When it comes to neurotrauma, prevention is the best medicine. Still, accidents can happen in an instant. When a patient is brought to the emergency room with a head injury, doctors will learn as much as possible about his or her symptoms and how the injury occurred. The person’s condition is assessed quickly to determine the extent of injury.
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Patients with a mild TBI or concussion usually do not require surgery. They generally need rest. Medication will sometimes be provided for headaches and, in some cases, seizures. Speech therapy and psychological support may be beneficial for some patients. Treatment depends on the type of symptoms you experience. Most symptoms, like headaches, dizziness and memory problems, are mild and and will usually go away within a few weeks. It is important to be honest about your symptoms with your healthcare provider. The UC Neurotrauma Center will coordinate care with specialists in many fields, including vestibular therapists, optometrists, speech pathologists, neurologists and others.
After a patient is discharged home they will need constant supervision for the next 24-48 hours from a loved one to watch for changes. Recovery will happen over a few weeks but can take up to a few months. Patients are encouraged to go easy on themselves as they recover.
Patients with a severe TBI often have multiple areas of primary brain injury and are at increased risk of secondary injury.
Secondary injury is an injury that occurs as a result of the body’s response to the primary injury. The inflammatory response of a brain injury causes extra fluid to collect in the brain in an attempt to heal the injury. In other areas of the body, swelling (edema) is a good response, but it can be dangerous in the brain where space is limited by the skull. The swelling causes injury to parts of the brain that were not initially injured, resulting in “secondary brain injury.”
This swelling happens gradually and can occur up to a week after the primary injury. Nurses and doctors in the neuroscience intensive care unit (NSICU) will monitor patients closely for signs of cerebral edema, or swelling of the brain tissue, by analyzing their responsiveness and exam results. The NSICU at UC Health has state-of-the-art neuromonitoring to watch and treat our patients. Neuromonitoring includes monitoring brain activity and often involves placing a monitor inside the brain. Neuromonitoring allows us to detect and treat brain pressure increases and brain oxygen level decreases.
Surgery is sometimes necessary to repair skull fractures, repair bleeding vessels or remove large blood clots.
- Craniotomy is a procedure that involves removing a section of skull bone in order to access the brain. After the intended procedure is completed the bone is replaced and secured.
- Craniectomy is the removal of a portion of the skull bone to allow room for the brain to swell. This procedure is typically done when a patient has a large amount of damage to an area of the brain and the swelling becomes life-threatening. The bone will be removed in the operating room and stored in a freezer. The swelling will slowly decrease over the next few weeks to months. Patients will require the use of a helmet for protection while the bone flap is out. Most patients will be discharged to a facility for recovery, and approximately 1-3 months later, the patient will return to the hospital to have the bone flap replaced in a procedure called a cranioplasty.
Other procedures may be necessary for a patient’s recovery. These procedures help transition their care from the Neuroscience Intensive Care Unit to an area that will focus on weaning patients from a breathing machine and starting more therapy sessions.
- Tracheotomy is a procedure that involves making a small incision in the patient’s neck to place a breathing tube into the windpipe. A ventilator, or breathing machine, will then be connected to assist the patient with normal breathing.
- Percutaneous Endoscopic Gastrostomy (PEG) Tube is a feeding tube that is inserted directly into the stomach through the abdominal wall. A small camera is placed down the patient’s throat into the stomach to aid with the procedure and to ensure correct placement of the PEG tube. This allows the patient to receive adequate nutrition until they are able to eat enough food on their own.
These procedures are not necessary for every brain injured patient, however if required they can safely be removed once a patient no longer needs their help for recovery.
The recovery process varies by patient and can be prolonged. Often after a severe TBI a patient may be different from the way they were before the injury. There are local patient support groups that might make this transition easier.
Patients with severe TBI are cared for in our 20-bed Neuroscience Intensive Care Unit (NSICU) through the UC Neurocritical Care program, which features 24-hour care from a highly trained nursing and technical staff. The NSICU was expanded and upgraded to include state-of-the-art equipment in every patient room. The latest physiologic monitoring is available, including cerebral oxygenation, continuous EEG and minimally invasive cardiac output. The NSICU also houses its own portable CT scanner which allows on-demand imaging inside the unit while eliminating the risk of moving critically ill patients to another floor.
Our neurointensivists are experts in the relatively new specialty known as neurocritical care. Their role is to coordinate and manage the critical-care needs of patients admitted to the NSICU. Patients in the NSICU typically have experienced a significant neurological event, such as a stroke or traumatic brain injury, and most have undergone neurosurgery. Because families are seldom prepared for the crisis that brings a loved one to the NSICU, they too require support and information. Neurointensivists work in the unit full-time, caring for patients, meeting with families, and overseeing research that could lead to better patient outcomes.
The UC Neurotrauma Center is served by UC Health Air Care & Mobile Care, a helicopter transport system that is nationally recognized for excellence in emergency trauma care.
Our expert physical medicine and rehabilitation team both manages inpatient rehabilitation care and coordinates outpatient follow-up care to ensure continuum of care after discharge. We work collaboratively with Daniel Drake Center for Post-Acute Care, the area’s leading long-term rehabilitation facility.
The UC Neurotrauma Center is dedicated to improving outcomes for our patients through new therapies. Patients who come to us may have the opportunity to enroll in a clinical trial that is exploring a promising new medication or therapy designed to maximize recovery or minimize damage to the brain or spinal cord following traumatic injury.
Because there is no proven medical treatment for neurotrauma, prevention is the best medicine. These tips can help prevent brain injury and head trauma:
- Always wear a seat belt.
- Always obey highway laws.
- Always wear a helmet when bicycling, skateboarding or riding a motorcycle.
- Do not talk on a cell phone or send or view text messages while driving.
- Do not drive until cleared by your doctor after having a seizure.
- Hold onto handrails when using stairs.
- Never stand on the top step of a ladder.
- Wear skid-resistant footwear in wintery weather.
- Enter unfamiliar bodies of water feet-first.
- Make sure the water is 10- to 12-feet deep when diving.