What Is A TBI?

Traumatic brain injury occurs when an external mechanical force causes brain dysfunction. Traumatic brain injury (TBI) is a complex injury with a broad spectrum of symptoms and disabilities. The impact on a person and his or her family can be devastating.

Traumatic brain injury, often referred to as TBI, is most often an acute event similar to other injuries. That is where the similarity between traumatic brain injury and other injuries ends. One moment the person is normal and the next moment life has abruptly changed.

A brain injury is different from a broken limb or punctured lung. An injury in these areas limit the use of a specific part of your body, but your personality and mental abilities remain unchanged. Most often, these body structures heal and regain their previous function. Brain injuries do not heal like other injuries. No two brain injuries are alike and the consequence of two similar injuries may be very different. Symptoms may appear right away or may not be present for days or weeks after the injury. Some symptoms last days or weeks, while others can last years, or a lifetime.

TBI is a common injury that is often missed initially when a medical team is focused on saving the individual’s life. Although the medical technology has advanced significantly, the effects of TBI are significant. Some of the symptoms of traumatic brain injury can look like emotional or behavioral problems, even though they are actually due to TBI. Some people may recognize TBI symptoms immediately, while for others, these symptoms don’t show up right away or can be ignored or minimized at first. Ignoring symptoms of a TBI could make the symptoms worse and recovery more challenging and prolonged.

Emerging Assessment Frameworks

A new diagnostic approach being piloted in trauma centers and developed at Mount Sinai, expands on traditional scales like the Glasgow Coma Scale by incorporating imaging, biomarkers, and patient history to improve accuracy in predicting outcomes and guiding treatment. This multidimensional model promises to refine diagnoses and reduce premature end-of-life decisions (UCSF Framework; Mount Sinai Framework)

The mechanisms of the highest causes of brain injury: Open head Injury, Closed Head Injury, Deceleration Injuries, Chemical/Toxic, Hypoxia, Tumors, Infections and Stroke.

Causes and Mechanisms of TBI

Globally, the most frequent causes include:

Falls
Traffic accidents
Violence, such as gunshot wounds, child abuse, or beatings
Sports related injuries
Occupational or home accidents
Suicide attempts
Military engagements (explosions, IED, etc)

Underlying injury typpes include open vs closed head trauma, deceleration injuries, hypoxia, and checkical or infectious diseases.

Levels of Severity

Mild traumatic brain injury occurs when:

Glasgow Coma Scale Score is 13-15
Loss of consciousness is very brief, usually a few seconds or minutes
Loss of consciousness does not have to occur, the person may be dazed, confused or disoriented. A mild traumatic brain injury is diagnosed only when there is a change in the mental status at the time of injury. The change in mental status indicates that the person’s brain functioning has been altered, this is called a concussion by many providers (a concussion is a brain injury).
Testing or scans of the brain may appear normal

Moderate Traumatic Brain Injury

A moderate traumatic brain injury occurs when:

Glasgow Coma Scale score is 9-12
A loss of consciousness lasts from a few minutes to a few hours
Confusion lasts from days to weeks
Physical, cognitive, and/or behavioral impairments last for months or are permanent.
Testing or scans of the brain may appear normal

Most brain injuries result from moderate and minor head injuries. Such injuries usually result from a non-penetrating blow to the head, and/or a violent shaking of the head. As luck would have it many individuals sustain such head injuries without any apparent consequences. However, for many others, such injuries result in lifelong disabling impairments.

Persons with moderate traumatic brain injury generally can make a good recovery with treatment or successfully learn to compensate for their deficits.

Severe Brain Injury

Severe head injuries usually result from crushing blows or penetrating wounds to the head. Such injuries crush, rip and shear delicate brain tissue. This is the most life threatening, and the most intractable type of brain injury.

Typically, heroic measures are required in treatment of such injuries. Frequently, severe head trauma results in an open head injury, one in which the skull has been crushed or seriously fractured. Treatment of open head injuries usually requires prolonged hospitalization and extensive rehabilitation. Typically, rehabilitation is incomplete and for most part there is no return to pre-injury status. Closed head injuries can also result in severe brain injury.

Functional Impacts and Long Term Risks

TBI can cause a wide range of functional short- or long-term changes affecting thinking, sensation, language, or emotions.

TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other neurodegenerative conditions, and brain disorders that become more prevalent with age.

Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.

A study in BMJ Mental Health reveals that women exposed to domestic violence often experience repetitive mild TBIs, resulting in decades of mental health challenges, highlighting the need for trauma-informed care in vulnerable populations.

