Traumatic brain injury

Traumatic brain injury (Traumatic brain injury)

1) Disease description (causes and symptoms)

• Definition: A condition in which brain function is temporarily reduced or damaged by an external impact. In mild cases, there may be no evidence of structural abnormalities in the brain (concussion), while severe cases are accompanied by structural damage such as bleeding or contusions.
• Causes: Traumatic impacts such as traffic accidents, falls, sports injuries, and industrial accidents are the main causes.
• Pathophysiology: Neural function declines due to shear forces and contusions of the brain caused by impact, as well as vascular injury, cerebral edema, and bleeding. In mild cases, neurophysiological imbalance and temporary dysfunction are the primary features.
• Main symptoms: Loss of consciousness (temporary or persistent), headache, dizziness, nausea and vomiting, fatigue, impaired concentration and memory, sensory hypersensitivity, confusion, seizures, and in severe cases, coma or neurological deficits.
• Clinical considerations: Symptoms may not occur immediately but may worsen several minutes to several hours later. Older adults, people taking anticoagulants, and people with bleeding disorders are at higher risk. Among all patients, those with loss of consciousness lasting 6 hours or more are classified as a severe group and may have a poorer prognosis (approximately 10% based on the provided data).

2) Treatment methods and precautions

• Initial emergency treatment
  • Secure the airway, breathing, and circulation, and assess the Glasgow Coma Scale (GCS). If GCS ≤ 8, securing the airway (intubation) should be considered.
  • If neurological deterioration or decreased consciousness, focal neurological deficits, persistent vomiting, severe headache, or recurrent seizures occur, brain CT should be performed immediately and neurosurgical evaluation obtained.
  • If bleeding or extensive contusions are present, surgical treatment (such as decompressive craniectomy or hematoma removal) may be necessary.
  • Management of elevated intracranial pressure (ICP): intracranial pressure monitoring, hyperosmolar therapy (mannitol/hypertonic saline), and limited temporary hyperventilation (short term), etc.
• Conservative treatment
  • Mild cases often improve with rest and observation. Acetaminophen (Tylenol) is recommended as an analgesic (if there is a risk of bleeding or as directed by a physician, use of nonsteroidal anti-inflammatory drugs requires caution).
  • If seizures occur, use of anticonvulsants may be considered (the decision regarding preventive treatment during the acute phase should be made by a specialist).
  • For people taking anticoagulants, discontinuation of anticoagulants and reversal treatment (such as blood products) may be considered depending on the condition.
• Rehabilitation
  • Multidisciplinary rehabilitation (including physical therapy, occupational therapy, speech therapy, and neuropsychological rehabilitation) after assessing physical, cognitive, behavioral, and social functioning.
  • Recovery varies greatly among individuals, and functional recovery may be possible due to brain plasticity.
• Precautions (self-care)
  • Follow the physician’s instructions on when to resume drinking alcohol, high-intensity exercise, driving, and operating important machinery.
  • If symptoms worsen (changes in consciousness, persistent vomiting, severe headache, focal paralysis, seizures, etc.), visit the emergency room immediately.
• Complications
  • Chronic headaches, cognitive and emotional changes, possible chronic traumatic encephalopathy (with repeated injuries), refractory seizures, and neurological deficits, etc.

3) Outpatient visit checkpoints (items to prepare and things to observe)

• Items and documents to prepare
  • List of currently taken medications (including anticoagulants, antiplatelet agents, antidepressants, etc.)
  • Past medical history (bleeding disorders, surgeries, previous brain injuries, etc.)
  • Test results received from the emergency room or hospital (bring CT/MRI reports and image files if possible), and recent test values
  • Record of the time and circumstances of symptom onset, whether loss of consciousness occurred, and its duration
  • Description of the circumstances at the time of the accident by a caregiver or witness (site of impact, whether fainting or seizures occurred, etc.)
  • Symptom diary: record changes in headache severity, frequency of vomiting, drowsiness, dizziness, memory decline, etc.
• Information to tell the doctor in advance during the outpatient visit
  • Whether you are taking anticoagulants (medication name and dose)
  • Alcohol or drug use (at the time of the accident)
  • History of previous head injuries and frequent headaches or seizures

(Including example questions)

• “What was the exact time when the symptoms began, and how long did the loss of consciousness last?”
• “Are you currently taking any medications or supplements?”

4) Examples of general questions to ask the doctor

• What is the expected course and prognosis of this condition?
• Is a CT or MRI necessary? When should it be performed?
• What should I do about the medication I am currently taking (e.g., anticoagulants)?
• What medications can I take to relieve the pain? What are the side effects?
• Should I start anticonvulsants immediately to prevent seizures?
• When can I resume daily activities (driving, work, exercise, and drinking alcohol)?

5) Examples of condition-specific questions

• 1. I lost consciousness (or, if I experienced dizziness or vomiting). Could you tell me specifically whether there are any warning signs indicating that I need a CT scan? (For example, recurrent vomiting, severe headache, focal neurological abnormalities, etc.)
• 2. I am taking anticoagulants (such as warfarin or DOACs). What should I do after the injury? Is discontinuation of the anticoagulant and reversal treatment necessary?

Note: The information above is general information. Individual diagnosis and treatment should be discussed with the treating medical professionals.