Brain injury: treatment & diagnosis
Initial treatment of a brain injury
is often in the emergency department with a priority on an initial
diagnosis, stabilizing the patient's condition, and appropriate
Stabilizing a patient can include breathing assistance (e.g. the
use of ventilators) and maintaining blood circulation. Secondary
problems such as blood clotting, bleeding and brain swelling, and
oxygen supply to the brain will also be treated.
Tests & diagnosis
Once stabilized, various tests will usually be conducted to
determine the cause and extent of the brain injury, which can be
established with X-rays, Computerized Axial Tomography (CT),
Magnetic Resonance Imaging (MRI), and other tests.
The CT brain scan provides a series of X-rays at different
levels of the brain and can be used to determine whether surgery is
needed. Depending on the results of the scan the patient may be
transferred to an operating room for surgery, intensive care unit
(ICU) or a general surgical/medical ward. An MRI provides a
detailed picture of the brain without using X-rays.
Approximately half of severe brain injuries will need surgery to
remove or repair hematomas or contusions. These are often emergency
procedures. In other cases such as some brain tumours more time is
available to prepare the patient for surgery.
Prior to surgery a doctor will, when possible, seek informed
consent from the patient. Informed consent means understanding the
costs, benefits and possible adverse outcomes of surgery.
There are many tests done prior to surgery - not all of them
relate to the brain as the doctor will ensure your other organs are
capable of surviving surgery. Patients can be anxious the night
prior to surgery and have trouble sleeping - medication can be
prescribed to ensure a good night's sleep.
Intensive care unit (ICU)
Patients may be placed in the ICU if special drugs or assistance
with breathing are needed. The patient is attached to a range of
tubes and machines which can be disturbing for visitors to
The patient is often heavily sedated and may be unconscious. Pads
may cover the eyes to keep them closed and to prevent them from
drying out. If an operation was required, the patient's hair may
have been partly shaved.
If the patient is unconscious, it is generally accepted that
visitors should behave as if the person is conscious and talk to
them. Typically patients do not remember anything of their stay in
the intensive care unit.
Sometimes when the brain is injured swelling occurs and fluids
accumulate within the brain space. Because the skull restricts the
brain, this swelling can create a dangerous degree of intracranial
pressure (ICP) which can be relieved through medication, catheters
In cases where spinal injury is even suspected the patient may
be placed in a hard collar and receive special nursing care. It is
important to remember that hard collars are used as a precaution if
there is any possibility of spinal injury - it does not mean that
the patient definitely has a spinal injury.
Coma is a loss of consciousness in which patients typically do
not open their eyes, do not speak and cannot follow instructions.
In the case of a mild brain injury, the loss of consciousness, or
coma, may last for one or two minutes, while coma after a severe
injury can continue for days and, in some cases, even longer.
Patients may also be put in an induced coma if it will help with
the recovery process.
A measure called the Glasgow Coma Scale (GCS) is used to monitor
the level of coma and the patient's emergence from coma. It rates
the patient according to response to stimulation, eye opening and
ability to speak. A fully conscious person has a score of 15, a
person in profound coma has a score of 3. Usually a shorter
duration of coma and lower depth of coma (i.e. higher GCS score) is
associated with a greater degree of recovery from the
Post-traumatic amnesia (PTA)
An individual coming out of a coma doesn't just wake up, but
will go through a gradual process of regaining consciousness. This
may last for hours, days or weeks. The patient will not be able to
remember recent events, often even things that happened minutes
Individuals in PTA can be fully awake but are confused about the
time, day of the week, where they are, what is happening, and
sometimes who they are. They may be afraid, aggressive,
disinhibited, agitated and restless. If physically able, they may
wander. Too much stimulation during this time can compound the
person's confusion and distress.
In conjunction with the Glasgow Coma Scale, length of PTA is
frequently used as a guide to the severity of brain injury.
References and further information