What Is a TBI (Traumatic Brain Injury)?

Written by Madeline Laguaite
Medically Reviewed by Shruthi N, MD on November 13, 2024
14 min read

A traumatic brain injury (TBI) is an injury to your brain, often caused by a blow to the head. TBIs can damage nerve cells and cause bleeding or swelling in your brain. 

Most TBIs are treatable, but they can affect your daily life and cause you physical, mental, or emotional stress.

A number of things can cause a traumatic brain injury. Some of the most common causes are:

  • Car, motorcycle, and bicycle accidents, including those that lead to whiplash
  • Falls, especially in older people and children
  • Sports injuries, especially from football, boxing, soccer, hockey, baseball, lacrosse, and skateboarding
  • Violence, like explosions, domestic violence, gunshots, child abuse, and shaken baby syndrome

A TBI can cause you to lose consciousness, have amnesia for a while, be confused for weeks, or go into a coma. A TBI from a crushing or a penetrating blow can be life-threatening and life-altering. You'll most likely need surgery and rehabilitation.

TBI risk factors

People 65 or older are most likely to need hospital care for a traumatic brain injury, often because of a fall. No matter what their age, people who were assigned male at birth are more likely to have a serious TBI.

People who are most at risk of a traumatic brain injury include: 

  • Kids, particularly newborns and those under 5 years old
  • Teenagers and young adults between the ages of 15 and 24
  • Adults who are 60 or older

Traumatic brain injuries can be split into two main categories: penetrating and non-penetrating. It’s possible to have just one or both, depending on what caused the injury. 

Penetrating TBI. A penetrating TBI, also called an open TBI, is when something goes through your skull and into brain tissue, like a bullet or a piece of bone. Usually, this type only hurts one part of your brain.

Non-penetrating TBI. A non-penetrating TBI, also called a blunt TBI or closed head injury, happens when an outside force is strong enough to move your brain inside your skull. Some of the most common causes of this type include:

  • Car accidents
  • Falls
  • Being hit with something
  • Sports injuries
  • Blasts or explosions 

Besides the broader penetrative and non-penetrative types, traumatic brain injuries fall into more specific categories:

Concussions

Concussions are the most common kind of TBI. They aren't usually life-threatening, but there are dangers.

These injuries may not show up in initial tests and could take as long as a few years to completely heal. Immediate symptoms can be loss of consciousness or feeling dazed or confused. But it may take a while before you have any symptoms.

If you take a hit to the head, be on the lookout for these symptoms:

Contusions

With this form of TBI, you have bruiseson your brain that cause bleeding. If the injured area is large enough, you may need surgery.

Acquired brain injuries

Acquired brain injuries (ABIs) aren't caused by trauma. They're caused by other things, such as a stroke, tumor, fluid, or an infection you get after birth. Often, they keep your brain from getting enough oxygen.

ABIs can have serious effects on your life. Like TBIs, they may cause problems with movement, thinking, emotions, and behavior, depending on what area was injured.

Diffuse axonal injury (DAI)

DAI is one of the most common types of brain injuries. It often happens during a car accident, sports injury, or fall. DAI damages your brain’s white matter, making it harder for nerve cells to communicate information. Brain damage from a DAI can be temporary or permanent. 

Hematoma

When a blood vessel in your brain bursts, it causes bleeding inside and around your brain. That’s called a hematoma. There are a few types, depending on where the bleeding happens. They include:

  • Epidural hematomas
  • Subdural hematomas
  • Intracerebral hematomas
  • Subarachnoid hemorrhage

Skull fracture

You get a skull fracture when the bone in your skull breaks or cracks. It’s often caused by blunt force trauma, like being hit in the head very hard. It can harm your brain tissue and its blood vessels. 

A traumatic brain injury can cause many symptoms, both physical and mental. Your symptoms could show up right after your injury or hours or days afterward. 

