Traumatic Brain Injury Treatment -Procedures, Side effects, Recovery time, Costs and alternatives

Traumatic brain injury is an injury of the brain which is caused by a massive blow to the head of the person. This injury tends to penetrate through to the head thereby causing disruption of usual functioning of the brain. This injury can also be termed as intracranial injury. Traumatic brain injuries are classified on the basis of the severity and the impact of the injury on the brain. In traumatic brain injury often the skull of the patient gets damaged. The after effect of traumatic brain injury includes physical, social, emotional, behavioral and cognitive changes. When normal brain injury happens to a person then he/she may lose consciousness. But in case of traumatic brain injury, a patient might be in a state of unconsciousness for more than 6 hours.

Some of the events that may cause a traumatic brain injury include:

• Falling from a ladder, while bathing, from the staircase and several other falls are the most common cause of traumatic head injury occurring in a house of a person.
• Outside the house, the major cause of traumatic brain injury includes the accidental collisionof vehicles.
• Gunshot to the head can also cause traumatic brain injury.
• Traumatic brain injuries can also occur in sports like a hard cricket ball hitting the head of a player, extreme sports like a car or bike races, and boxing.

A severe traumatic brain injury can bring several permanent changes to the state of consciousness of a person like a person may go into a coma, can be brain dead, and if the damage is widespread then a person may go into a vegetative state. After a traumatic brain injury, a patient may develop hydrocephalus (fluid building up in the brain), infections of the brain like meningitis, convulsions, damage to the blood vessels of the brain. Traumatic brain injuries may also lead to paralysis of the patient, swallowing problem, speech problem, loss reasoning, judgment, and memory. Other after-effects of traumatic brain injury include loss of self-control, anxiety, depression, anger, and difficulty in identifying objects.

The treatment for traumatic brain injury includes surgical procedures, medications, and several rehabilitation therapies. The course of the treatment shall depend on the patient condition and the doctor shall chose the course of treatment by examining the patient through physical examination and through the insights provided by CT scan and MRI scan.

A patient suffering from a mild traumatic brain injury may get treated with just rest and some pain relieving medications.

However, in cases of severe traumatic injury, a patient may have to undergo the following treatment procedure:

Emergency care: At first the doctor tries to stabilize the condition of the patient to enhance the chances of survival of the patient. A patient may be stabilized by making sure sufficient oxygen is reaching the brain, reducing the blood loss of the patient, and controlling the blood pressure. Once the patient is stabilized then an emergency surgical procedure is conducted by the doctors. The surgical procedure would be done for removing the hematomas (blood clots) as bleeding both within and outside the brain causes a hematoma which can indirectly put excessive pressure of the brain. Then the damaged bones of the skull would be either repaired or removed. Steps would be taken to stop the flow of blood. The surgery would also drain out the cerebral spinal fluid that gets accumulated for releasing the pressure inside the skull of the patient.

1. Medications: Once the surgical procedure is complete the patient is given medications like :
   • Anticonvulsants: the patients that have undergone traumatic brain injury are at an increased risk of experiencing a seizure. Usually, the seizures occur within the first week after the occurrence of injury.
   • Diuretic: this medicine is initially given intravenously as it is helpful reducing the excessive fluids that get accumulated within the brain after injury. This reduces the pressure on the brain.
   • Anticoagulants: these medications are given to prevent the formation of blood clots.
   • Anti-anxiety medications: these are given for reducing the feeling of fear and nervousness.
   • Stimulants would be given for enhancing alertness in the patient.
2. • Rehabilitation therapies: the after-effects of traumatic brain injury can so damaging that a patient might be required to relearn some basic skills like walking, speaking and swallowing. The rehabilitation therapies usually begin at the hospital but are continued after the patient is discharged from the hospital. The rehabilitation therapies include
   • Occupational therapy: in this patient learns to perform daily activities.
   • Speech therapy: this helps the patient in speaking and swallowing.
   • Physiotherapy: in this therapy functionality and coordination of the muscles that get affected after the injury are worked upon
   • A patient may also undergo psychological, vocational and cognitive therapy for the betterment of their condition.
   • Surgeries: Surgery is carried out in case of emergency surgery so as to minimize additional damage to brain tissues. Surgery are performed for removing clotted blood also known as hematomas, for repairing skull fractures, to avoid bleeding in the brain and opening a window in the skull. so as to relieve pressure inside the skull.

