Traumatic Brain Injury

Last Updated: October 5, 2023

Traumatic Brain Injury (TBI) is damage to the brain caused by a sudden injury - like a bump, blow, or jolt.

Traumatic Brain Injury falls under theBrain Healthcategory.

What is traumatic brain injury?

Traumatic brain injury (TBI) is a disruption in the normal function of the brain that can be caused by physical trauma. TBIs are classified as either “closed”, meaning the skull remains intact, or “open”, meaning the skull has been fractured.[1]. TBIs are further classified as mild, moderate, or severe. Mild TBI is often referred to as concussion. Severe brain injury can cause coma, permanent disability, or death.[2]

What are the main signs and symptoms of traumatic brain injury?

Mild TBI results in signs and symptoms such as the following:[3]

  • Headache
  • Nausea and vomiting
  • Fatigue
  • Loss of balance or dizziness
  • Blurred vision
  • Trouble with memory and concentration
  • Sleep disturbances

Moderate and severe TBI can initially look similar to mild TBI, with symptoms becoming worse over time. Signs and symptoms of a moderate or severe TBI can include the following:[4]

  • Persistent or worsening headache
  • Severe vomiting
  • Slurred speech
  • Loss of vision
  • Confusion or agitation
  • Loss of coordination
  • Seizures
How is traumatic brain injury diagnosed?

Clinically, medical professionals assess TBI by taking a thorough history and completing a neurological examination looking for signs and symptoms of TBI in order to classify it appropriately. A TBI is diagnosed if one or more of the following clinical signs is noted after head trauma:

  • A decreased level of consciousness or a loss of consciousness after the injury
  • Alterations of mental state (e.g., confusion)
  • Post-traumatic amnesia
  • Neurological deficits (e.g., loss of balance, slurred speech, visual loss)
  • An intracranial lesion

A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the brain may be done to check for any head or brain injuries that require neurosurgical intervention.[5]

What are some of the main medical treatments for traumatic brain injury?

Mild TBI can be treated with monitoring and appropriate strategies for returning to normal daily activities and sport. This doesn’t usually require medication, although medicines for managing symptoms like pain and nausea could be used.[3]

In moderate to severe cases, patients receive emergency neurological life support with an emphasis on monitoring pressure on the brain. Surgery to relieve this pressure may be necessary.[6] Once the patient is stable, monitoring of the pressure will continue and patients may receive non-invasive treatments to reduce the pressure, such as osmotic therapy. [7]

Have any supplements been studied for traumatic brain injury?

Vitamin E and vitamin C supplementation have shown some positive effects in the context of TBI, but more research is needed to identify the ideal timing and dosing of each.[8] Curcumin, found naturally in tumeric, has potential anti-inflammatory effects and could help by blocking pathways that cause neuroinflammation after TBI.[9] Supplementing with docosahexaenoic acid (DHA), an omega-3 fatty acid, has some promising outcomes in early research, but further studies are needed to offer dosages specifically for TBI. A vitamin D supplement could help with recovery from TBI in people with low vitamin D levels at the time of the injury. Similarly, supplementing with magnesium could help improve long-term outcomes.[10]

How could diet affect traumatic brain injury?

There are no specific dietary strategies that are closely related to improved recovery from TBI. However, having a BMI within normal ranges and eating a diet that contains sufficient micronutrients is likely to be valuable when recovering from a TBI. In particular, being underweight can worsen outcomes, although this is not specific to TBI.[11]

Are there any other treatments for traumatic brain injury?

Multiple new medical treatments are being studied for use in TBI. Statins, a class of drugs used primarily to reduce cholesterol, can reduce inflammation in the vascular system, and may reduce neural cell death after an injury.[12] Progesterone, a neurosteroid, is being investigated for potential neuroprotective effects.[13] Cyclosporin A is an immunosuppressive drug that is also being looked into for neuroprotective properties, although finding an effective dosage is difficult because high doses can have severe side effects.[14] Targeted temperature management is sometimes used as a neuroprotective strategy. It involves lowering the body temperature in an attempt to lower the oxygen demand of the brain tissue.[15] Hyperbaric oxygen therapy focuses instead on providing more oxygen to the damaged tissue. High pressure environments, like those generated in a hyperbaric oxygen chamber, make it possible to have higher than normal oxygenation levels in the blood. This oxygen can be absorbed into the brain tissue, and potentially help the brain to heal more efficiently.[16][17] Erythropoietin (EPO) treatment has been used for TBI as well. EPO is a type of cytokine that helps the body produce red blood cells. It has antioxidant and anti-inflammatory effects and shows some promise in neuroprotection and improving outcomes in people with TBI.[18][19] Persisting functional impairments may require long-term interventions from medical specialists. These may include cognitive behavioral therapy, balance training, and vestibular therapy.[20][21][22]

What causes traumatic brain injury?