Signs and Symptoms of A Brain Injury

Headache
Nausea and/or Vomiting
Dizziness, loss of balance
Clear fluid draining from nose or ears
Visual disturbances, visual changes, blurred vision, slanted vision, double vision, Visual processing issues
Fatigue, drowsiness, difficulty sleeping, sleeping more than usual, insomnia, inability to awaken someone from sleep
Endocrine or hormone changes. Common problems can include reduced sex drive (loss of libido or interest), difficulties with sexual functioning (such as erectile problems) and behaving sexually at inappropriate times or in inappropriate ways.
Amenorrhea or menses irregularity (for women)
Sensory problems, ringing in the ears, a bad taste in the mouth or changes in the ability to smell, difficulty writing or understanding speech, change in tastes
Sensitivity to different types of lights and or sounds
Memory loss, concentration problems, slurred speech, delayed response to questions
Mood changes, mood swings, anxiety, depression, anxious, personality changes, agitation, combativeness or other unusual behavior
Convulsions or seizures
Dilation of one or both pupils of the eyes
Weakness or numbness in fingers and toes

Brain Injury In Infants and Children

The Centers for Disease Control and Prevention (CDC) reports that traumatic brain injury (TBI) is the number one cause of disability and death among children and adolescents in the United States. Kids with brain injuries might not be able to communicate headaches, sensory problems, confusion, and similar symptoms.

Modes of injury include motor vehicle accidents, bicycle accidents, falls, sporting injuries, and child abuse.

The symptoms of a brain injury in children are similar to the symptoms experienced by adults, but the functional impact can be very different, though. The major difference between children and adults with brain injury is that with adults, there are prior academic records, I.Q. scores, and job histories to rely on. The brain of a child is continuing to develop. The cognitive impairments of children may not be immediately obvious after the injury, but may become apparent as the child gets older and faces increased cognitive and social expectations for new learning and more complex, socially appropriate behavior. These delayed effects can create lifetime challenges for living and learning for children and everyone they are associated with. Some children may endure lifelong physical challenges.

Some things to keep in mind are that the greatest challenges many children with brain injury face are changes in their abilities to think, learn, and develop socially appropriate behaviors. Common deficits after brain injury include difficulty in processing information, impaired judgment, and reasoning. When an adult is injured, these deficits can become apparent in the months following the injury. For a child, it may be years before the deficits from the injury become apparent.

Prior information was that a child with a brain injury would recover better than an adult because there was more “plasticity” in a younger brain, but recent research has shown that this is not the case. A brain injury actually has a more devastating impact on a child than an injury of the same severity on a mature adult.

In a child with traumatic brain injury, you may observe:

(any of the signs or symptoms listed for the adults above – more signs and symptoms may change or develop as they grow older and their brain develops more)

Change in eating or nursing habits
Unusual or easy irritability, difficulty controlling emotions
Persistent crying and inability to be consoled
Change in ability to pay attention
Change in sleep habits or patterns
Seizures
Sad or depressed mood, lowered self-esteem, violent acting out, Lack of Motivation
Drowsiness
Loss of interest in favorite toys or activities
Endocrine Changes
Cognitive changes

TBI is a leading cause of disability and mortality in youth. Symptoms often appear later, especially as developmental demands increase in adolescence. Research shows children may face more prolonged and severe consequences than previously believed

Long Term Monitoring Needed For Kids Entering Puberty

Traumatic brain injury (TBI) is no longer seen as a one-time event, but rather as a condition that can evolve over time, requiring consistent follow-up and care. As noted by the American College of Surgeons (2024), TBI is increasingly recognized as both an acute and chronic medical condition, with long-term consequences that demand ongoing management and reassessment.

Secondary declines can occur 24–36 weeks after an initial recovery plateau, suggesting the need for extended follow-up.

Behavioral issues can emerge immediately or years post-injury, affecting up to 50% of pediatric survivors. Persistent post-concussive symptoms (PPCS) affect about 25% of children more than six months after a mild TBI, particularly prevalent in adolescents and cases from motor vehicle accidents.

Puberty adds complexity: sex hormone changes, brain connectivity shifts, and emotional maturation may trigger or reveal symptoms only then. A small body of research suggests rare cases of precocious puberty or endocrine dysfunction may follow severe TBI, highlighting the importance of long-term monitoring.

This is especially important in children and adolescents, whose brains are still developing. The prefrontal cortex, which governs executive functions like impulse control, planning, and decision-making, does not fully mature until late adolescence or early adulthood. As a result, many executive function impairments may not appear until puberty, when developmental expectations increase and the brain’s regulatory systems begin to mature.

Studies have shown that even when a child seems to recover well in the early stages post-injury, new cognitive and behavioral challenges can emerge years later as the brain is called upon to perform more complex tasks. For example, difficulties with inhibition, emotional regulation, working memory, and flexible thinking often don’t manifest until adolescence, and may be missed if long-term monitoring isn’t in place.