Traumatic Brain Injury (TBI) - Treatment

Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible. Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize an individual with TBI and focus on preventing further injury. Primary concerns include insuring proper oxygen supply to the brain and the rest of the body, maintaining adequate blood flow, and controlling blood pressure. Imaging tests help in determining the diagnosis and prognosis of a TBI patient. Patients with mild to moderate injuries may receive skull and neck X-rays to check for bone fractures or spinal instability. For moderate to severe cases, the imaging test is a computed tomography (CT) scan. Moderately to severely injured patients receive rehabilitation that involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support.

Initial treatment focuses on saving the victim's life. Rescue or emergency personnel unblock airways, assist breathing, and keep blood circulating. Cardiopulmonary resuscitation may be as necessary. Treatment then focuses on stabilizing the patient. Hospital personnel then take over, working to maintain the body fluid levels and prevent or treat infections and other complications.

Several types of TBI require surgery. Surgery may be performed within hours or days of the injury, if a blood clot causes increased intracranial pressure (ICP). Some clots must be removed; others must not be removed because of the danger of disturbing them. Subdural hematomas and intracerebral hemorrhages may also increase ICP, sometimes necessitating surgery.

During treatment, swelling in the brain (edema) is monitored and treated. Brain edema can have dire consequences, causing increased pressure inside the head (intracranial pressure or ICP). Because the skull is hard, ICP can compress or squeeze the soft brain tissue against it, preventing blood from circulating adequately in the brain tissue and causing damage to brain cells. Most edema subsides within a few days or weeks, but a few minutes or hours of excessive ICP can cause permanent damage.

To manage this condition, a device called an ICP monitor can be inserted through the skull to provide physicians with a constant pressure reading. If the ICP rises too high, medications are administered to draw fluid out of the brain and into blood vessels, decrease the brain's metabolic requirements, and increase blood flow to the injured tissues. The patient also can be placed on a ventilator to ensure an adequate supply of oxygen (hyperventilation), which is necessary to promote healing. When brain swelling is particularly severe, elevated pressure can only be relieved temporarily by surgically removing a portion of the skull. This allows swollen tissues to bulge out reducing the risk for pressure-induced damage.