Traumatic brain injury (TBI)

Diagnosis  

When more serious traumatic brain injuries (TBIs) left untreated, the effects can quickly worsen. Emergency personnel, such as healthcare providers, must act swiftly to examine the situation.  

• Physical examination: You might be able to give healthcare providers information that will help them determine the injured person’s condition if you witnessed someone getting injured or if you arrived right away.  

• Glasgow Coma Scale: The Glasgow Coma Scale assigns scores for abilities between three and fifteen. Less severe injuries correspond to higher ratings.  

A person’s capacity to follow instructions and move their eyes and extremities is tested with this 15–point test that helps healthcare providers in determining the initial severity of a brain injury. Another important indicator is the coherence of speech.  

• Imaging tests  

• Computerized tomography (CT) scan: In an emergency room, this test is typically the first one carried out when a traumatic brain injury is suspected. A sequence of X–rays is used in a CT scan to produce a detailed image of the brain. In addition to rapidly revealing fractures, a CT scan can detect blood clots (hematomas), brain tissue edema, contusions, and bleeding in the brain.  
• Magnetic resonance imaging (MRI): A MRI creates a detailed image of the brain by using magnets and strong radio waves. If the patient’s symptoms fail to get better right away following the accident, this test could be used once their condition has stabilized.  

• Intracranial pressure monitor: Increased pressure within the skull because of tissue swelling following a traumatic brain injury can lead to further brain damage. To track this pressure, healthcare providers may place a probe into the skull.  

Treatment 

Treatment options vary for mild and moderate/severe traumatic brain injuries, with recommendations adapting to individual circumstances.  

• Mild injury: For treating mild traumatic brain injuries, rest and over–the–counter pain relievers are typically sufficient for managing headaches. However, individuals with mild traumatic brain injuries should have their symptoms monitored at home for any worsening or new indications. Follow–up medical appointments with a healthcare provider may be necessary to assess the progress. The healthcare provider will offer guidance on when it’s safe to return to work, school, or leisure activities. It’s generally recommended to avoid activities that exacerbate symptoms for the first few days or until cleared by the healthcare provider. Complete abstention from all mental and physical exercise is not advised; instead, gradually reintroducing regular routines is typical.  
• Immediate emergency care: When a person has moderate to severe traumatic brain damage, emergency care focuses on keeping blood pressure stable, ensuring they have enough oxygen and blood flow, and preventing more head or neck injuries.  

It’s possible for people with severe injuries to also have untreated additional injuries. In the hospital’s emergency room or intensive care unit, more treatments will be directed toward reducing secondary brain damage brought on by bleeding, inflammation, or low oxygen delivery.  

• Medications: Following an injury, medications to prevent further brain damage may include:  

• • Anti–seizure drugs: During the first week following their brain injury, those with moderate to severe traumatic brain injuries are susceptible to seizures.  

During the first week, a medication that prevents seizures may be administered in order to prevent further brain damage from seizures. Only in cases of seizures are ongoing anti–seizure medications administered.  

• • Coma–inducing drugs: Due to the reduced oxygen requirement of a comatose brain, healthcare providers occasionally use medications to place patients into temporary comas. This is particularly beneficial if blood arteries are unable to provide appropriate levels of nutrients and oxygen to brain cells due to compression caused by elevated head pressure.  
  • Diuretics: These medications cause tissues to retain less fluid and produce more urine. Intravenous diuretics are used to lower intracranial pressure in patients suffering from traumatic brain injury.  

• Surgery: It could be necessary to do emergency surgery to prevent more brain tissue injury. The following issues can be resolved by surgery:  

• • Blood clot removal (hematomas): Bleeding from the outside or inside the brain can cause a hematoma, or accumulation of clotted blood, which puts pressure on the brain and harms its tissue.  
  • Repairing skull fractures: Severe skull fractures or the removal of skull fragments from the brain may require surgery.  
  • Bleeding in the brain: Surgery may be necessary to stop brain hemorrhage resulting from head injuries.  
  • Opening a window in the skull: Draining collected cerebrospinal fluid or creating a window in the skull to allow greater space for swelling tissues are two surgical methods for reducing pressure inside the skull.  

• Rehabilitation: Rehabilitation is usually necessary for those who have suffered a major brain damage. Basic abilities like walking and speech might need to be learned again by the patients. The intention is to increase their capacity to carry out daily routine tasks.  

Typically, therapy starts in the hospital and continues at a residential treatment center, an inpatient rehabilitation unit, or through outpatient treatments. Each person’s rehabilitation program and length vary based on the extent of their brain injury and the specific area of the brain that was damaged.