Traumatic Brain Injury

Hope Through Research
Traumatic
Brain Injury
National Institute of Neurological Disorders
and Stroke
National Institutes of Health

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Cover: Gary Weinstein of Takoma Park, Maryland,
pictured with his wife Julie Wiatt and his son Zak,
suffered a severe head injury when a ball shattered
his skull while he was coaching a baseball team practice
in the spring of 2001. A year after his injury, he returned
to work and is back to coaching.
This pamphlet was written and published by the National
Institute of Neurological Disorders and Stroke (NINDS),
the United States’ leading supporter of research on disorders
of the brain and nerves, including traumatic brain injury.
NINDS, one of the U.S. Government’s National Institutes
of Health in Bethesda, Maryland, is part of the Public
Health Service within the U.S. Department of Health
and Human Services.

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Table of Contents
Page
Introduction ............................................. 1
What is a Traumatic Brain Injury? ................ 3
What Are the Signs and Symptoms
of TBI? ................................................... 3
What Are the Causes of and Risk
Factors for TBI? ....................................... 4
What Are the Different Types of TBI? ............ 5
What Medical Care Should a TBI
Patient Receive? ........................................ 6
How Does a TBI Affect Consciousness? ......... 10
What Immediate Post-Injury Complications
Can Occur From a TBI? ............................ 13
General Trauma ................................. 16
What Disabilities Can Result From a TBI? ..... 18
Are There Other Long-Term Problems
Associated With a TBI? ............................. 23
What Kinds of Rehabilitation Should
a TBI Patient Receive? ............................. 25
How Can TBI be Prevented? ...................... 27
What Research is the NINDS Conducting? ..... 28
Clinical Trials Research ....................... 34

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Where Can I Find More Information? ............ 35
Glossary ................................................ 36
Information Resources
Traumatic Brain Injury Research Centers
(see pocket inside back cover)

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Introduction
Traumatic brain injury (TBI) is a major public
health problem, especially among male adolescents
and young adults ages 15 to 24, and among elderly
people of both sexes 75 years and older. Children
aged 5 and younger are also at high risk for TBI.
Perhaps the most famous TBI patient in the his-
tory of medicine was Phineas Gage. In 1848, Gage
was a 25-year-old railway construction foreman
working on the Rutland and Burlington Railroad
in Vermont. In the 19th century, little was under-
stood about the brain and even less was known
about how to treat injury to it. Most serious injuries
to the brain resulted in death
due to bleeding or infection.
Gage was working with explo-
1
sive powder and a packing
rod, called a tamping iron,
when a spark caused an
explosion that propelled
the 3-foot long, pointed
rod through his head. It
penetrated his skull at the
top of his head, passed
through his brain, and
exited the skull by his temple.
This computer-generated graphic
Amazingly, he survived the
shows how, in 1848, a 3-foot long,
pointed rod penetrated the skull
accident with the help of
of Phineas Gage, a railway
physician John Harlow who
construction foreman. The rod
treated Gage for 73 days.
entered at the top of his head,
passed through his brain, and
Before the accident Gage was
exited his skull by his temple.
a quiet, mild-mannered man;
Gage survived the accident but
suffered lasting personality and
after his injuries he became
behavioral problems.

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an obscene, obstinate, self-absorbed man. He
continued to suffer personality and behavioral
problems until his death in 1861.
Today, we understand a great deal more about
the healthy brain and its response to trauma,
although science still has much to learn about how
to reverse damage resulting from head injuries.
TBI costs the country more than $48 billion a year,
and between 2.5 and 6.5 million Americans alive
today have had a TBI. Survivors of TBI are often
left with significant cognitive, behavioral, and
communicative disabilities, and some patients
develop long-term medical complications, such
as epilepsy.
Other statistics dramatically tell the story of
head injury in the United States. Each year:
2
• approximately 270,000 people experience
a moderate or severe TBI,
• approximately 70,000 people die from head
injury,
• approximately 1 million head-injured people
are treated in hospital emergency rooms,
• approximately 60,000 new cases of epilepsy
occur as a result of head trauma,
• approximately 230,000 people are hospitalized
for TBI and survive, and
• approximately 80,000 of these survivors
live with significant disabilities as a result
of the injury.