TBI is caused by an external force applied to the head, resulting in an injury to the brain. In people over 65, TBIs are most commonly caused by a fall. In younger people, they are most commonly caused by motor vehicle accidents, sports injuries, and interpersonal violence.[2]

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  1. ^Traumatic brain injury & concussion(2018)
  2. ^Traumatic brain injury(MedlinePlus)
  3. ^Eapen BC, Bowles AO, Sall J, Lang AE, Hoppes CW, Stout KC, Kretzmer T, Cifu DXThe management and rehabilitation of post-acute mild traumatic brain injury.Brain Inj.(2022-Apr-16)
  4. ^Guidelines for the management of severe TBI, 4th edition(Brain trauma foundation)
  5. ^Silverberg ND, Iverson GL, , Cogan A, Dams-O-Connor K, Delmonico R, Graf MJP, Iaccarino MA, Kajankova M, Kamins J, McCulloch KL, McKinney G, Nagele D, Panenka WJ, Rabinowitz AR, Reed N, Wethe JV, Whitehair V, , Anderson V, Arciniegas DB, Bayley MT, Bazarian JJ, Bell KR, Broglio SP, Cifu D, Davis GA, Dvorak J, Echemendia RJ, Gioia GA, Giza CC, Hinds SR, Katz DI, Kurowski BG, Leddy JJ, Sage NL, Lumba-Brown A, Maas AI, Manley GT, McCrea M, Menon DK, Ponsford J, Putukian M, Suskauer SJ, van der Naalt J, Walker WC, Yeates KO, Zafonte R, Zasler ND, Zemek RThe American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury.Arch Phys Med Rehabil.(2023-May-19)
  6. ^Sahuquillo J, Dennis JADecompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury.Cochrane Database Syst Rev.(2019-Dec-31)
  7. ^Shi J, Tan L, Ye J, Hu LHypertonic saline and mannitol in patients with traumatic brain injury: A systematic and meta-analysis.Medicine (Baltimore).(2020-Aug-28)
  8. ^Khalili H, Abdollahifard S, Niakan A, Aryaie MThe effect of Vitamins C and E on clinical outcomes of patients with severe traumatic brain injury: A propensity score matching study.Surg Neurol Int.(2022)
  9. ^Khayatan D, Razavi SM, Arab ZN, Niknejad AH, Nouri K, Momtaz S, Gumpricht E, Jamialahmadi T, Abdolghaffari AH, Barreto GE, Sahebkar AProtective effects of curcumin against traumatic brain injury.Biomed Pharmacother.(2022-Oct)
  10. ^Finnegan E, Daly E, Pearce AJ, Ryan LNutritional interventions to support acute mTBI recovery.Front Nutr.(2022)
  11. ^Lucke-Wold BP, Logsdon AF, Nguyen L, Eltanahay A, Turner RC, Bonasso P, Knotts C, Moeck A, Maroon JC, Bailes JE, Rosen CLSupplements, nutrition, and alternative therapies for the treatment of traumatic brain injury.Nutr Neurosci.(2018-Feb)
  12. ^Sultan W, Sapkota A, Khurshid H, Qureshi IA, Jahan N, Went TR, Dominic JL, Win M, Kannan A, Tara A, Ruo SW, Alfonso MStatins' Effect on Cognitive Outcome After Traumatic Brain Injury: A Systematic Review.Cureus.(2021-Aug)
  13. ^Pan ZY, Zhao YH, Huang WH, Xiao ZZ, Li ZQEffect of progesterone administration on the prognosis of patients with severe traumatic brain injury: a meta-analysis of randomized clinical trials.Drug Des Devel Ther.(2019)
  14. ^Dixon CE, Bramlett HM, Dietrich WD, Shear DA, Yan HQ, Deng-Bryant Y, Mondello S, Wang KK, Hayes RL, Empey PE, Povlishock JT, Tortella FC, Kochanek PMCyclosporine Treatment in Traumatic Brain Injury: Operation Brain Trauma Therapy.J Neurotrauma.(2016-Mar-15)
  15. ^Madden LK, Hill M, May TL, Human T, Guanci MM, Jacobi J, Moreda MV, Badjatia NThe Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society.Neurocrit Care.(2017-Dec)
