ETIOLOGY:

The majority of head injuries occur in young adults as a result of sports injuries and accidents
involving cars/motorcycle. In many of these accidents, excessive alcohol intake is a contributing
factor. Unfortunately, a high blood Alcohol level can impede neurologic assessment by making
the signs of injury.
Alcohol, because of its dehydrating effects, tends to delay the onset of cerebral edema and
elevation of ICP, but there may be greater increased ICP at a later time. Other systemic injuries,
such as a chest injury/shock, can have the same effect.

Traumatic brain injury (TBI), a form of acquired brain injury, occurs when a sudden trauma
causes damage to the brain. TBI can result when the head suddenly and violently hits an object,
or when an object pierces the skull and enters brain tissue.  Symptoms of a TBI can be mild,
moderate, or severe, depending on the extent of the damage to the brain.   

CLINICAL MANIFESTATION:
MILD

may remain conscious or may experience a loss of consciousness for a few seconds or
minutes.
Other symptoms of mild TBI include:
headache
Confusion
Lightheadedness
dizziness,
blurred vision or tired eyes
ringing in the ears
bad taste in the mouth,
fatigue or lethargy
a change in sleep patterns
behavioral or mood changes
and trouble with memory, concentration, attention, or thinking.

MODERATE TO SEVERE

may show these same symptoms, but may also have a :

headache that gets worse or does not go away

repeated vomiting or nausea
convulsions or seizures
an inability to awaken from sleep
 dilation of one or both pupils of the eyes
slurred speech
weakness or numbness in the extremities
loss of coordination,
and increased confusion, restlessness, or agitation.

CAUSES:
The five most common causes of head injuries or TBI (Traumatic Brain Injury) are:

 Car Accidents (passenger and pedestrian)

 Bicycle /Motorcycle Accidents
 Falls (especially kids and the elderly)
 Sports
 Acts of Violence/Assault

Some head injuries result in prolonged or nonreversible brain damage. This can occur as a
result of bleeding inside the brain or forces that damage the brain directly. These more serious
head injuries may cause:

 Coma
 Chronic headaches
 Loss of or change in sensation, hearing, vision, taste, or smell
 Paralysis
 Seizures
 Speech and language problems

HEAD INJURY OVERVIEW

Head injury is a general term used to describe any trauma to the head, and most
specifically to the brain itself.

TYPES OF HEAD INJURY:

1. CONCUSSION: reversible interference and brain function, usually resulting from a mild blow
to the head, which causes sudden excessive movement of the brain, disrupting neurologic
function and leading to loss of consciousness.
2. CONTUSSION: is a bruising tissue with rupture of small blood vessels and edema that
usually results from a blunt blow to the head.
3. SKULL FRACTURE: A skull fracture is a break in the bone surrounding the brain and other
structures within the skull.

 Linear skull fracture: A common injury, especially in children. A linear skull fracture
is a simple break in the skull that follows a relatively straight line. It can occur after
seemingly minor head injuries (falls, blows such as being struck by a rock, stick, or
other object; or from motor vehicle accidents).
 Depressed skull fractures: These are common after forceful impact by blunt
objects-most commonly, hammers, rocks, or other heavy but fairly small objects.
These injuries cause "dents" in the skull bone .
 Basilar skull fracture: A fracture of the bones that form the base (floor) of the skull
and results from severe blunt head trauma of significant force.
 Compound fractures: Involve trauma to the environment and is likely to be
severely damaged because bone fragments may penetrate the tissue and the risk
of infection is high.
 Comminuted fractures: consist of several fracture lines but may not be
complicated.

