Traumatic Brain Injury

Diagnosis

Traumatic brain injuries (TBI) may be medical emergencies. Severe TBIs can worsen rapidly without treatment, so prompt assessment is crucial.

Glasgow Coma Scale
This 15-point test helps assess the initial severity of a brain injury by checking a person’s ability to follow directions, move their eyes and limbs, and speak coherently. Scores range from 3 to 15, with higher scores indicating less severe injuries.

Information about the injury and symptoms
Medical personnel may need details about how the injury occurred and its effects, including:

• How the injury happened
• Whether the person lost consciousness and for how long
• Changes in alertness, speech, or coordination
• Where and how force was applied to the head or body

Imaging tests
• Computerized tomography (CT) scan – Provides a detailed view of the brain to detect fractures, bleeding, blood clots, contusions, and swelling.
• Magnetic resonance imaging (MRI) – Uses magnets and radio waves for detailed images, often after stabilization or if symptoms persist.

Intracranial pressure monitor
In cases of swelling, a probe may be inserted into the skull to monitor pressure and prevent further brain damage.

Treatment

Treatment depends on the severity of the injury.

Mild injury
• Rest and over-the-counter pain relievers for headache
• Close monitoring at home for new or worsening symptoms
• Gradual return to normal activities with relative rest

Immediate emergency care
For moderate to severe injuries, emergency treatment focuses on:
• Ensuring adequate oxygen and blood supply
• Maintaining blood pressure
• Preventing further head or neck injury

Medications
• Anti-seizure drugs – Given to prevent seizures in the first week after injury
• Coma-inducing drugs – Reduce oxygen demand in the brain
• Diuretics – Reduce fluid in tissues and lower intracranial pressure

Surgery
Surgery may be necessary to:
• Remove clotted blood (hematomas)
• Repair skull fractures
• Stop bleeding in the brain
• Relieve pressure by draining cerebrospinal fluid or creating a window in the skull

Rehabilitation
Rehabilitation helps patients regain skills and independence. Therapy may begin in the hospital and continue as inpatient, residential, or outpatient care. Specialists involved may include:

• Physiatrist – Oversees rehabilitation and manages medical issues
• Occupational therapist – Helps with daily living skills
• Physical therapist – Improves mobility, balance, and movement
• Speech and language therapist – Enhances communication and use of assistive devices
• Neuropsychologist – Assesses cognition, behavior, and emotional well-being
• Social worker or case manager – Coordinates services and family support
• Rehabilitation nurse – Provides ongoing care and discharge planning
• TBI nurse specialist – Educates and coordinates care for patients and families
• Recreational therapist – Assists with leisure activities and time management
• Vocational counselor – Evaluates work readiness and provides employment guidance