• In earlier wars, many soldiers receiving head injuries did not survive because of wounds to other parts of their bodies. Today, modern body armor allows more soldiers with head injuries to survive.
• Better field hospitals and faster trauma treatment also improve survival rates for severely injured soldiers, allowing more of those with brain injuries to return home.
• Explosive devices are the enemy’s favorite weapon and the most common cause of concussive brain injuries. Injury occurs not only from the blast itself, but also from flying objects striking the head, and from the impact of the head striking something after the body is flung through the air by the blast.

Types of TBI

Traumatic brain injuries generally fall into either of two categories.

• Closed head injury. In a closed head injury, there is no physical sign of injury to the head other than possibly a bump or bruise.
• Open or penetrating head injury. A visible head wound clearly identifies an open or penetrating head injury.

TBI is also classified according to severity.

• Mild TBI.  Someone with a mild TBI will typically recover fully within one year.
• Moderate TBI. Those suffering moderate TBIs will recover to some degree but have lingering mental and/or emotional deficits, usually for the remainder of their lives. Nonetheless, they may seem normal to others who do not know them well.
• Severe TBI. A severe TBI is accompanied by noticeable mental and/or emotional disability, and sometimes physical disability as well.

How War TBI Goes Undiagnosed

TBI is always suspected when there is a visible head wound. Soldiers with obvious head wounds are routinely screened for the effects of brain injury.

But those who have experienced a TBI from a closed head injury may not be diagnosed. This type of injury can be caused by whiplash or any similar sudden movement of the head that causes the brain to violently strike the inside of the skull.  A closed head injury can occur not only in an explosive blast, but also from a fall or a vehicle accident, or from a flying object striking the helmet.

TBI symptoms vary depending on the part of the brain that is affected and the type and severity of the injury. Symptoms can be a mixture of difficulties related to:

· Cognitive impairment – Reduction in intellect, memory, reasoning, math or language skills
· Behavioral issues – Anger, self-centeredness, aggressiveness, inappropriate behaviors
· Emotional problems – Depression, apathy, low self-esteem, social withdrawal, irritability

Complicating the diagnosis of TBI is the fact that some of these symptoms can be attributed to post-traumatic stress disorder (PTSD), effectively masking the existence of the brain injury.

A mild or moderate TBI is especially likely to go undiagnosed if the victim suffers no other physical wounds that would lead to being seen or evaluated by a doctor.

With so many Iraqi War and Afghan War veterans suffering catastrophic injuries and amputations, it is difficult for a veteran with a closed head TBI to compete for government medical services. In fact, even those veterans who suffered devastating open head injuries with obvious TBI are having a difficult time obtaining rehabilitation services through the Veterans Administration. Some seriously wounded have waited up to six months, and others are still waiting.

What to Do

If you are experiencing problems with thinking or memory, or emotional or behavioral problems after serving in Iraq or Afghanistan, read the following two articles to see how those problems compare to the symptoms of TBI.

• Cognitive Impairment in Brain Injury Cases
• Emotional Symptoms Following a Brain Injury

If the symptoms seem to indicate the possibility of a TBI, try to recall when you may have received a blow to the head or experienced a violent head motion.  Be aware, however, that it is not uncommon for someone who received a closed head injury to be unable to remember the event that caused it.  If you don’t recall an event that may have caused an injury to your head, do you recall a time when you felt confused or suffered from a headache and were unable to remember what happened immediately beforehand? Any such recollection can help substantiate the possible existense of a TBI.

If your symptoms are mild, you’ll probably recover fully after several months to a year following the injury.

For more bothersome symptoms, however, you should see a physician. Sometimes, the signs of a TBI can be seen on an MRI or CT scan, but not always. Doctors also have ways to test for thinking or memory problems or evaluate psychological and behavioral problems to arrive at a diagnosis of TBI.

If you have a TBI, it’s important to acknowledge it and obtain assistance. Various types of therapies can help you learn how to compensate for many of the effects of TBI and resuming leading a productive and happy life.

Related Articles

• Recovery and Rehabilitation
• 1st Carnival of Hope for TBI Survivors
• Brian’s Story

Statistical studies have examined the prevalence and nature of sports-related brain injuries, and the results are probably not what you would have expected.

Percentage of Head Injuries by Sport

The Consumer Product Safety Commission compiles statistics on head injuries seen in hospital emergency rooms categorized by sport. Its data uncovers some surprising facts:

• Cycling accidents are the leading cause of head injuries, leading to twice as many hospital visits compared to the leading organized sport, football.
• Head injuries from recreational or off-road vehicle activities (such as mini-bikes, ATVs, dune buggies, and go-carts) surpass all organized sports except football.
• The number of basketball and baseball head injuries each exceed head injuries from playing soccer.
• Head injuries are more common in golf than in hockey.