Mild TBI symptoms

What symptoms you have after a mild TBI can be different for everyone. Even a mild TBI can change how you feel, behave, think, and sleep. Symptoms include:

  • Feeling sick or throwing up 
  • Headaches
  • Tiredness 
  • Sensory problems, like blurry vision, a bad taste in your mouth, changes in the way you smell things, or ringing in your ears
  • Passing out for a few seconds to minutes
  • Feeling disoriented or confused
  • Being sensitive to noise or light
  • Dizziness or balance issues
  • Problems communicating
  • Trouble remembering things
  • Feeling groggy or “slowed down”
  • Trouble thinking clearly, concentrating, or paying attention
  • Feeling anxious, nervous, sad, angry, or more emotional than usual
  • Trouble falling asleep or getting quality sleep, or sleeping more than usual

Your symptoms will get better over time, usually within a few weeks.

Moderate to severe TBI symptoms

If your traumatic brain injury is more serious, you could have the above symptoms along with others like: 

  • A headache that doesn’t get better or gets worse with time
  • Dilated pupils, where the dark part of your eye gets bigger in one or both eyes 
  • Throwing up a lot
  • Clear liquid coming out of your nose or ears
  • Weakness or numbness in your fingers or toes
  • Slurring your words 
  • Seizures or other uncontrollable movements
  • Passing out for minutes to hours
  • Not being able to wake up

Symptoms of TBI in children

Babies and young kids can also have traumatic brain injuries but might not be able to tell you how they’re feeling. If you think your child might have a TBI, look out for signs like:

  • Crying a lot, for long periods (and not being able to be comforted) 
  • Not nursing or eating the way they usually would
  • Mood changes, like feeling sad or becoming fussy or angry quickly
  • Changes in how they pay attention
  • Not being interested in play or toys 
  • Changes in the way they sleep
  • Throwing up
  • Seizures

See a doctor if you think you’ve had any kind of brain injury. And follow your doctor's recommendations.

TBIs can cause any number of problems. Physically, you need rest. But you may feel exhausted mentally and emotionally, too. You may not be able to think or communicate well, and it can dull your sensory skills. Be on the lookout for changes in these areas, among others:

  • Anxiety
  • Depression
  • Memory
  • Muscle function
  • Judgment
  • Sight
  • Sound
  • Smell
  • Taste
  • Touch
  • Understanding

TBIs can increase the risk of brain diseases, such as Alzheimer’s and Parkinson’s.

If doctors think you have a TBI, they'll ask questions about your symptoms and your injury. They may do a neurological exam, which involves both questions and physical examinations, to test your:

  • Hearing and speech
  • Sensory skills
  • Motor skills
  • Balance and coordination

They’ll also look for any changes in your mood, behavior, or thinking. 

People with more serious TBIs may not be able to discuss their condition. If you saw someone get hurt, doctors or first responders might ask you questions about what happened. Your answers can help them understand how serious the injury is.

Other tools for TBI diagnosis

Doctors use imaging tests like CT scans or MRI scans to get a view of your brain and see how badly it's injured. They also might use an intracranial pressure monitor to measure swelling caused by a TBI. To do this, they put a small device called a probe through your skull to measure the pressure and swelling.

Glasgow coma scale

Doctors and first responders can use the Glasgow coma scale to quickly get a better idea of the injured person’s state. It’s a 15-point test that checks how well you can move and follow directions. The higher the score, the less serious the injury.

 

The way a traumatic brain injury is treated depends on how serious it is.

Mild TBI treatment

For mild TBIs, the main treatment is lots of rest and medication for pain if you have headaches. Usually, you’ll need to have someone keep an eye on you to watch for new symptoms or symptoms that don’t go away. 

For the first couple of days, your doctor will probably suggest relative rest, which means you need to steer clear of some physical and cognitive (thinking) activities that could make things worse. Your doctor will let you know when it’s safe to go back to school, work, or your other normal activities. 

Kids and teenagers who have sports-related injuries shouldn’t go back to playing sports until a concussion specialist says it’s OK. It's important to prevent future TBIs since it’s harder to get better after a second or third one.

Severe TBI treatment

For more serious traumatic brain injuries, doctors start by giving you emergency treatment. They’ll protect your neck or head from more harm and make sure your blood pressure and oxygen levels are under control. They'll try to keep bleeding, inflammation, or lack of oxygen supply to the brain from doing further damage.

If you also have other injuries, doctors at the hospital will treat them to protect you from further harm.

