Levels of Brain Injury
Traumatic brain injuries (TBIs) usually can be divided into three categories: Severe traumatic brain injuries, moderate traumatic brain injuries, and mild traumatic brain injuries. However, even though the term "mild" is used as a classification, brain injuries are never mild. Any brain injury is a serious condition that warrants medical attention.
Brain injuries can also be divided into closed head injuries and open head injuries. Diagnosing open head injuries is clear-cut because the skull has usually been penetrated. Closed head injuries are harder to diagnose. When someone sustains a head injury caused by an external force or object but there is no fracture, this type of head injury is called a closed head injury.
The brain can swell during a closed head injury, which can be dangerous for the injured person. The brain has nowhere to expand because there is only a limited amount of space in the human skull. Intracranial pressure can then increase inside the skull. The swelling of the brain can cause the compression of brain tissues, leading to greater injury. The swollen area of the brain may even expand into the openings that are available in the skull, such as the eye sockets. This can compress and impair the way the nerves of the eyes function. Medical personnel should examine the person's pupils right away to see if this problem has arisen.
Mild Traumatic Brain Injuries
There may or may not be a loss of consciousness when someone has a mild traumatic brain injury. Accompanying loss of consciousness, however, usually lasts from a few seconds to several minutes. A person with a mild TBI can also seem confused or dazed.
Objective brain tests, such as MRI's or CT scans may render normal results. A mild TBI can be diagnosed only if there was a change in a person's mental state at the time the injury occurred. The change is a sign that there has been a modification in the injured person's brain function. This is usually referred to as a concussion.
Mild TBI symptoms include fatigue, headache, irritability, sleeping problems, sensitivity to noise, light sensitivity, concentration problems, balance problems, memory problems, inability to think quickly, depression, nausea, and emotional mood swings. A person with a mild TBI should call a doctor or 911 right away or go to an emergency room. Most people with a mild TBI take less than one year to recover from their brain injury.
Moderate Traumatic Brain Injuries
A moderate TBI frequently takes place when loss of consciousness lasts anywhere from a few minutes to a few hours. A person with a moderate TBI can experience confusion lasting anywhere from a few days to several weeks. Cognitive, physical, and/or behavioral impairments can last for months and may even be permanent.
Severe Traumatic Brain Injuries
Severe TBIs can happen after an extended state of unconsciousness or a coma lasting for days, weeks, or months. Severe TBIs can be categorized into different subgroups:
- Akinetic Mutism
- Coma
- Locked-in Syndrome
- Vegetative State
- Persistent Vegetative State
- Minimally Responsive State
Akinetic mutism occurs when there is damage to the dopaminergic pathways leading to the brain. This type of damage can lead to little or no spontaneous speech, minimal body movement, visual tracking or eye opening, and an incomplete and infrequent ability to obey commands. Akinetic mutism differs from being in a minimally responsive state in that the lack of speech and movement that accompanies akinetic mutism is not because of a neuromuscular disturbance.
A coma is when a person is unconsciousness and cannot be woken up. A person in a coma is minimally responsive or does not respond at all to stimuli and cannot initiate any voluntary activities. Coma patients appear to be sleeping. A person whose severe TBI results in a coma can improve substantially. Often, however, this person will be left with permanent behavioral, cognitive, or physical impairments.
Locked-in syndrome is a rare type of neurological condition that occurs when a person cannot physically move any body part except for the eyes. A person with locked-in syndrome is conscious and retains the ability to think.
The term vegetative state is used to describe a severe TBI in which the ability to interact with the environment is not present even though arousal is evident. A person that is in a vegetative state may be able to open his or her eyes spontaneously or as a response to stimuli. The patient can also respond to pain with rapid breathing, increased heart rate, sweating, or posturing. Normal respiratory functions, sleep-wake cycles, and digestive functions are frequently present. There is no physical test to diagnose a vegetative state. Neurobehavioral assessments are used to make a diagnosis.
Persistent vegetative state describes a vegetative state lasting longer than a month. The characteristics and criteria are the same as someone characterized as being in a vegetative state.
A minimally responsive state refers to a person with a severe TBI who is no longer in a vegetative state or a coma. Primitive reflexes, not consistently being able to follow simple commands, and being aware of stimuli from the environment are a few characteristics associated with a person that is in this state. Assessing the purposefulness or meaningfulness of a behavior is done by evaluating the conditions and frequency of the way the patient responds.
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