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Traumatology · Additional topics

Traumatic Brain Injury

Trauma craniocerebrale

Traumatic brain injury is damage to the head structures, which is often part of polytrauma. It can be closed or open depending on the integrity of the aponeurosis and requires strict adherence to diagnostic and first-aid protocols.

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TBI SymptomsSomnolence, headache, loss of consciousness, vomiting, and amnesia.
Closed InjuryThe cranial aponeurosis is intact, and the internal environment remains sealed.
Open InjuryThe aponeurosis is breached, creating communication with the external environment.
First AidAn unconscious casualty is placed in the lateral position to prevent aspiration.
2 min readFor medical studentsUpdated 10.10.2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesPending instructor review

Classification of Traumatic Brain Injuries

In clinical practice, head injuries are divided into two main groups depending on the integrity of the soft tissues and the epicranial aponeurosis:

  • Closed TBI: the cranial aponeurosis remains intact, keeping the internal environment sealed. The skin and soft tissues may be damaged and bones fractured.
  • Open TBI: the aponeurosis is damaged, creating direct communication with the external environment. Such injuries are divided into non-penetrating (the dura mater is unaffected) and penetrating (the dura mater is breached).

Clinical manifestations

Brain injuries are accompanied by characteristic signs that help suspect the condition:

  1. General weakness, somnolence, and severe headache.
  2. Dizziness, nausea, and vomiting.
  3. Loss of consciousness of varying depth.
  4. Amnesia — loss of memory for events immediately preceding or accompanying the injury.
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First aid for the casualty

Proper actions before medical personnel arrive save lives and prevent dangerous complications:

  • The casualty should be carefully placed on their back while continuously monitoring respiration and pulse.
  • In case of loss of consciousness, the person must be turned onto their side to prevent tongue drop and aspiration of vomitus.
  • If wounds are present, apply a clean dressing. In open injuries, bandages are first applied circularly around the edges of the wound and only then cover it from above.

Specifics of the clinical course in polytrauma

When brain injury is combined with injuries to other regions, the clinical picture changes:

  • Shock symptoms may be masked: in diencephalic lesions, instead of a drop in blood pressure, normotension and bradycardia are observed.
  • Respiratory disorders in combined pathology often come to the foreground, preceding hemodynamic disturbances.
  • Normal blood pressure combined with motor agitation may indicate developing cerebral hypoxia rather than patient stability.
How to memorize

Closed — aponeurosis intact; open — aponeurosis ruptured.

Class and exam questions

What is the main difference between closed and open TBI?

The main criterion is the state of the cranial aponeurosis. In closed injury, it is intact and the internal environment is sealed, whereas in open injury, it is damaged, providing communication with the external environment.

How to properly position an unconscious casualty?

The patient must be placed in the lateral position. This is a crucial measure to prevent aspiration of vomitus and airway obstruction by the tongue.

What is amnesia in traumatic brain injury?

This is a symptom that erases from the casualty's memory the events that directly caused the injury, as well as preceding events.

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What else to study on this topic

  • Mutual aggravation syndrome in polytrauma
  • Diagnostic features and challenges in detecting occult injuries
  • The effect of traumatic brain injury on blood pressure parameters
  • Mechanisms of catatrauma and the classical triad of injuries
  • Organization of a multidisciplinary approach and surgical priorities

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  • Complete study guide on Traumatic Brain Injury and 812 more pages of the subject
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Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.