causes are motorcycle accidents, falls, assaults, and gunshot wounds. There are two different types of traumatic brain injuries, closed head injuries, and open head injuries.

In a closed head injury, a blow to the head causes the brain to be jostled against the inside of the skull. The movement and collision with the skull cause bruising, tearing of blood vessels, and bleeding to the brain, said Brad Nakase who is a personal injury and employment lawyer. Sometimes if the impact is strong, the brain may be ricocheted into the opposite side of the skull, causing twin contusions on opposite sides of the brain. Damage like this to specific areas of the brain is easy to identify on MRI and CAT scans.

Another way the brain can be damaged in closed head injuries is by stretching and tearing of neuronal axons when the brain moves. Neuronal axons are nerve cells which carry the messages from other parts of the brain and body. This damage is not easily detected through scans due to the small size of neuronal axons. However, due to the effect this damage has on the patient’s ability to function, the injury is clear.

Closed head injuries can cause damage in localized brain areas, or throughout the whole brain depending on the nature of the injury. When a car or motorcycle accident happens at speed, the damage is often worse as the brain will move rapidly within the skull. This will cause the tearing of the neuronal axons, as mentioned above. This injury is called a diffuse axonal injury.

The second type of traumatic brain injury is an open traumatic brain injury which is where the skull is fractured or penetrated by an object. This happens in gunshot wounds and stabbings; it can also happen in car accidents if the skull is fractured or penetrated by windshield glass. These injuries tend to be limited to one specific area rather than affect the whole brain. Open traumatic brain injuries can still be severe, depending on the area of the brain that gets damaged. If any veins or arteries are torn or severed by the foreign object, it can cause death.

What Symptoms Show Immediately After a Traumatic Brain Injury?
A lot of things happen in the brain following trauma. Parts of the brain may not receive oxygen as blood supply is cut off, and brain chemicals might be released from their cells, causing secondary cell death. These processes will not be visible to us, though, but we can see the effect on the patient’s functioning. One of the most obvious signs of traumatic brain injury is a loss of consciousness, though it is not always present. Loss of consciousness will happen at the time of the brain trauma and can last a few seconds, all the way up to months depending on the injury. When loss of consciousness lasts a long time, it is called a coma. In the days following brain trauma deterioration in breathing and motor functions may also be seen.

When a brain trauma patient regains consciousness, they will often be confused, disorientated, irritable, and even aggressive. This is because of the trauma to their brain and the damage to different regions. Over time, these symptoms will subside as the brain recovers from the trauma. Unlike other parts of the body, the brain does not regenerate well, so certain functions and parts of the brain will be permanently damaged. Rehabilitation can help with some functionality, but some brain injury patients will have permanent deficits and disability.

How Is The Severity of Brain Injury Measured?
The degree of severity is not an easy thing to measure, as brain injuries vary so much. Generally, there are some things that doctors look at like the duration of memory loss and loss of consciousness.

The Glasgow Coma Scale is a widely practiced method to determine the level of brain injury. The doctor will assess the patient in three categories by asking questions, giving commands, and presenting stimuli. The three categories are:

• Eye response
• Verbal response
• Motor skills

The lower the score, the more severe a brain injury is. A score of less than three would indicate the patient is in a deep coma and unresponsive. If the patient scores higher than 9, then they are not in a coma but not fully alert. 15 or higher is a fully conscious person.

There are three levels of brain injury:

• Mild traumatic brain injury – loss of consciousness would have been for less than 20 minutes and a Glasgow Coma Score of 13-15. The patient may be confused and have difficulty concentrating but can still function.

• Moderate traumatic brain injury – Loss of consciousness could have been for a few hours or days. The initial Glasgow Coma Score would have been between 9 and 12. In a moderate traumatic brain injury, some deficits would be apparent, and months of rehabilitation will be necessary. There is the possibility that deficits will be permanent.

• Severe traumatic brain injury – The patient may have been in a coma for a while and scored an initial Glasgow Coma Score of less than 8. Severe traumatic brain injuries will usually leave the patient with a permanent disability.

The initial severity of the traumatic brain injury does not predict long term recovery or what kind of deficits they may experience. It is just a way for doctors to categorize a brain injury and the sort of needs the patient may have.

How Long Does It Take To Recover From Traumatic Brain Injury?
Recovery will vary between patients, but generally, a mild brain injury will recover much quicker than moderate or severe injuries. Even mild brain injuries may take someone years to recover from with the help of rehabilitation. It will all depend on the affected part of the brain and the patient.

Moderate and severe brain injuries might have a few stages to recovery, though. Permanent deficits and disabilities are common, so patience is necessary for the rehabilitation process. Some patients may need long term care and support to lead a normal life.

How Is Recovery Measured After a Traumatic Brain Injury?
For moderate or severe brain injuries, the recovery is measured by the Rancho Los Amigos Scale. This scale gives eight levels from a deep coma to full awareness and functioning. The levels of the scale reflect the process of the brain as it stabilizes, heals, and regroups.

It will depend on the level of brain damage how quickly a patient passes through each stage. Some may never progress through all eight stages, and some may be stuck on a stage for years before progressing.

Rancho Los Amigos Scale
• Level One (No Response) – The patient does not respond to any stimuli and is in a deep coma.

• Level Two (Generalized Response) – The patient sleeps most of the day but has brief periods of waking. All responses and movements are reflexes and not purposeful.

• Level Three (Localized Response) – The patient is alert for longer periods of time. They react to commands, but reactions are inconsistent. Reactions are appropriate to the type of stimulus presented.

• Level Four (Confusion and Agitation) – The patient is more aware and confused with their situation. They will display silly or aggressive behavior as their brain struggles to cope with the disorganization. The patient will have a short attention span and will be unable to participate in treatment properly. They are also unable to perform basic tasks such as eating by themselves.

• Level Five (Confused, Inappropriate, Not Agitated) – The patient is able to follow simple commands consistently, and they can do natural tasks such as eating. They will struggle to follow complex commands. Long-term memory is starting to return though short-term memory, learning new skills and concentrating for more than a few minutes is still difficult.

• Level Six (Confused, Appropriate) – The patient is aware of their deficits, family and friends, and can carry out tasks independently. Skills learnt in treatment or rehabilitation will be carried from one session to another. The patient will start to show goal-orientated behavior but will still need direction.

• Level Seven (Automatic, Appropriate) – The patient is able to automatically do their daily routine and learn new skills. Their learning will still be slower than before the injury. There are still problems with short-term memory, problem-solving, and judgement.

• Level Eight (Purposeful, Appropriate) – There may still be social, emotional, and cognitive impairments, but the patient is able to function in the community.

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