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What is a Traumatic Brain Injury?
TBI, also called acquired brain injury or simply
head injury, occurs when a sudden trauma causes
damage to the brain. The damage can be focal —
confined to one area of the brain — or diffuse —
involving more than one area of the brain. TBI
can result from a closed head injury* or a pen-
etrating head injury. A closed injury occurs when
the head suddenly and violently hits an object
but the object does not break through the skull.
A penetrating injury occurs when an object
pierces the skull and enters brain tissue.
What Are the Signs and Symptoms of TBI?
3
Symptoms of a TBI can be mild, moderate, or
severe, depending on the extent of the damage to
the brain. Some symptoms are evident immediately,
while others do not surface until several days or
weeks after the injury. A person with a mild TBI
may remain conscious or may experience a loss
of consciousness for a few seconds or minutes. The
person may also feel dazed or not like himself for
several days or weeks after the initial injury. 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.
* Terms in Italics are defined in the Glossary, page 36.

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A person with a moderate or severe TBI 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 sei-
zures, 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/or increased confusion, restless-
ness, or agitation. Small children with moderate to
severe TBI may show some of these signs as well
as signs specific to young children, such as per-
sistent crying, inability to be consoled, and/or
refusal to nurse or eat. Anyone with signs of
moderate or severe TBI should receive medical
attention as soon as possible.
What Are the Causes of and Risk
4
Factors for TBI?
Half of all TBIs are due to transpor-
tation accidents involving automo-
biles, motorcycles, bicycles, and
pedestrians. These accidents are
the major cause of TBI in people
under age 75. For those 75 and
older, falls cause the majority of
TBIs. Approximately 20 percent of
TBIs are due to violence, such as
firearm assaults and child abuse,
Transportation accidents
and about 3 percent are due to
involving automobiles,
motorcycles, bicycles,
sports injuries. Fully half of TBI
and pedestrians account
incidents involve alcohol use.
for half of all TBIs and
are the major cause
The cause of the TBI plays a role
of TBIs in people
in determining the patient’s out-
under age 75.
come. For example, approximately

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91 percent of firearm TBIs (two-thirds of which
may be suicidal in intent) result in death, while
only 11 percent of TBIs from falls result in death.
What Are the Different Types of TBI?
Concussion is the most minor and the most common
type of TBI. Technically, a concussion is a short
loss of consciousness in response to a head injury,
but in common language the term has come to
mean any minor injury to the head or brain.
Other injuries are more severe. As the first line
of defense, the skull is particularly vulnerable to
injury. Skull fractures occur when the bone of the
skull cracks or breaks. A depressed skull fracture
occurs when pieces of the broken skull press into
5
the tissue of the brain. A penetrating skull fracture
occurs when something pierces the skull, such as a
bullet, leaving a distinct and localized injury to
brain tissue.
Skull fractures can cause bruising of brain tissue
called a contusion. A contusion is a distinct area
of swollen brain tissue mixed with blood released
from broken blood vessels. A contusion can also
occur in response to shaking of the brain back
and forth within the confines of the skull, an injury
called “contrecoup.” This injury often occurs in
car accidents after high-speed stops and in shaken
baby syndrome, a severe form of head injury that
occurs when a baby is shaken forcibly enough to
cause the brain to bounce against the skull. In
addition, contrecoup can cause diffuse axonal

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injury, also called shearing, which involves
damage to individual nerve cells (neurons) and
loss of connections among neurons. This can
lead to a breakdown of overall communication
among neurons in the brain.
Damage to a major blood vessel in the head can
cause a hematoma, or heavy bleeding into or
around the brain. Three types of hematomas
can cause brain damage. An epidural hematoma
involves bleeding into the area between the skull
and the dura. With a subdural hematoma, bleed-
ing is confined to the area between the dura and
the arachnoid membrane. Bleeding within the
brain itself is called intracerebral hematoma.
Another insult to the brain that can cause injury
is anoxia. Anoxia is a condition in which there is
6
an absence of oxygen supply to an organ’s tissues,
even if there is adequate blood flow to the tissue.
Hypoxia refers to a decrease in oxygen supply
rather than a complete absence of oxygen. With-
out oxygen, the cells of the brain die within several
minutes. This type of injury is often seen in near-
drowning victims, in heart attack patients, or in
people who suffer significant blood loss from other
injuries that decrease blood flow to the brain.
What Medical Care Should a TBI
Patient Receive?
Medical care usually begins when paramedics or
emergency medical technicians arrive on the scene
of an accident or when a TBI patient arrives at the
emergency department of a hospital. Because

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Document Outline

• Cover Page
• Table of Contents
• Introduction
• Traumatic Bain Injury (TBI)
• Signs and Symptoms of TBI
• Causes of and Risk Factors
• Different Types of TBI
• Medical Care for TBI Patients
• TBI & Consciousness
• Post Injury Complications
• TBI & Disabilities
• Long-Term Problems with a TBI
• Rehabilitation
• Prevent TBI
• NINDS Research on TBI
• How Can I Find More Info
• Glossary
• Information Resources
• Head Injury Research Centers
• Credits

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