Many factors, including the size, severity, and location of the brain injury, influence how a TBI is treated and how quickly a person might recover. One of the critical elements to a person’s prognosis is the severity of the injury. Although brain injury often occurs at the moment of head impact, much of the damage related to severe TBI develops from secondary injuries which happen days or weeks after the initial trauma. For this reason, people who receive immediate medical attention at a certified trauma center tend to have the best health outcomes. Show Treating mild TBIIndividuals with mild TBI, such as concussion, should focus on symptom relief and “brain rest.” In these cases, headaches can often be treated with over-the-counter pain relievers. People with mild TBI are also encouraged to wait to resume normal activities until given permission by a doctor. People with a mild TBI should:
Even after symptoms resolve entirely, people should return to their daily activities gradually. Brain functionality may still be limited despite an absence of outward symptoms. Very little is known about the long-term effects of concussions on brain function. There is no clear timeline for a safe return to normal activities although there are guidelines such as those from the American Academy of Neurology and the American Medical Society for Sports Medicine to help determine when athletes can return to practice or competition. Further research is needed to better understand the effects of mild TBI on the brain and to determine when it is safe to resume normal activities. Preventing future concussions is critical. While most people recover fully from a first concussion within a few weeks, the rate of recovery from a second or third concussion is generally slower. In the days or weeks after a concussion, a minority of individuals may develop post-concussion syndrome (PCS). People can develop this syndrome even if they never lost consciousness. The symptoms include headache, fatigue, cognitive impairment, depression, irritability, dizziness and balance trouble, and apathy. These symptoms usually improve without medical treatment within one to a few weeks but some people can have longer lasting symptoms. In some cases of moderate to severe TBI, persistent symptoms may be related to conditions triggered by imbalances in the production of hormones required for the brain to function normally. Hormone imbalances can occur when certain glands in the body, such as the pituitary gland, are damaged over time as result of the brain injury. Symptoms of these hormonal imbalances include weight loss or gain, fatigue, dry skin, impotence, menstrual cycle changes, depression, difficulty concentrating, hair loss, or cold intolerance. When these symptoms persist 3 months after their initial injury or when they occur up to 3 years after the initial TBI, people should speak with a health care provider about their condition. Treating severe TBIImmediate treatment for the person who has suffered a severe TBI focuses on preventing death; stabilizing the person’s spinal cord, heart, lung, and other vital organ functions; and preventing further brain damage. Persons with severe TBI generally require a breathing machine to ensure proper oxygen delivery and breathing. During the acute management period, health care providers monitor the person’s blood pressure, flow of blood to the brain, brain temperature, pressure inside the skull, and the brain’s oxygen supply. A common practice called intracranial pressure ICP monitoring involves inserting a special catheter through a hole drilled into the skull. Doctors frequently rely on ICP monitoring as a way to determine if and when medications or surgery are needed in order to prevent secondary brain injury from swelling. People with severe head injury may require surgery to relieve pressure inside the skull, get rid of damaged or dead brain tissue (especially for penetrating TBI), or remove hematomas. In-hospital strategies for managing people with severe TBI aim to prevent conditions including:
People with TBIs may need nutritional supplements to minimize the effects that vitamin, mineral, and other dietary deficiencies may cause over time. Some individuals may even require tube feeding to maintain the proper balance of nutrients. Following the acute care period, people with severe TBI are often transferred to a rehabilitation center where a multidisciplinary team of health care providers help with recovery. The rehabilitation team includes neurologists, nurses, psychologists, nutritionists, as well as physical, occupational, vocational, speech, and respiratory therapists. Cognitive rehabilitation therapy (CRT) is a strategy aimed at helping individuals regain their normal brain function through an individualized training program. Using this strategy, people may also learn compensatory strategies for coping with persistent deficiencies involving memory, problem solving, and the thinking skills to get things done. CRT programs tend to be highly individualized and their success varies. A 2011 Institute of Medicine report concluded that cognitive rehabilitation interventions need to be developed and assessed more thoroughly. Other factors that influence recoveryGenesEvidence suggests that genetics play a role in how quickly and completely a person recovers from a TBI. For example, researchers have found that apolipoprotein E ε4 (ApoE4) — a genetic variant associated with higher risks for Alzheimer’s