Traumatic Brain Injury (TBI) Treatments
Traumatic brain injury (TBI) is physical harm to the brain (lacerating, stretching or compressing of brain tissue) caused by a sudden and violent outside force. The force may take the form of a penetrating object (e.g., a bullet), a blow to the head or the head striking an object.
Often, TBI injuries require long-term medical care, and the costs associated with this care can be exorbitant. When another party is at fault or partly at fault for a head injury, people harmed may be eligible for compensation. If you think your TBI injuries or those of a loved one were caused by someone else's negligence, a personal injury attorney can help you determine your legal rights, provide you with examples of settlements, and discuss with you the possibility of filing a lawsuit seeking compensation for your suffering.
In this article you will find information about traumatic brain injury treatment. TBI treatment depends on the nature and severity of injuries. Nevertheless, it can be understood as a process which includes the following stages: initial treatment, primary injury treatment, secondary injury treatment and rehabilitation.
Initial traumatic brain injury treatment aims to stabilize the patient. Clearing airways, providing ventilation to the lungs, restoring heart function and controlling blood loss are key to the prevention of hypoxia (oxygen deficiency) and hypotension (low blood pressure), which can quickly end in death.
Primary Injury Treatment
Treatment of primary injuries includes addressing medical problems caused by structural damage to the brain and managing intracranial pressure (ICP).
Medical problems may include:
- Skull fracture (a break in the bone)
- An object (bullet, knife, etc.) penetrating the brain
- Hematoma (formation of blood clots)
- Hemorrhage (bleeding)
- Contusions (bruising)
- Concussion (transient brain function failure)
- Diffuse axonal injury (nerve fiber damage)
Structural damage often leads to increased intracranial pressure (ICP), which, if not properly managed, can lead to secondary injuries. ICP occurs because the skull, which houses the brain, is an unyielding structure and can only tolerate small amounts of added volume, such as the buildup of fluid (blood, cerebrospinal fluid, etc.) and swollen brain tissue. When ICP exceeds normal levels, brain tissue compresses, causing secondary injury.
ICP may also interfere with normal blood flow to the brain. Under ordinary circumstances, proper blood flow to the brain is maintained by a combination of blood pressure and automatic artery contraction and dilation. However, in the presence of ICP, automatic contracting and dilating is thwarted, leading either to increased blood flow and therefore increased ICP and increased potential for brain tissue compression or reduced blood flow (ischemia), which can lead to brain tissue death.
Treatment of Skull Fractures. Most skull fractures require no intervention. However, surgery may be used to raise a depression in the skull, to remove splintered bone fragments from brain tissue or to remove part of the skull where underlying swelling is excessive and ICP is elevating. Where bone has been removed, plastic will be substituted at a later date. Antibiotics and immunization against tetanus are administered after surgery. Anticonvulsants may be prescribed to prevent seizures.
Treating an Open Head Injury. In the case of an open head injury, surgery is used to remove a penetrating object from brain tissue along with necrotic (dead) tissue and areas of infection. Afterward the wound is thoroughly flushed and antibiotics and tetanus immunization are given. Anticonvulsants may also be prescribed to victims of an accidental open head injury.
Treating a Hematoma. A hematoma, caused by a torn blood vessel(s), is the accumulation of clotty blood between the surface of the brain and the membranes surrounding the brain or between the membranes themselves. Anticoagulants may be used in some circumstances, though this is a matter of controversy. When an expanding hematoma causes ICP and threatens to cause additional brain damage, the clotted blood is drained. This is accomplished either by drilling a tiny hole in the skull and drawing out the clot(s) or, when the clots are too thick, by performing a craniotomy (removing a portion of the skull). Later, the missing portion of the skull is replaced by plastic. After surgery, an anticonvulsant may be prescribed to reduce the chances of a seizure.
Treating a Hemorrhage. Clotting agents may be used to control bleeding under some circumstances. In other situations, surgery may be required to repair or remove damaged structure(s) (blood vessels, large contusions, etc.) that are causing the bleeding. In addition, depending on where the bleeding is occurring, a catheter may be inserted to drain blood buildup. Where blood loss is extensive, a blood transfusion may be warranted. Anticonvulsant medicine also may be prescribed.
Treating a Contusion. A contusion is a bruise (area of broken blood vessels) on the brain. Most contusions are not helped by medical intervention. However, when contusions are so large or become so large that they dangerously increase ICP and threaten to cause additional injury to the brain, they may need to be surgically removed.
