Types and Severity of TBI

Chapter 4 – Types and Severity of Traumatic Brain Injury (TBI)

Types and Severity of Traumatic Brain Injury (TBI)

Not all brain injuries are the same. Some people experience a brief concussion and recover fully within days or weeks. Others suffer severe, long-lasting damage that can affect every part of life. That’s why doctors categorize TBIs based on their type and severity — to help guide diagnosis, treatment, and recovery.

Mild, Moderate, and Severe TBI

Doctors often use the Glasgow Coma Scale (GCS) to assess how serious a brain injury is. This scale scores a person’s ability to open their eyes, move, and speak. The total score helps classify the TBI as:

  • Mild TBI (Concussion) – GCS score 13–15
    • May cause brief loss of consciousness or none at all
    • Symptoms can include headache, dizziness, confusion, or memory loss
    • Often doesn’t show up on a CT or MRI scan
    • Recovery usually happens within weeks or months
  • Moderate TBI – GCS score 9–12
    • Longer loss of consciousness (more than 30 minutes)
    • Visible damage may show on brain scans
    • Symptoms may last for months or become long-term
  • Severe TBI – GCS score 3–8
    • Prolonged unconsciousness or coma
    • Major, visible brain injury (bleeding, swelling, or crushed tissue)
    • High risk of long-term disability or death

Types of TBI

There are several different types of traumatic brain injury. Some happen on the surface of the brain, while others damage deep internal structures.

  • Concussion – The most common type of mild TBI. Caused by sudden shaking or impact. Symptoms may include nausea, confusion, or sensitivity to light and sound.
  • Contusion – A bruise on the brain. Caused by a direct blow to the head. May involve bleeding and swelling.
  • Coup-Contrecoup Injury – The brain strikes one side of the skull and then rebounds to hit the opposite side. This causes injury at two locations.
  • Diffuse Axonal Injury (DAI) – Caused by strong rotation or shaking of the head. Damages nerve fibers (axons) throughout the brain. Often seen in car accidents or falls.
  • Penetrating Injury – Occurs when an object (like a bullet or shrapnel) enters the brain through the skull. Often results in localized but severe damage.
  • Second Impact Syndrome – A second head injury occurs before the first one fully heals. Rare but often deadly, especially in athletes.

Open vs. Closed Head Injuries

  • Closed Head Injury – The skull remains intact, but the brain is injured inside. This is the most common type, often caused by falls or car accidents.
  • Open Head Injury – The skull is broken or pierced, exposing brain tissue. These injuries are often more visible and easier to diagnose but can carry high risks of infection and bleeding.

Why It Matters

The type and severity of TBI greatly affect the treatment path and chances of recovery. A person with a mild concussion may need rest and monitoring, while someone with severe TBI may need emergency surgery and long-term rehab.

Understanding these differences helps families ask better questions, prepare for challenges, and work closely with the medical team to build the best plan for recovery.

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