  16. ^Biggs AT, Dainer HM, Littlejohn LFEffect sizes for symptomatic and cognitive improvements in traumatic brain injury following hyperbaric oxygen therapy.J Appl Physiol (1985).(2021-May-01)
  17. ^Harch PGSystematic Review and Dosage Analysis: Hyperbaric Oxygen Therapy Efficacy in Mild Traumatic Brain Injury Persistent Postconcussion Syndrome.Front Neurol.(2022)
  18. ^Cai JFToward a comprehensive evaluation of alternative medicine.Soc Sci Med.(1987)
  19. ^Katiyar V, Chaturvedi A, Sharma R, Gurjar HK, Goda R, Singla R, Ganeshkumar AMeta-Analysis with Trial Sequential Analysis on the Efficacy and Safety of Erythropoietin in Traumatic Brain Injury: A New Paradigm.World Neurosurg.(2020-Oct)
  20. ^Schneider KJ, Critchley ML, Anderson V, Davis GA, Debert CT, Feddermann-Demont N, Gagnon I, Guskiewicz KM, Hayden KA, Herring S, Johnstone C, Makdissi M, Master CL, Moser RS, Patricios JS, Register-Mihalik JK, Ronksley PE, Silverberg ND, Yeates KOTargeted interventions and their effect on recovery in children, adolescents and adults who have sustained a sport-related concussion: a systematic review.Br J Sports Med.(2023-Jun)
  21. ^Xin Li, Yuwei Feng, Jianping Xia, Xuan Zhou, Nan Chen, Zhengquan Chen, Qimeng Fan, Hong Wang, Peiyuan Ding, Qing DuEffects of Cognitive Behavioral Therapy on Pain and Sleep in Adults with Traumatic Brain Injury: A Systematic Review and Meta-AnalysisNeural Plast.(2021 Nov 11)
  22. ^Søberg HL, Andelic N, Langhammer B, Tamber AL, Bruusgaard KA, Kleffelgaard IEffect of vestibular rehabilitation on change in health-related quality of life in patients with dizziness and balance problems after traumatic brain injury: A randomized controlled trial.J Rehabil Med.(2021-Apr-21)
  23. ^Patricios JS, Schneider KJ, Dvorak J, Ahmed OH, Blauwet C, Cantu RC, Davis GA, Echemendia RJ, Makdissi M, McNamee M, Broglio S, Emery CA, Feddermann-Demont N, Fuller GW, Giza CC, Guskiewicz KM, Hainline B, Iverson GL, Kutcher JS, Leddy JJ, Maddocks D, Manley G, McCrea M, Purcell LK, Putukian M, Sato H, Tuominen MP, Turner M, Yeates KO, Herring SA, Meeuwisse WConsensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022.Br J Sports Med.(2023-Jun)
  24. ^Returning to sports and activity(Centre for disease control)
  25. ^Kim JJ, Gean ADImaging for the diagnosis and management of traumatic brain injury.Neurotherapeutics.(2011-Jan)
Examine Database References
  1. Brain Injury Symptoms - Ata Mahmoodpoor, Ghaffar Shokouhi, Hadi Hamishehkar, Hassan Soleimanpour, Sarvin Sanaie, Jahan Porhomayon, Fatemeh Rasouli, Nader D NaderA pilot trial of l-carnitine in patients with traumatic brain injury: Effects on biomarkers of injuryJ Crit Care.(2018 Jun)
  2. Fatigue Symptoms - P P Kalinskiĭ, V V Nazarov[Use of phenotropil in the treatment of asthenic syndrome and autonomic disturbances in the acute period of mild cranial brain trauma]Zh Nevrol Psikhiatr Im S S Korsakova.(2007)
  3. Fatigue Symptoms - George Sakellaris, George Nasis, Maria Kotsiou, Maria Tamiolaki, Giorgos Charissis, Athanasios EvangeliouPrevention of traumatic headache, dizziness and fatigue with creatine administration. A pilot studyActa Paediatr.(2008 Jan)
  4. Memory - McLean A Jr, Cardenas DD, Burgess D, Gamzu EPlacebo-controlled study of pramiracetam in young males with memory and cognitive problems resulting from head injury and anoxiaBrain Inj.(1991 Oct-Dec)