Treating a Concussion. A concussive brain injury, also referred to as mild traumatic brain injury (MTBI), does not involve structural damage to the brain. Concussions are treated with bed rest, nutritious food, plenty of liquid and, if necessary, a mild pain reliever. In addition, the patient is warned against risking a second head injury while recovering. A second concussion can cause permanent brain damage or death. A follow-up visit to a physician is recommended after all symptoms have subsided (approximately two weeks after injury) before reengaging in normal physical activities.
Postconcussive syndrome (PCS) may occur in some individuals. This condition, which is characterized by persistent symptoms such as headache, upset stomach, blurred vision, ringing in the ears and depression, may last as long as 12 months or, in some cases, indefinitely.
Treatment for PCS largely has been confined to prescribing rest and various pharmaceuticals to address symptoms, headache and depression in particular. Recently, however, researchers at the University of Buffalo have introduced a carefully monitored exercise program that is proving beneficial in eliminating persistent symptoms, especially among athletes. Ongoing research aims to understand why and how this method works.
Treating Diffuse Axonal Injury (DAI). A diffuse axonal injury (DAI) is harm done to nerve fibers. There is no treatment to repair DAI. However, a sedative and medicine to reduce brain swelling may be given.
Secondary Injury Treatment
Secondary injury treatment for an open or closed head injury begins with therapies to prevent or minimize their severity. This may include maintaining proper ICP, lung ventilation, blood pressure and blood sugar, and providing appropriate intravenous fluids, nutrition, vitamins and electrolytes, such as potassium and magnesium.
Despite best efforts, conditions leading to secondary injuries may develop. Among others, they may include ischemia, edema, hydrocephalus, infection, vasospasm and epilepsy. These are addressed in the following ways:
- Ischemia. Ischemia (restricted blood flow to parts of the brain) is treated by maintaining proper ICP and ensuring sufficient blood circulation by manipulating blood volume and pressure.
- Edema. Edema (swollen brain tissue due to increased water content) is treated with diuretics, electrolytes and intravenous fluids to prevent dehydration.
- Hydrocephalus. Hydrocephalus, which is a buildup of fluid (a combination of blood and cerebrospinal fluid) inside the brain, may be treated by inserting a tube (shunt) through the skull and into the inner chambers of the brain to drain off excess fluid. The overflow then is diverted into the abdomen or some other body cavity, where it can be absorbed.
- Infection. An infection (abundance of harmful bacteria) often is successfully treated with antibiotics. Large pockets of abscess may need to be surgically removed.
- Vasospasm. Vasospasm (uncontrollable narrowing or contracting of blood vessels) is treated intravenously with large amounts of medicated fluid. The goal of this therapy is to thin the blood, increase the amount of blood and raise blood pressure so that blood can be circulated despite blood vessel malfunction.
- Epilepsy. Epilepsy (seizure) often is controlled with seizure medications. When epilepsy is resistant to medication, surgery to remove the part of the brain responsible for the seizures may be in order. A vagus nerve stimulator (VNS) may be implanted in some individuals. The VNS sends periodic signals to the vagus nerve in the neck in an effort to manage unpredictable bursts of electrical energy that produce seizures.
Once physical injuries are stabilized, traumatic brain injury patients are evaluated and recommended for a program of rehabilitation. The goal of traumatic brain injury rehabilitation is to help patients recover as many brain functions (cognitive, language, motor, sensory, planning and decision-making) as possible and reenter society. Rehabilitation programs are designed to meet patients' individual needs. Multidisciplinary approaches are common and may include, among others:
- Psychotherapy, which addresses depression and behavior problems associated with TBI
- Physical therapy, which uses exercise, stretching, massage, heat, etc., to strengthen and extend the range of motion of various parts of the body, for example arms and legs, and improve mobility
- Speech therapy, which helps TBI patients relearn language skills
- Occupational therapy, which teaches patients how to once again do normal, daily activities, such as taking a bath and getting dressed. Occupational therapy may also involve teaching patients new job skills
Patients with severe brain damage, for example coma, may require long-term or permanent, full-time care.
If you believe you or a loved one has suffered a traumatic brain injury as a result of another person's carelessness, contact local attorneys near you to discuss the possibility of reaching a settlement with those responsible. Alternatively, you may be able to file a lawsuit seeking compensation for your losses.
Approximately 5.3 million people in the United States have TBI-related disabilities.
Source: Centers for Disease Control and Prevention (CDC).