Treatment for Traumatic Brain Injury
Treatment for traumatic brain injury varies. The treatment can address the acute phase of the injury or involve surgical therapy. It can also include rehabilitative measures that help the person move forward. Some injuries are mild and respond to rest, while others require life-saving emergency measures. Since the type and intensity of traumatic brain injuries vary, let’s take a look at treatment from that perspective.Initial Treatment for Traumatic Brain Injury: Assessment
The initial assessment of a traumatic brain injury is initiated when the patient arrives at the hospital. He or she will be met by the trauma team. This team will pay close attention to the patient’s vital signs and use resuscitative measures if needed as they attempt to stabilize them. Blood tests, initial scans, and x-rays will be ordered. After diagnosis, a neurosurgeon will be called in to assist the trauma team. In addition, a general surgeon may be involved. Once stabilization is achieved, the patient will be transferred to a specialized trauma unit where they will be carefully monitored.Initial Injury and Secondary Trauma
The initial treatment for traumatic brain injury is focused on both the trauma episode and secondary harm to the brain. The initial traumatic brain injury can cause cerebral edema or swelling, injury to the tissues of the brain, intracranial bleeds, and reduced brain blood flow. Low cerebral perfusion pressure (low blood flow to the brain) is influenced by low systemic blood pressure. It is also influenced by high intracranial pressure. High intracranial pressure can be due to increased cerebrospinal fluid and swelling of brain tissue. Secondary injury is often due to low oxygen in the brain or too much carbon dioxide, low blood pressure, and high intracranial pressure. The object is to keep the secondary injuries from causing an already bad situation to get worse.How Intracranial Hypertension Is Related to a Head Injury
Intracranial hypertension can result from a serious head injury. It occurs quickly after the injury, and as the pressure rises, it can be fatal. It may be necessary to remove a piece of the patient’s skull to relieve the pressure. If the patient is using a ventilator to breathe, adjusting the settings may lower the intracranial pressure. In some cases, intravenous drugs may be used to lower the pressure. If the intracranial pressure is not reduced, the patient may suffer permanent brain damage, and this could be life-threatening.Acute Treatment for Traumatic Brain Injury
After the patient is examined by the neurosurgeon, all attempts to minimize secondary injury are undertaken. Since such injury is often caused by rising intracranial pressure, a device used to monitor this may be placed in the head, and results are sent to a recording device. There are a few risks associated with the procedure. If the patient is alert, the surgeon will explain the risk and ask for signed consent. The process can be done using local or general anesthesia.
The following are different ways to monitor the intracranial pressure:
- Subdural screw: This screw or bolt is placed through a hole that has been drilled into the skull. The screw bridges the subdural mater, which is one of three membranes that cover the spinal cord and brain to protect it. This method is used to record intracranial pressure from within the subdural space when results are needed immediately,
- Epidural sensor: This method is less invasive. The sensor is placed above the subdural space through a hole in the skull. While this method can measure and record intracranial pressure, it cannot be used to remove excess cerebrospinal fluid (CSF) if it becomes necessary.
- Intraventricular catheter: This is the most accurate method. A catheter is placed into the left ventricle of the brain. The left ventricle contains CSF. If the intracranial pressure is too high, CSF can be drained through the catheter. Even a small amount can lower the intracranial pressure.
Different classes of drugs are used to achieve sedation in the TBI patient. Their use prevents subsequent brain injury and agitation. If airway protection or ventilation assistance is required, sedative agents are used to assist in intubation. Continued sedation permits manipulation of ventilation control. Some drugs are also useful in seizure control. Common medications used to curtail or limit secondary damage are:
- Diuretics (water pills): Diuretics are used to reduce fluid levels in the body by increasing urination. If given as a treatment for traumatic brain injury, they can minimize brain pressure.
- Coma-inducing medication: A TBI patient is often placed in a temporary coma. This is done because the comatose brain does not require as much oxygen perfusion to survive. If high intracranial pressure is keeping the flow of oxygen to the brain low, this is a particularly effective maneuver.
- Anti-seizure meds: Seizures are common the first seven days after brain injury. As a treatment for traumatic brain injury, drugs that control seizures prevent this from happening and subsequent damage. If ongoing seizures are a problem, anti-seizure medications are continued.
- Spasticity control: After a TBI, disrupted brain signals can cause the muscles to tighten. This is referred to as spasticity and is common with TBI. Medications can be used to reduce this.
When family members are faced with traumatic brain injury, their focus is on the welfare of their loved one. If the TBI was caused by negligence, a personal injury lawyer could help recover damages that will take the strain of financial worries away. The lawyer can investigate the accident and determine who was at fault. He or she can interview medical experts and negotiate with the insurance company. If the insurer reneges on their obligation, your San Francisco traumatic brain injury attorney can file a personal injury lawsuit on your behalf.Surgical Treatment for Traumatic Brain Injury
Often, treatment for traumatic brain injury involves surgery. This is true of both open TBI and closed head injuries. Surgery is used for the following conditions:
- Skull fractures: A surgical procedure is often needed when the skull is fractured. This is particularly true of a depressed skull fracture. This type of fracture does not heal as well as a linear fracture. Depressed fractures are often comminuted where the bone is broken into pieces. This may result in the pieces of bone being displaced inward. Surgery is needed to extract the pieces of bone from the brain.
- Hematoma: This clot within or outside the brain causes pressure to build. To relieve the pressure, surgery is used to remove the clot. By removing the clot, the pressure is immediately lowered. This can be done by drilling a small hole in the skull and aspirating the clot. This is fairly noninvasive, but problems can occur in finding the bleed or totally draining it. The surgeon may decide to use endoscopic surgery. The same approach is taken, but an endoscope equipped with a camera is used. Another method to remove the clot uses a CT scan and is called stereotactic aspiration. This procedure is more precise.