Depending on the injury, treatment of a severe TBI can involve surgery. You might need surgery to: 

  • Fix skull fractures or remove pieces of skull from the brain
  • Make a hole in the skull to give swollen tissues more room
  • Drain fluid to ease pressure
  • Stop bleeding in the brain
  • Remove clotted blood (hematomas)

Medications for TBI

After the injury, doctors might give you medications to protect against damage. For example, you might need:

  • Diuretics to help ease swelling and pressure in the brain
  • Anti-seizure medications during your first week after the TBI, since you're at a higher risk of having a seizure
  • Drugs to put you into a temporary coma if pressure in your brain makes it hard for brain cells to get nutrients and oxygen 

Complications can crop up right away or later on after a traumatic brain injury. The more serious the TBI, the more serious the complications can be. 

A moderate or severe TBI can affect your awareness. You could face:

  • A coma, where you’re not awake or reacting to anything around you
  • A minimally conscious state, where you might have some idea of what’s going on around you 
  • A vegetative state, where you lack awareness but might make sounds, open your eyes, or move 
  • Brain death, a permanent state in which there’s not noticeable activity in the brain or brain stem

You can have physical complications after an injury to the brain, including:

  • Headaches you get often
  • Vertigo, which causes dizziness and makes you feel like you’re spinning
  • Infections, especially with penetrative TBIs
  • Damage to blood vessels in your brain, which can lead to blood clots or a stroke
  • Seizures you might get soon after your TBI or even years later
  • Fluid buildup in your brain (hydrocephalus) that causes swelling and pressure

If the injury is close to the base of your skull, it can hurt the nerves in your brain (cranial nerves). This can cause symptoms like: 

  • Vision problems, like double vision or not being able to see clearly
  • Hearing problems, like ringing in your ears or hearing loss
  • Changes in your sense of smell or taste
  • Trouble swallowing
  • Being unable to move your face

Second impact syndrome

If you’ve had a TBI, take steps to avoid another injury to your brain. Even with mild TBIs, repeated injuries can do lasting damage to your nervous system and weaken your mental awareness. If you get repeated TBIs in a short period of time, they could lead to death.

Make sure your doctor says your first TBI has fully healed before you return to your usual activities. Although concussions are generally considered mild, getting a second concussion before the first one has healed can be deadly. This is known as second impact syndrome.

Second impact syndrome causes fast and serious brain swelling. The symptoms happen almost right away and include:

  • Dilated pupils
  • Loss of eye movement
  • Inability to breathe
  • Unconsciousness

Symptoms will worsen quickly. At the least, second impact syndrome will result in a severe TBI and have long-lasting effects on your everyday life.

Long-term effects of traumatic brain injuries 

A TBI can have other long-term effects, too. You might notice changes in the way you think. For example, you might have trouble with memory, paying attention, and learning new things. You might also have trouble with executive functioning, like staying organized, problem-solving, planning, and making decisions. 

After a TBI, it’s pretty common to have trouble communicating with others. It can be frustrating. For example, you might:

  • Have trouble talking and writing
  • Have trouble understanding writing and speech
  • Have a hard time starting, stopping, or following a conversation
  • Struggle to understand nonverbal cues or changes in tone and pitch

 A TBI might also lead to changes in emotions and behavior. You might have mood swings, or feel anxious, sad, depressed, or angry. You might also have a hard time with empathy – understanding someone else’s thoughts and feelings – even if you were empathetic before. This can make it harder to control yourself. You might have verbal or physical outbursts and have trouble in social situations.

TBI and stroke

A TBI can increase your chances of some other conditions. For example, studies have shown that people who’ve had a traumatic brain injury are more likely to have a stroke later in life than those who haven't.

Chronic traumatic encephalopathy (CTE)

CTE is a brain disorder that gets worse as time goes on. Research shows that having multiple TBIs is linked to CTE. People with CTE have trouble with: 

  • Thinking and communicating
  • Understanding others
  • Depression
  • Confusion
  • Becoming annoyed or frustrated easily

Because it gets worse over time, it can take years for symptoms to show up. 

TBI and dementia (Post-traumatic dementia, or PTD)

PTD can show up after just one serious traumatic brain injury. Like CTE, it can get worse over time. Researchers are still studying PTD, but so far, there seems to be a link between getting dementia later in life and having a moderate or severe TBI in the past.