Children’s Head Injuries in Sports

The same Consumer Product Safety Commission study also categorizes sports-related head injuries for children 14 and younger. In this population the data changes slightly, with bicycle accidents now accounting for almost three times the number of injuries as any other single sport.

To learn of the risks involved, continue to the next page.

Despite the debate over the cellular processes involved, the symptoms of a concussion are well recognized and may include any combination of the following:

• Headache
• Dizziness, lack of coordination, loss of balance
• Nausea or vomiting
• Blurred vision, double vision, or sensitivity to light
• Confusion, disorientation, difficulty concentrating or sleeping
• No memory of events immediately before or after the injury
• Irritability and behavioral changes
• Inappropriate emotional responses

What is Post-Concussion Syndrome?

The specific symptoms appearing after a concussion vary between individuals, and can be partially dependent on the force of the head trauma and location. Post-concussion syndrome is a handy shorthand for referring to the unique set of persistent symptoms experienced by any one person after a concussion.

Some physicians use the term to describe the normal occurrence of these symptoms within the days and weeks following the injury. Others apply the term only for cases when the symptoms persist longer than three months. Symptoms lasting longer than three to six months may be referred to as persistent or prolonged post-concussion syndrome. A significant debate is still occurring regarding terminology and diagnosis.

How is Post-Concussion Syndrome Diagnosed?

Mild concussion is frequently undetectable with MRI or CT scans, so doctors rely primarily on the reporting of a head injury followed by the existence of symptoms related to concussion.

How is Post-Concussion Syndrome Treated?

Post-concussion syndrome is a collection of symptoms, and, therefore, the symptoms are treated individually as needed. For headaches, medication can be prescribed. Problems with memory or thinking are addressed by rehabilitation specialists who can help the individual develop coping strategies for dealing with particular cognitive impairments. Emotional and behavioral issues can be assessed by a psychologist or psychiatrist who can prescribe appropriate therapy or medications.

How Long Does Post-Concussion Syndrome Last?

For most people, concussion symptoms go away a few days to a few weeks after the injury. Half of all sufferers are symptom free within one month. In these cases, a post-concussion syndrome diagnosis is not likely to be applied.

Of those whose symptoms persist longer than a month, two-thirds recover within three months after the injury.

In the relatively few cases lasting longer then three months, recovery may occur within one year. If the symptoms continue beyond one year, they are often permanent.

Why is Post-Concussion Syndrome Being Debated?

The central controversy surrounding post-concussion syndrome is to what degree it is caused by a physical injury or by psychological factors. Numerous studies have produced a variety of conflicting results.

Statistically, persistent concussion symptoms are more likely to occur if the following conditions exist:

• History of psychological problems, depression, personality disorder, or alcohol abuse before the injury
• Pre-existing medical condition or illness
• Previous head injury or history of headaches
• Low socioeconomic status or low cognitive ability
• Lawsuit related to the injury

Females and people older than forty are also more likely to suffer prolonged symptoms.

Complicating the debate is that the criteria for diagnosis can be applied to a significant number of people who have not experienced a head injury. Otherwise healthy individuals may have headaches, dizziness, insomnia, fatigue, irritability, or problems with memory or concentration completely unrelated to concussion. These symptoms can also be related to a variety of medical conditions, which can lead to a specific illness not being properly diagnosed in a head injury victim when the symptoms are summarily ascribed to post-concussion syndrome.

Finally, despite our prowess in medical imaging, it is still not clear to scientists how mild brain trauma alters brain function.

Related Articles

• Concussion Symptoms

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Contusion

Contusion generally refers to any type of bruise. A bruise occurs when an injury damages blood vessels under the skin and they leak below the skin surface, usually causing a large purple lump.

A brain contusion (or “cerebral contusion”) is similar except you can’t see the bruise because it’s hidden inside the skull. A contusion differs from a concussion because while a concussion may cause brain injury it does not cause significant bleeding.

Some brain contusions can be minor and will heal on their own without any specific treatment. A severe contusion can be life threatening, however, as blood leaking into the skull cavity exerts pressure on the brain which can cause additional brain damage.

Hemorrhage

Hemorrhage means bleeding. Any time a blood vessel is broken and bleeding, whether internally or externally, it’s referred to as a hemorrhage. A brain hemorrhage describes broken blood vessels in the brain and may also be called:

• Cerebral hemorrhage
• Intracerebral hemorrhage
• Intra-axial hemorrhage

A brain hemorrhage is often serious because blood collecting inside the skull’s confined space creates pressure on delicate brain tissues potentially causing irreparable brain damage. In cases of brain hemorrhage, doctors will monitor the intracranial pressure and perform surgery to drain the fluid buildup if necessary. (See Types of Brain Surgery for Head Injuries.)