4. INTRACRANIAL (INSIDE THE SKULL) HEMORRHAGE (BLEEDING)

Head/brain:

 Subgaleal hematoma – between the galea aponeurosis and periosteum

 Cephalohematoma – between the periosteum and skull
 Epidural hematoma – between the skull and dura mater
 Subdural hematoma – between the dura mater and arachnoid mater
 Subarachnoid hematoma – between the arachnoid mater and pia
mater (the subarachnoid space)
 Othematoma – between the skin and the layers of cartilage of the ear

5. OPENED HEAD INJURIES: are those involving fractures/penetration of the brain by sharp
objects.
6. CLOSED HEAD INJURIES: occurs when the skull is not fractured in the injury, but the brain
tissue is injured and blood vessels may be ruptured by the force exerted against the skull.
7. CONTRECOUP INJURY: occurs when an area of the brain contralateral to the site of direct
damage in injured as the brain bounces off the skull.
 DIAGNOSTIC STUDIES
1. CT scan (with/without contrast): Screening image of choice in acute brain injury. Identifies
space-occupying lesions, hemorrhage, skull fractures, brain tissue shift.
2. MRI: Uses similar to those of CT scan but more sensitive than CT for detecting cerebral
trauma, determining neurologic deficits not explained by CT, evaluating prolonged interval of
disturbed consciousness, defining evidence of previous trauma superimposed on acute trauma.
3. Cerebral angiography: Demonstrates cerebral circulatory anomalies, e.g., brain tissue shifts
secondary to edema, hemorrhage, trauma.
4. X-rays: Detect changes in bony structure (fractures), shifts of midline structures
(bleeding/edema), bone fragments.
5. PET/SPECT tomography: Detects changes in metabolic activity in the brain and may be used
for differentiation of head injuries. (These procedures are not in widespread clinical use, but are
more often used for research.)
6. Audiometry, otology, and vestibular function tests: Diagnostic procedures that identify
hearing loss, reasons for balance problems, and/or eighth cranial nerve dysfunction.
7. Lumbar puncture and CSF analysis: May be performed in patient with suspected or known
increased intracranial pressure when CT or MRI is not diagnostic. Generally contraindicated in
acute trauma.
8. ABGs: Determines presence of ventilation or oxygenation problems that may
exacerbate/increase intracranial pressure.
9. Serum chemistry/electrolytes: May reveal imbalances that contribute to increased
intracranial pressure (ICP)/changes in mentation.
10. Toxicology screen: Detects drugs that may be responsible for/potentiate loss of
consciousness.

NURSING DIAGNOSIS:
 Disturbed thought processes related to brain damage, confusion, or inability to follow
instructions
 Impaired physical mobility related to hemiparesis, loss of balance and coordination,
spasticity, and brain injury
 Impaired verbal communication related to brain damage
 Ineffective airway clearance and impaired gas exchange related to brain injury
 Risk for impaired skin integrity related to immobility
 Risk for imbalanced body temperature related to damaged temperature-regulating
mechanisms in the brain
 Interrupted family processes related to unresponsiveness of patient, unpredictability of
outcome, prolonged recovery period, and the patient’s residual physical disability and
emotional deficit
 Deficient fluid volume related to decreased LOC and hormonal dysfunction
TREATMENT
 Anyone with signs of moderate or severe TBI should receive medical attention as soon as
possible. Because little can be done to reverse the initial brain damage caused by trauma,
medical personnel try to stabilize an individual with TBI and focus on preventing further
injury. Primary concerns include insuring proper oxygen supply to the brain and the rest of
the body, maintaining adequate blood flow, and controlling blood pressure. Imaging tests
help in determining the diagnosis and prognosis of a TBI patient.
 Patients with mild to moderate injuries may receive skull and neck X-rays to check for
bone fractures or spinal instability. For moderate to severe cases, the imaging test is a
computed tomography (CT) scan.
 Moderately to severely injured patients receive rehabilitation that involves individually
tailored treatment programs in the areas of physical therapy, occupational therapy,
speech/language therapy, physiatrist (physical medicine), psychology/psychiatry, and
social support.

PROGNOSIS
The potential for improvement after TBI can be unpredictable. Progress can be painfully slow
and the patient may never be the same as he was before the injury. As the brain heals,
personality and behavior may change and the patient may face new issues and challenges. 
Picture of the areas of the brain subject to injury