- Bleeding: Bleeding into the brain may require surgery to stop the bleed. It can also be used to repair torn blood vessels injured by trauma. This prevents the expansion of blood in the brain.
- Excessive pressure: Sometimes, the pressure increases so much that part of the skull must be removed to relieve it. This is called a craniectomy. This is an emergency effort to save the person’s life. It can reduce intracranial pressure due to bleeding or other injuries. If it is not relieved, the pressure can cause the brain to be pushed down onto the brain stem, ending in permanent damage or death. The piece of skull is stored until the patient has recovered. Until then, a special helmet is worn to protect the area. Upon recovery, the portion of the skull that was removed and stored is replaced. This is called a cranioplasty. If the skull is not suitable for replacement, a skull implant is used. There are risks with this procedure such as infection, however, most craniectomies are successful.
Some of the complications associated with brain surgery include:
- Speech problems
- Motor weakness
- Coordination difficulties
- Vision problems
- Infection in the skull or brain
- Swelling of the brain
- Permanent brain damage
- Inflammation of the brain (meningitis)
- Brain abscess formation
- Full or partial paralysis
- Loss of awareness (vegetative state)
- Spinal infection
Concussions differ in terms of intensity. They are caused by a blow to the head and are the mildest form of traumatic brain injury. The impact results in the brain moving around in the skull. A concussion is treated mainly by rest. Headaches common with concussion respond to acetaminophen. It is best not to take aspirin or ibuprofen since both can increase the risk of bleeding. Many times, your physician will instruct you to take time off from school or work. Generally, symptoms last for about a week, however, some can persist for much longer in many people. In addition, some people can develop post-concussion syndrome where symptoms last for weeks or months or more after the initial incident. General steps you can take to improve after a concussion are:
- Avoid certain stimuli such as loud music or videos.
- Get a good night’s rest, and nap when you are tired.
- Gradually resume normal activities as directed by your doctor.
- Return to work or school when your physician says you can.
- Ask if you can start with half days or three days a week.
- Avoid alcohol.
- Don’t take medications other than those approved by your medical professional.
- Avoid flying on a plane in the period after the concussion.
- When you do return, let school authorities and your employer know you had a concussion.
- Avoid strenuous physical activity.
Watch the following video which helps explain traumatic brain injury:Rehabilitation
After treatment for traumatic brain injury, rehabilitation plays an important role. Many patients need to relearn basic skills such as talking and ambulating. The duration and type of rehabilitation differ depending on the degree of injury. It usually begins in the hospital setting and inpatient rehabilitation centers. Later, the individual continues therapy with outpatient appointments. During the rehabilitation therapy, patients see an assortment of doctors and specialists, including:
- Physiatrist: This is a physician who is trained in physical medicine. He or she oversees and manages the patient’s rehabilitation and prescribes necessary medication.
- Physical therapist: A physical therapist helps with problems involving movement such as balance and walking.
- Occupational therapist: Learning or relearning skills needed in routine activities is assisted by an occupational therapist.
- Neuropsychologist: Determining the cognitive issues and performance the patient is capable of after treatment for traumatic brain injury is the job of a neuropsychologist. This specialist will help the individual learn ways to cope and manage behavior. He or she may also help them with psychological and emotional problems.
- Speech pathologist: Learning to speak again or use devices that help with communication is assisted by a speech pathologist.
- Social worker (case manager): This team member facilitates communication between all rehabilitation team members. He or she also helps put the patient in touch with service agencies and helps plan the patient’s care.
- Nurse specialist: A nurse who is trained in all aspects of traumatic brain injury helps family members understand the recovery process and the injury.
- Recreation therapist: Leisure activities have an important place in the recovery process. This therapist assists individuals in managing time and such activities.
- Vocational counselor: In order to return to work, it is important to assess the patient’s ability to do so. The vocational counselor provides knowledge of opportunities in the workplace and assists the patient in getting back to work.
Coping with everyday life, relationships and communication can be challenging after treatment for traumatic brain injury. There are things you and your family can do to make it easier, including:
- Join a support group: Input from others who are facing the same challenges are of immeasurable help.
- Meditation: Use meditation to help you focus.
- Establish a routine: Following a routine is essential to avoid confusion. Keeping items in the same place makes it easier.
- Learn to write everything down: At first, it is vital to write things down such as names, phone numbers and even things you need to do. This helps your mind focus.
- Accommodations at work or in school: Work with people at the job site or in school to make adjustments that you may need. You would be surprised how anxious they are to help if you give them a chance.
- Incorporate breaks: You may need to take breaks at work. Talk with your employer about how this can best be accomplished.
- Eliminate distractions: It may be necessary to keep focused when doing a task. Avoiding distractions may help that happen.
- Work with a compassionate and experienced Bay Area traumatic brain injury lawyer if your injury was caused by a negligent party.
I’m Ed Smith, a San Francisco brain injury lawyer. Brain injuries can be traumatic and involve extensive medical treatment. This is compounded by financial issues such as high medical bills and lost time from work. To obtain the compensation you require and deserve, you need the help an injury lawyer can provide. Phone me at (415) 805-7284 locally or (800) 404-5400 long-distance for free and friendly advice. You can also contact me online at my website AutoAccident.com.
I belong to the Top One Percent of the National Association of Distinguished Counsel. This association allows only those attorneys who display the highest level of legal excellence in their practice. I am also a member of the Million Dollar Advocates, a forum of lawyers who have won or settled cases for over $1 million for a client.
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