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Treatment and Diagnosis of Brain Injury - Fact Sheet
When a brain injury occurs
and medical attention is required, the initial place of treatment is likely to
be the emergency department of a hospital. The priority of care is to make an
initial diagnosis, stabilise the patient’s condition and arrange for
appropriate treatment.
Stabilisation
includes providing respiration (breathing assistance which may require the use
of ventilators) and maintaining blood circulation. Medical staff will also
attend to secondary problems that arise from the injury, such as blood
clotting, bleeding and brain swelling, and they will ensure that the oxygen
supply to the brain is maintained. The treatment team caring for the patient at
this point can be expected to involve emergency medical and nursing staff
including the neurosurgical registrar and neurosurgical consultant.
Tests
X-rays,
Computerised Axial Tomography (CT),  Magnetic Resonance Imaging (MRI), and other
tests may be performed to establish the nature and extent of the patient’s
injuries. 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, but is more
expensive.
Surgery
Approximately
half of severely head-injured patients will need surgery to remove or repair
haematomas 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.
Pre-surgery
Prior to
surgery your doctor will, when possible, seek informed consent from you.
Informed consent means that you understand the costs, benefits and possible
adverse outcomes of surgery. In an effort to fulfil their legal obligations
some doctors will describe a long list of all the potential disasters that
might occur during and after surgery. This can be frightening to say the least
so be aware that you can tell your doctor how much or how little information
you want.
There are a
myriad of tests to be done prior to surgery and not all of them are specific to
your brain. Your doctor needs to be sure that your other organs are capable of
surviving surgery so an examination of your heart and lungs as well as blood
tests is common.
The night
before your surgery you may be feeling anxious or frightened, possibly
experiencing some difficulty sleeping. If you are feeling anxious or feel you
will need medication to help you sleep, tell the nursing staff.
Surgery
On the day
of your surgery you will be wheeled in your bed from the ward to the operating
theatre where the nurses will double or even triple check everything from your
name to any allergies you may have.
You may
also notice that operating theatres are quite cold. If you feel cold say so and
a nurse can get you a heated blanket.
Next comes
your meeting with the anaesthetist who will give you some intravenous
medication that will send you to sleep.
Post-surgery
The next
thing you know the operation is over and you are either in the recovery room or
in the intensive care unit.
It is
common for people to experience headache immediately after brain surgery and
you should notify the recovery nurses immediately if you are in pain.
The
recovery room is attached to the operating theatre and you will be kept there
until you are awake enough to be transferred back to the ward
Intensive Care
It may be
necessary for the patient to go to an intensive care unit (ICU) if special
drugs or assistance with breathing are required. Here the patient is attached
to a range of tubes and machines. This may be disturbing for visitors to view.
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. The patient’s
breathing may be assisted by a Ventilator and the patient will be unable to
speak. Visitors are often unsure of how to behave but it is generally accepted
that you should talk to the person and behave as if the person is conscious. It
is not known if the patient can hear or understand what is going on.
Typically
patients do not remember anything of their stay in the intensive care unit.
Brain Swelling
After any
surgery, it is not unusual, at first, to feel worse than you did before. This
can be depressing if you are not prepared for it. You have just had brain
surgery. That is a lot for your body to cope with. The post-op swelling means
it will be a while before you feel the benefit from your surgery.
Sometimes
when the brain is injured swelling occurs and fluids accumulate within the
brain space. It is normal for bodily injuries to cause swelling and disruptions
in fluid balance. But when an injury occurs inside the skull-encased brain,
there is no place for swollen tissues to expand and no adjoining tissues to
absorb excess fluid. This leads to increased intracranial pressure (ICP). High
ICP can cause delicate brain tissue to be crushed, or parts of the brain to
herniate across structures within the skull, causing severe damage.
Spinal Injuries
In cases
where spinal injury is even suspected the patient may be placed in a Hard Collar
and receive special nursing care to prevent further injury to the spine. It is
important to remember that hard collars are used if there is any possibility of
spinal injury. Hard collars are used as a precaution and do not mean that the
patient 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.
Glasgow
Coma Scale
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 injury. However, patients who have
been in a coma for a long time tend to experience varying levels of recovery
with some patients improving beyond the level that was initially expected.
An
individual coming out of a coma doesn’t just wake up, but will go through a
gradual process of regaining consciousness. This stage of recovery is called
Post Traumatic Amnesia (PTA) and may last for hours, days or weeks. In this
stage, an individual will not be able to store continuous or recent memory,
such as what happened just a few hours or even minutes ago. Individuals in PTA
are partially or fully awake, but are confused about the day and time, where
they are, what is happening and sometimes who they are. They may be afraid,
physically and verbally aggressive, disinhibited, agitated and restless. If
physically able, they may wander. They may have hallucinations and delusional
beliefs such as an adult believing he or she is a child. It is important to
remember that this behaviour is due to the brain injury and that 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. A commonly used interpretation of the
scale involves the following:
Further Information
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Treatment and diagnosis of brain injury 
