Traumatic Brain Injury

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Traumatic Brain Injury
Traumatic Brain Injury
Video: Traumatic Brain Injury
Video: Overview of Traumatic Brain Injury (TBI) 2023, February
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traumatic brain injury

Traumatic brain trauma is an injury to the skull bone that is associated with a functional disorder of the brain. Common causes are falls, traffic accidents and sports injuries. Symptoms vary depending on the severity of the trauma.

A traumatic brain injury can quickly become life-threatening or have serious consequences. A quick diagnosis and treatment is important.

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  • What types of skull fractures can be distinguished?
  • What types of brain injuries can be distinguished?
  • What are the causes of traumatic brain injury?
  • What are the symptoms?
  • How is the diagnosis made?
  • How is traumatic brain injury treated?
  • Whom can I ask?
  • How are the costs going to be covered?

Not every head injury automatically leads to a traumatic brain injury: even after multiple skull fractures, the brain tissue can be (largely) uninjured. Conversely, severe brain injuries can occur without breaking the skull bones. A distinction between pure fractures of the skull bones and brain injuries is only possible in hospitals.

What types of skull fractures can be distinguished?

Depending on which skull bone is affected by the injury, a distinction is made between the facial skull fracture (e.g. broken nose or jawbone), skull fracture (fracture of the bony roof of the skull) and the base of the skull. Multiple structures are affected in severe injuries. Furthermore, skull fractures are divided into closed and open fractures:

  • Closed (covered) skull fractures: The skin in the area of ​​the fracture is intact, no bone parts are visible from the outside. If the fragments shift against each other, this can lead to changes in the shape of the skull and to damage to brain tissue. Fragments of bone parts on the inside of the roof of the skull can also penetrate the brain. Skull base fractures are a special case, in which there is a connection between the sterile interior of the skull and the non-sterile cavities of the facial skull or the ear canal and thus an increased risk of infection. Since all blood vessels and nerve connections between the body and the brain run through the base of the skull, a fracture of the base of the skull can result in damage to the base and thus disturbances in vital functions.
  • Open skull fractures: A wound is created over the bone fracture so that meninges or the brain itself can be exposed. In addition to the risk of brain injury, there is also a high risk of infection here.

More on the topic: broken bones

What types of brain injuries can be distinguished?

Brain injuries caused by external violence (such as a fall or blow) include:

  • Concussion (Commotio cerebri): Temporary (reversible) functional disorder in which no organic damage to the brain can be detected (e.g. by computer tomography or magnetic resonance tomography). The patient is either unconscious or only briefly unconscious. Most of the time, there is a memory disorder or memory gap (amnesia) for a certain period of time before and / or after the accident; nausea, vomiting or headache often occur.
  • Brain contusion or brain contusion (contusio cerebri): The brain tissue hits the bones by force, organic damage can be demonstrated (e.g. a bruise). The symptoms are usually more pronounced than with a concussion, with prolonged unconsciousness and under certain circumstances failure symptoms such as movement or sensory disorders.
  • Squeezing or compression of the brain (Compressio cerebri): Since the brain is almost completely surrounded by bones, it cannot "evade" in the event of a bleeding or an increase in intracranial pressure. The increased pressure can damage all or part of the brain. For the injured person this means danger to life or the possibility of permanent damage.

What are the causes of traumatic brain injury?

A traumatic brain injury is caused by violence on the head and is associated with brain dysfunction of varying severity. The most common causes of head trauma include:

  • Traffic accidents, especially with motorcycles
  • Falls: Older people and children are primarily affected by severe falls with head injuries. Often it is a fall out of bed, from the ladder, over the stairs, etc.
  • Sports injuries: The head is affected in around ten percent (women) to 15 percent (men) of sports injuries. Above all, contact sports (e.g. soccer, ice hockey or martial arts) and sports that are associated with high speeds (e.g. skiing, snowboarding, motor sports) are associated with an increased risk. Head injuries are also common in equestrian sports, not only when falling, but also when the horse's head is knocked up while riding or when the animal is knocked out. The summation of repeated small traumatic brain injuries, primarily in boxing and American football, but also in football through the header game, can lead to chronic brain damage (chronic traumatic encephalopathy) with serious health consequences (e.g. Depression, dementia).Wearing a protective helmet in sports such as cycling and mountain biking, skiing, luge, skeleton, football, ice hockey, baseball or horse riding significantly reduces the risk of severe head or facial skull injuries.

What are the symptoms?

Typical symptoms of head injuries include:

  • (strong headache,
  • external signs of injury, e.g. bruise, bump,
  • Bleeding,
  • Swellings and misalignments (e.g. of the nose with a broken nose),
  • Asymmetry of the face (with facial skull fractures) as well
  • open breaks.

The following signs indicate that the brain is involved (e.g. concussion, bruised skull):

  • Dizziness,
  • vomiting several times immediately after the event or up to six hours afterwards,
  • Disorientation, gaps in memory,
  • Failure symptoms such as movement disorders,
  • slurred speech, sudden change of character, unsteady gait,
  • Pupillary difference (different sized pupils of the right and left eye),
  • clear fluid (brain fluid) leaks out of the ears, nose or mouth
  • sudden drowsiness, difficulty being awakened, loss of consciousness,
  • Seizures.

Severe traumatic brain injury can result in immediate death from respiratory or cardiac arrest.

How is the diagnosis made?

In addition to a questioning of the injured person (or his / her unconsciousness perceived by witnesses), a careful medical examination of the head, the brain functions, the cervical spine and, if necessary, the entire body is carried out. If blood or relatively clear fluid (cerebrospinal fluid, liquor cerebrospinalis) escapes from the nose or ears, there may be a fracture of the base of the skull. Depending on the findings, an X-ray examination, computed tomography or magnetic resonance tomography is carried out to confirm the diagnosis. If necessary, additional special examinations are carried out, e.g. the recording of brain waves (electroencephalography, EEG).

How is traumatic brain injury treated?

In principle, the first aid guidelines apply to initial treatment for traumatic brain injuries by medical laypeople. In the case of severe traumatic brain injuries and unconscious people, the focus is on securing vital functions at the scene of the accident.

The following also applies to first aid: If the injured person is a motorcyclist, the helmet must always be removed! Only in this way is it possible to regularly check breathing until the rescue service arrives and, if necessary, to carry out life-saving first aid measures. More on the topic of correct helmet removal: Emergency: head injury

Further clarification and treatment must take place as soon as possible. Injuries to the brain can quickly become life-threatening or have serious consequences. Cerebral haemorrhages and skull fractures are usually treated surgically, depending on their location and extent.

Note Even with a supposedly harmless concussion, observation in the hospital for 24 to 48 hours is recommended.

Serious symptoms can also occur with a delay, e.g. increased tiredness, increasing confusion and drowsiness, unusual behavior, restlessness, dizziness, headache, nausea and vomiting, movement disorders, seizures or loss of consciousness.

Note After a traumatic brain injury, a bruise can sometimes only cause symptoms a few weeks or months later, as pressure builds up on the brain. In the event of increasing headaches, changes in behavior, gait disorders or symptoms of paralysis, a doctor should be examined immediately.

Whom can I ask?

If you suspect a traumatic brain injury, dial the emergency number 144 or go to the nearest emergency room immediately.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Rehabilitation & cure
  • Medical aids & aids
  • Health Professions AZ

and via the online guide to reimbursement of social insurance costs.

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