Life after a traumatic brain injury might look a little different, depending on how serious your injury was. Rehabilitation (rehab) and coping strategies can help you get back to your daily activities at school, work, and at home. 

TBI rehab

If you have a more serious traumatic brain injury, TBI rehab can help you relearn skills you've lost. Most people start rehab in a hospital after they're hurt and continue it in a treatment center. How long you need to do rehab and what it looks like can vary. 

Your TBI rehab team could include:

  • Physiatrists, who usually oversee the TBI rehab process
  • Physical therapists, who help you relearn physical skills like walking or balance
  • Neuropsychologists, who provide psychotherapy and help you manage your behavior 
  • Case managers or social workers, who help you and your family better understand care decisions and planning
  • Occupational therapists, who help you relearn or improve the things you do in daily life
  • Speech and language therapists, who help you improve your communication skills
  • TBI rehab nurses, who manage your care
  • Traumatic brain injury nurse specialists, who educate your loved ones about your injury and recovery
  • Recreational therapists, who use recreational activities to help you reach your goals
  • Vocational counselors, who can help you with returning to work 

TBI recovery timeline

Your TBI recovery timeline depends on how serious the injury was and what part of your brain was affected. Getting help right away after a TBI gives you the best chances of recovery.

Your genes also affect how long it takes you to recover. How old you are and how many TBIs you’ve had have an effect, too. Older people are more likely to have lasting symptoms. 

How to cope with a TBI

Adjusting to life after a traumatic brain injury can be difficult. It can help to join a support group for other TBI survivors. You’ll be able to talk through your frustrations and fears, get emotional support, and learn strategies for coping. If you need help finding support groups for TBI survivors, your doctor or TBI rehab specialists should be able to help.

It might help to:

  • Keep up a daily routine using a schedule.
  • Write things down, like important dates, to-do’s, and other things that might be hard to remember.
  • Keep items at home and work in a dedicated place so they’re easier to find.
  • Take the same route to work, school, and other places each time to avoid confusion.
  • Adjust expectations at work or school. You might need more time to do certain tasks.
  • Take breaks as you need them.

If your TBI is serious, help from friends or family members can make these things easier.

There are many ways to lower the chances of getting a traumatic brain injury. For example:

  • Wear a helmet anytime you ride a bike, motorcycle, skateboard, or snowmobile.
  • Wear your seatbelt in the car and make sure small children are safe in the back in their booster or car seat. 
  • Pay attention to your surroundings, especially when crossing the street. 
  • Never drive under the influence of alcohol or other drugs. 

If you’re older, consider taking these steps to prevent accidents at home: 

  • Put handrails in the bathroom and along the staircase.
  • Use non-slip mats in the bathtub.
  • Make sure floors are clear of clutter. 
  • Get rid of rugs that could trip someone.
  • Make sure your home has good lighting throughout. 

Exercising and getting regular checkups for vision can also help you avoid falls. 

For young kids, installing window guards, child-proof safety gates at the top of the stairs, and keeping floors clear of clutter are good strategies. Never let your kids play on balconies, fire escapes, or in other unsafe environments. 

A traumatic brain injury is an injury to your brain, often caused by a blow to the head. The effects of brain injuries are different for everyone. Your treatment and recovery will depend on the cause of your injury, the location, and how serious it is.

Here are some commonly asked questions about traumatic brain injuries. 

Can you recover from a traumatic brain injury?

It's possible to recover from most traumatic brain injuries. How well you can recover and how long it takes depend on how serious the injury was, how quickly you got help, how old you are, and your genes, among other things.

Is epilepsy considered a traumatic brain injury?

While epilepsy isn’t a type of TBI, traumatic brain injuries can cause seizures. You can have seizures within the first week of your TBI or later on. If seizures start later, they’re more likely to happen again and lead to epilepsy.

Does the brain fully heal after a traumatic brain injury?

Brain cells that are damaged or die after a traumatic brain injury usually don’t heal or come back to life. But that doesn’t mean you can’t recover. In some cases, especially with younger people, other areas of the brain can “make up for” the areas that were damaged by the TBI. 

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