What You Need to Know About Brain Injury in Children and Adults

An estimated 2.5 million people in the U.S. sustain a traumatic brain injury each year. And about 5.3 million Americans live with a TBI-related disability. As pediatric neurosurgeon David A. Chesler, MD, PhD, and neurorehabilitation neurologist Andrew Goldfine, MD, explain, proper diagnosis and treatment are key.

What causes a traumatic brain injury?
Dr. Chesler: A traumatic brain injury (TBI) is caused by a bump, blow or jolt to the head or a penetrating head injury. However, not all blows or jolts to the head result in a TBI. When a sudden force comes in contact with the skull, the force may disrupt how the brain normally functions and cause brain tissue to stretch or tear from the sudden movement. The three top causes for a traumatic brain injury are a car accident, use of firearms, and falls. Young adults and the elderly are the age groups at the highest risk.

Are there different levels of TBI?
Dr. Goldfine: Each level is defined by the length of time during which a person loses consciousness. A mild TBI, which is also known as a concussion, often leads to a brief loss of consciousness or temporary confusion. Then, hours later, the patient can develop nausea, vomiting, dizziness and headache. With a severe TBI, the loss of consciousness lasts for more than a day. Typically, the longer the loss of consciousness, the higher the degree of brain injury. However, many people with a concussion experience persistent symptoms for months.

Can other injuries occur as a result?
Dr. Chesler: Yes. All levels of TBI can be associated with bleeding inside the skull, brain swelling, brain damage due to a lack of oxygen, infection inside the skull, seizures, and increased fluid inside the skull (hydrocephalus). These TBI-associated injuries can appear hours or days after the initial injury and need to be addressed immediately by skilled specialists in an emergency room or intensive care unit of a hospital.

How is TBI diagnosed?
Dr. Goldfine: TBI is diagnosed based on the events that led up to the injury, the symptoms experienced by the patient, and the exam provided by the physician. Imaging tests such as CT (computerized tomography) and MRI (magnetic resonance imaging) scans can help determine the level of brain damage and reveal related complications such as bleeding and hydrocephalus. These tests are not typically required in cases of a mild TBI, unless there are abnormalities found during the neurological exam.

How is TBI treated?
Dr. Goldfine: If the TBI is mild and a concussion is suspected, over the counter medications may be prescribed. The patient will need lots of rest and close monitoring until the symptoms subside and there are no worsening or new symptoms. Patients with more severe TBI require hospitalization to watch for and treat complications such as bleeding and hydrocephalus.

When is surgery necessary?
Dr. Chesler: Immediately following a TBI, the most important thing is to stabilize the patient. Over the first few hours to days following the initial injury, a patient may require surgery to minimize further injury from increased pressure within the skull, swelling of the brain or to treat bleeding within or around the brain.

What about rehabilitation?
Dr. Goldfine: Most people with a concussion recover quickly and fully. But for some people, symptoms such as headache, poor balance and dizziness can last for days, weeks or longer. For those hospitalized after a severe TBI, almost half (43 percent) have a related disability one year after the injury. As a neurorehabilitation neurologist, it’s my job to determine the cause of the patient’s symptoms and guide the patient on the use of medications and rehabilitation to help resolve their symptoms and regain their independence. I work closely with our occupational, physical and speech therapists and neuropsychologists to assist patients in this recovery.

Why Stony Brook for treating TBI?
Dr. Chesler: As a Regional Trauma Center, Stony Brook offers the highest level of care to trauma patients. This allows us to deal with serious injuries immediately, which is key when minutes count. One of our six board-certified neurosurgeons is on call 24/7, as are special clinical staff and an operating room that is fully equipped to handle complex and severe injuries.
Dr. Goldfine: Our rehabilitation team, which includes a wide range of specialists, offers advanced medical and rehabilitation treatments often not available elsewhere. Stony Brook is also a major research institution with ongoing studies on TBI to improve care.

For more information about traumatic brain injury or our Regional Trauma Center, call (631) 444-4000 or visit neuro.stonybrookmedicine.edu