Brain Injury – Part III

This week, we will continue our discussion of brain injuries with a discussion of the diagnosis and treatment of traumatic brain injury (TBI).

How are TBIs diagnosed?

Remember that TBIs can be emergencies. Severe brain injuries can worsen rapidly if not treated appropriately and quickly. Doctors need to make a quick assessment of the situation.

If you see someone sustain a head injury, or arrive on the scene immediately after, you may be able to provide valuable information to help health care providers assess the situation. Try your best to remember and pass on details of the injury, such as:

• How the injury happened
• What part of their head was hit, and how hard, and if other body parts were struck
• If there was a fall, from what height the person fell
• Whether or not the person lost consciousness, and for how long
• Whether the person had trouble speaking or seemed confused immediately after the injury
• Whether the person's body was whipped around or severely jarred

What is the Glasgow Coma Scale?

This is a checklist that assesses and gives a certain number of points to things such as how well a person can follow directions, move their eyes, move their limbs, and speak coherently. It helps a doctor to make an initial assessment of the severity of the brain injury.

Are imaging tests required for diagnosis?

Tests such as a CT scan or MRI may or may not be used, depending on the severity of the injury. Mild TBIs usually do not require imaging unless there are underlying risk factors, such as being on blood thinner medication.

How is TBI treated?

Treatment for a TBI, particularly in the acute stage, depends on the severity of the injury.

Mild TBI treatment may include:

• Rest - Limited (but not complete avoidance of) both physical and mental activity
• Avoiding screen time, including television and electronic devices
• Over the counter pain relievers for headache
• Close monitoring to watch for any worsening signs or symptoms or persistent symptoms

Moderate to severe TBI treatment may include one or more of the following:

• Medications or fluids to maintain blood pressure
• Assuring the patient gets adequate oxygen, which may include a ventilator in severe cases
• Monitoring the pressure inside the skull
• Medications to prevent seizures
• Medication to help reduce pressure inside the brain
• Medication to temporarily induce a coma - because a comatose brain needs less oxygen and nutrients to function
• Emergency surgery - to remove blood clots, repair skull fractures, stop bleeding in the brain, or sometimes to open a window in the skull to help relieve pressure on the brain

What happens after the acute phase of treatment?

After a mild TBI, or concussion, a person is usually able to gradually return to normal activities over a period of a few days to several weeks.

After moderate to severe TBI, most people will require some type of rehabilitation. This may be done initially in a hospital or rehabilitation facility. Most people will require continued rehabilitation in the outpatient setting after returning home. Treatment may include:

• Physical therapy - to work on mobility, relearning movement patterns, strengthening, balance, and walking, including learning to use any mobility devices needed
• Occupational therapy - to work on fine motor skills, hand function, and skills to perform everyday activities
• Speech therapy - to improve communication skills and use any new communication devices that might be needed
• Neuropsychology - to assess and improve thinking and behavioral challenges, and help with emotional well being and coping with the injury
• Vocational retraining - may be necessary to help a person to return to work

I thought we might be able to discuss prevention today but I seem to have run out of space! We will discuss the important subject of how to decrease the risk of TBI next week.

If you have any questions about brain injuries, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor