Question 1

What is traumatic brain injury?

Accepted Answer

Traumatic brain injury is injury to the brain from external mechanical forces — including falls, road traffic crashes, violence, sports impacts, blast exposure and other trauma. It ranges from mild concussion (brief confusion, headache) through moderate injury to severe TBI (prolonged coma, permanent disability). TBI is the leading cause of injury-related death and disability globally and the most common cause of death in adults under 45.

Question 2

What are the types and severity of TBI?

Accepted Answer

By severity: mild TBI (GCS 13-15 — approximately 80% of cases; includes concussion): transient loss of consciousness <30 minutes, post-traumatic amnesia <24 hours; most recover well. Moderate TBI (GCS 9-12): LOC 30 minutes to 24 hours; significant neurological deficits; requires hospital admission. Severe TBI (GCS ≤8): coma lasting >24 hours; high mortality and major disability risk; requires ICU care. By mechanism: closed TBI (blunt force — most common); penetrating TBI (bullet, shrapnel — higher mortality); blast TBI (explosive overpressure — military/conflict).

Question 3

What happens in the brain after TBI?

Accepted Answer

Primary injury: immediate mechanical disruption at the moment of impact — axonal shearing, contusions (bruising), haematomas (epidural, subdural, intracerebral), brain lacerations. Secondary injury (hours to days after): cerebral oedema, intracranial hypertension, ischaemia (inadequate oxygen/glucose delivery), excitotoxicity (glutamate flood), mitochondrial dysfunction, neuroinflammation, and cell death. Secondary injury accounts for much of the mortality and disability after TBI — and is the target of intensive care management.

Question 4

Why is there no approved drug for TBI?

Accepted Answer

TBI's heterogeneity is the fundamental challenge. Unlike many diseases, TBI includes dozens of distinct injury patterns (diffuse axonal injury, focal contusions, subdural haematoma etc.) with different pathophysiologies — making a single drug unlikely to work for all TBI types. Over 30 neuroprotective agents have failed Phase 3 trials in TBI, including progesterone, hypothermia, nimodipine, erythropoietin and others. The field is moving toward: precision medicine approaches matching drugs to specific TBI subtypes; biomarker-guided trials (GFAP, UCH-L1, NfL); and combination therapies targeting multiple secondary injury mechanisms.

Question 5

What is chronic traumatic encephalopathy (CTE)?

Accepted Answer

CTE is a progressive neurodegenerative disease discovered in athletes exposed to repetitive head impacts — boxers (earliest descriptions), American football players (largest studies — 99% of NFL players donated to brain banks had CTE), rugby players, ice hockey players, and military veterans. CTE is caused by the accumulation of hyperphosphorylated tau protein in the brain — distinct from but resembling Alzheimer's disease. Symptoms: early behavioural changes (impulsivity, aggression), depression, short-term memory problems, progressing to dementia, Parkinson-like features, and suicidal ideation. CTE can only be diagnosed at autopsy.

Question 6

How are sports concussions managed?

Accepted Answer

"If in doubt, sit them out" — suspected concussion requires immediate removal from play, same-day evaluation, and no return to sport until cleared by a healthcare professional. Return-to-sport protocols are graduated (symptom-free × day → light aerobic exercise → sport-specific exercise → non-contact practice → full contact practice → return to competition). Rest is no longer recommended as the primary treatment — early sub-symptom-threshold aerobic exercise accelerates recovery. Repeated concussions before full recovery substantially increases risk of prolonged symptoms and possibly CTE.

Question 7

What are the long-term effects of TBI?

Accepted Answer

Physical: post-traumatic epilepsy (approximately 2% risk after mild TBI, up to 50% after severe penetrating TBI); post-concussive syndrome (headache, dizziness, cognitive slowing, fatigue — lasting >3 months in approximately 15-30% of mild TBI). Cognitive: attention, memory, processing speed deficits proportional to injury severity. Psychiatric: depression and anxiety (very common — approximately 20-30% after moderate-severe TBI); PTSD (especially in combat TBI). Degenerative: increased risk of Alzheimer's disease, Parkinson's disease and CTE after repeated TBI.

Question 8

How does GMJ News cover TBI?

Accepted Answer

GMJ News covers WHO TBI burden data, road traffic safety as primary prevention, CTE in athletes, severe TBI neurocritical care, concussion management in sport, and TBI-dementia research. TBI from road traffic accidents is a major cause of death and disability in Georgia — directly relevant to PHIG's injury prevention programme and the Georgian Medical Journal.

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