Traumatic brain injury (TBI) has garnered more attention within the last two decades, most notably due war-related injuries and domestic acts of mass violence. What makes recent, high-profile incidents of TBI more noticeable is that better techniques in neurosurgery and neurocritical care are improving survival rates for those affected by a severe TBI.
Improved Understanding Of TBI
TBI can be grouped according to the type of injury, blunt-force, or penetrating head trauma. Blunt-force head trauma encompasses any type of head injury that does not enter the skull. Common causes of blunt-force head trauma include motor-vehicle accidents, falls, and assaults. Other types of TBI that may not neatly classify as blunt-force include coup-contracoupe injuries.
On a smaller scale, this type of injury may result in a concussion. More serious variations of coup-contracoupe injuries include shaken baby syndrome or the violent whiplash-like motion that may occur during an automobile accident. In coup-contracoupe injuries, the brain violently hits the skull resulting in two sites of injury, opposite of each other. The most common type of penetrating head trauma is a gunshot wound, but other types of projectiles can also cause a penetrating head trauma.
Anticipating Common Post-Injury Problems
The immediate concern is often bleeding. Depending on the extent of bleeding, the patient may be immediately taken into surgery to clamp bleeding vessels in the brain and remove large blood clots. If the amount of bleeding is small, the risk of waiting versus surgery is weighed. In some cases, the bleeding may not continue and surgery may cause unnecessary risks. Once bleeding is under control the next concern is brain swelling.
In the past, little could be done to manage brain swelling. Now surgeons may choose to initially remove part of the skull to accommodate brain swelling or wait to determine if any swelling will be minor. This does not always solve the problem of brain swelling, since the amount of swelling can be catastrophic or areas of the brain can swell that cannot be mitigated by removing part of the skull. The risk of infection is a concern especially with penetrating head trauma or blunt-force injuries that result in open fractures of the skull.
Specialized Facilities And Training
Many hospitals have a neuro intensive care unit (NICU) which is important for monitoring patients after acute stabilization. The NICU has more capabilities to manage the unique needs of patients with life-threatening neurological conditions than a standard ICU. Relatively new subspecialties in medicine have been important for patient care. Fellowship programs exist for neurologists, neurosurgeons, and doctors in other branches of medicine to sub-specialize in the area of neurocritical care. Such advances in both facilities and training can improve the outcomes of TBI patients. Around the clock monitoring of vitals and frequent imaging tests, such as CT scans or MRI, may be necessary to detect subtle changes in a patient's injury and whether further surgery is necessary or watchful waiting is appropriate.
Even seemingly minor incidents can result in a critical TBI. Although some incidents of TBI cause catastrophic damage, improved understanding of TBI and specialized brain condition treatment has given critically ill patients the best chance of survival.