Hematoma

Hematoma describes a collection of blood in the body’s tissues. A bruise or contusion is also a hematoma. In head injuries, internal bleeding is often described based on how deep it is in relation to the three layers of the meninges. The meninges is the membrane surrounding the brain. Its layers from outside to inside are the:

• Dura mater
• Arachnoid mater
• Pia mater

An epidural hematoma is in the space below the skull bone and above the outer layer of the membrane surrounding the brain (the dura mater). The bleeding causing an epidural hematoma is typically associated with a skull fracture. Bleeding is typically from arteries and the onset of symptoms is rapid. In these cases, there is often minimal initial brain injury and chances of recovery are excellent with prompt treatment.

A subdural hematoma is in the space below the outer layer (dura mater) and above the middle layer of the membrane surrounding the brain (the arachnoid mater). It is often caused by violent movement to the head resulting in torn veins passing between these layers. Because there is no visible head injury and veins bleed slower than arteries, symptoms may not appear for a day or a week or more. The seriousness of the injury depends on the amount of bleeding.

A subarachnoid hematoma is in the space below the middle layer (arachnoid mater) and above the lower layer of membrane surrounding the brain. While often associated with a cerebral aneurysm (stroke), a skull fracture can also cause a subarachnoid hematoma. Approximately half of those suffering this type of injury will endure some degree of life-long impairment or chronic headache.

Related Articles

• MRI vs. CT Scans in Determining Brain Injuries

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Linear Skull Fracture

A linear skull fracture is the simplest and most common type of skull fracture, comprising 2/3 of all cases. In a linear fracture, the skull bone is cracked, but the skull is not opened. The fracture itself is not dangerous and can potentially heal without special treatment. The danger, however, is that a blow severe enough to crack the skull may also cause a concussion or brain contusion.

Diastatic Skull Fracture

At birth, the skull consists of separate plates that are not fully joined together. As we mature, the bones fuse together and the joint between two plates is called a skull suture. A fracture causing the skull to separate at a suture is a diastatic skull fracture. Some medical professionals also use the term to describe an injury resulting in a significant separation of the bone at the site of the fracture.

Comminuted Skull Fracture

When a severe blow shatters the skull bone into small pieces at the injury site, it’s a comminuted skull fracture. This can be a very serious injury if small bits of bone are driven into the brain, tearing it and causing bleeding. It is less serious if the pieces remain in place and serious intracranial bleeding is avoided.

Depressed Skull Fracture

An extreme case of a comminuted skull fracture is the depressed skull fracture in which the skull fragments are pushed inward. Severe injury to the brain and dangerous intracranial bleeding is practically unavoidable.

Basilar Skull Fracture

A basilar skull fracture occurs at the base of the skull. Also called a basal skull fracture, its seriousness depends on its severity. A basilar skull fracture often tears the membrane surrounding the brain allowing the fluid to leak out, typically through the ears or nose. Leaking and bloody fluid may also collect in the area around the eyes creating a condition called “raccoon eyes,” or the fluid may create bruising behind the ears, referred to as “Battle’s sign.”

Related Articles

• Treatment and Prognosis for Skull Fractures
• Types of Head and Brain Injuries
• Brain Injuries – Contusion, Hemorrhage and Hematoma

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Bump on the Head (”Goose Egg”)

A bump on the head (also called a “goose egg”) often describes a minor injury resulting in bleeding under the skin and a swollen, raised lump. If the injured person didn’t lose consciousness, the injury is usually not serious. The person should be observed closely for the next 48 hours, however, to detect any signs of a concussion associated with the event.

Open Head Injury

When someone has a badly bleeding cut on the scalp (a “scalp laceration”), we might say he “cut his head open.” It’s easy to assume that’s what an “open head injury” describes. But to medical professionals, an open head injury means at best a skull fracture, and at worst an object penetrating the brain.

Closed Head Injury

It can also be tempting to think that a closed head injury is the same thing as a bump on the head because the head isn’t “cut open.” In medical circles, however, a closed head injury describes an injury to the brain itself from impacting the interior of the skull or being damaged by violent movement when there is no visible exterior injury.

Concussion

The brain normally floats serenely inside the skull surrounded by a protective layer of fluid. When the head moves or stops suddenly due to a blow or a fall, the brain can be violently jarred and impact the interior of the skull resulting in a disruption of brain chemistry and function. This is called a concussion, and may sometimes cause the injured person to pass out for at least a few seconds. Concussions can be mild or severe depending on the amount of resulting brain injury.

Brain Contusion, Hemorrhage, and Hematoma

The terms contusion, hemorrhage and hematoma all relate to internal bleeding.

A brain contusion (or “cerebral contusion”) is a bruise on the brain. Some brain contusions can be minor and will heal on their own without any specific treatment. A severe contusion can be life threatening, however. Blood leaking into the skull cavity exerts pressure on the brain and can cause additional brain damage.