disease — is associated with worse health outcomes following a TBI. Much work remains to be done to understand how genetic factors, as well as how specific types of head injuries in particular locations, affect recovery processes. It is hoped that this research will lead to new treatment strategies and improved outcomes for people with TBI. AgeStudies suggest that age and the number of head injuries a person has suffered over his or her lifetime are two critical factors that impact recovery. For example, TBI-related brain swelling in children can be very different from the same condition in adults, even when the primary injuries are similar. Brain swelling in newborns, young infants, and teenagers often occurs much more quickly than it does in older individuals. Evidence from very limited CTE studies suggest that younger people (ages 20 to 40) tend to have behavioral and mood changes associated with CTE, while those who are older (ages 50+) have more cognitive difficulties. Compared with younger adults with the same TBI severity, older adults are likely to have less complete recovery. Older people also have more medical issues and are often taking multiple medications that may complicate treatment (e.g., blood-thinning agents when there is a risk of bleeding into the head). Further research is needed to determine if and how treatment strategies may need to be adjusted based on a person’s age. Researchers are continuing to look for additional factors that may help predict a person’s course of recovery. What are the types of traumatic brain injury medications?Medications administered for traumatic brain injuries depend on the type of injury, its severity and resultant functional impairment. Medications also vary depending on the stages of treatment, which include the acute phase of treatment immediately after the injury, and long-term management of chronic symptoms. The types of TBI medications include the following: Acute care medicationsLong-term management medications
How do traumatic brain injury medications work?Acute care medicationsOsmotic diureticsOsmotic diuretics work by decreasing the brain’s water content, which is drained and excreted in the urine. Osmotic diuretics are used for a short period during acute care to reduce the edema and intracranial pressure. Osmotic diuretic used for TBI treatment is:
AnticonvulsantsAnticonvulsant medications are administered to prevent seizures. TBI can result in excessive release of brain chemicals (neurotransmitters) which overstimulate the neurons resulting in seizures and secondary injury to the brain. Anticonvulsants used in TBI treatment include: ElectrolytesTraumatic brain injury can lower electrolyte levels which can adversely affect heart function and blood pressure. Magnesium improves blood flow to the brain and also plays a role in preventing overstimulation of the neurons by inhibiting an excitatory neurotransmitter known as glutamate. Electrolytes administered after a TBI include:
N-methyl-D-aspartate (NMDA) receptor antagonistsN-methyl-D-aspartate (NMDA) receptor antagonists reduce the hyperactivity of neurons and prevent secondary injury to the brain. Glutamate and another excitatory neurotransmitter known as aspartate, both of which are released after an injury, stimulate the NMDA receptors causing abnormal neuronal activity. NMDA receptor antagonists block the activity of NMDA receptors. NMDA receptor antagonist commonly prescribed after a TBI is:
BarbituratesBarbiturates which have sedative and anticonvulsant properties may be administered if other methods to lower the intracranial pressure are not effective. Barbiturates may also be administered to induce a medical coma in patients with severe brain injury. Barbiturates used in TBI treatment include:
Calcium channel blockersCalcium channel blockers help prevent blood vessel spasms and maintain blood supply to the brain. Calcium channel blockers have been found to be useful in preventing secondary damage after subarachnoid hemorrhages. The commonly used calcium channel blocker in TBI treatment is:
StimulantsStimulants help improve some aspects of cognitive functions such as alertness and attention, by increasing the levels of neurotransmitters such as norepinephrine and dopamine. Stimulants used in TBI treatment include:
Dopamine agonistsDopamine agonists stimulate the release of dopamine which helps improve alertness. An example of dopamine agonist used in TBI treatment is: Selective serotonin reuptake inhibitors (SSRIs)SSRIs increase the level of serotonin, a neurotransmitter that regulates mood. SSRIs are administered to treat emotional disturbances that can occur after a TBI. Examples of SSRIs used in TBI include: AntipsychoticsAntipsychotic medications are prescribed to treat psychosis and other mental conditions that can result from a TBI. A commonly prescribed antipsychotic medication is:
Muscle relaxersMuscle relaxers are used to relax muscle cramping and tightening because of injury to motor neurons in the brain. Commonly prescribed muscle relaxers include: Pain relieversPain relievers used for management of pain from TBI include: Your doctor should be consulted about the best choice of pain medicine to use, depending on the type of TBI. Some pain medicines may exacerbate bleeding in the brain. Additional information
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What is the best treatment for traumatic brain injury
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