A patient is eligible for the treatment of traumatic brain injury when the following conditions are satisfied:

• A patient is suffering from severe trauma to the head either because of an accident or any other cause.
• If after the injury of the head the patient loses his/her consciousness.
• There is severe bleeding from the site of the injury.
• Due to injury, the brain of the patient is not getting enough oxygen.
• If after the injury the patient suffers from conditions like paralysis, a problem in speaking and swallowing.
In the majority of the cases a severe blow to the head leading to loss of consciousness and bleeding is sufficient enough to make a patient eligible for treatment.

The eligibility of a patient for the treatment of traumatic brain injury depends upon the diagnosis of the doctor. A patient suffering from a minor head injury like a bump on the head is not eligible for treatment of traumatic brain injury. In the majority of the cases there are no patients who are not eligible for the treatment of this condition if a severe head trauma is being experienced by them.

Treatment given to a patient to provide relief from any condition has its share of side effects associated with it. Not only the treatment through medications has side effects but a treatment through surgical procedures also involves some side effects. A minor side effect experienced usually goes away after sometime while a patient experiencing a serious side effect may require emergency medical attention. In patients suffering from traumatic brain injury, the emergency surgical procedure may have the following side effects

• Surgical site infection
• Excessive loss of blood
• Severe pain in the head
• Some nerves of the brain may get damaged

The medications used for treating the after-effects of the traumatic brain injury have their share of side effects. The side effects associated with the use of diuretic include electrolyte imbalance, increased thirst, cramping of muscles, and dizziness. The side effects associated with anticonvulsants are sleepiness, fatigue, tremors, allergic reaction, and nausea. The sideeffects of anticoagulants are blood vomiting, passing of blood in urine, extensive bruising, and weakness.

The side effects of antianxiety medications are inclusive of insomnia, weight gain, nausea, restlessness, drowsiness, and loss of libido. In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialist immediately.

The post-treatment guideline is a list that contains what a patient is required to do after the treatment and what activities are restricted. The post-treatment guideline helps in the recovery of the patient. If the patient or the attendant of the patient follows the post-treatment guidelines religiously then the chances of reoccurrence of the condition are prevented. Some of the post- treatment guidelines to be followed after traumatic brain injury treatment are:

• A complete course of antibiotic must be done by the patient.
• The pain medications must be taken as advised by the doctor.
• The dressing of the surgical site must be done through sterile bandages.
• Proper hygiene must be maintained.
• All the therapies like physiotherapy and speech therapy must continue as advised by the doctor.
• If any slight discomfort is experienced by the patient then it must be informed to the doctor immediately.

The recovery of the patient from traumatic brain injury is based on the severity of the injury suffered by the patient thus it varies from patient to patient. No one can attempt to predict how long it will take a patient to recover. In minor cases, it may take a few months but in severe cases, the recovery can take several years. The recovery of the patient also depends upon the type of disability experienced by a patient and the age of the patient.

The cost of the emergency surgical procedure in treating traumatic brain injury is approximately 35,000 rupees per patient. This cost may vary based on the location of the hospital and the experienced surgeon who is conducting the surgery. The cost of the medicines like diuretics, anticonvulsants, antianxiety and anticoagulants ranges from 100 to 500 rupees. The cost of rehabilitation therapies like physiotherapy and speech therapy may vary based on the cities and experience of the therapists. The cost of entire treatment in case of traumatic brain injuries may cost lakhs of rupees.

The results of the treatment are never permanent when a patient suffers from traumatic brain injury. After the occurrence of injury, the majority of the patients may suffer from disabilities like paralysis of either complete body or some body parts. The patients after injury start experiencing seizures which are recurrent. Frequent visits are required to be made to the doctor’s clinic for recovering from the after-effects of the injury.

A patient may opt for some alternative modes of treatment from the traumatic brain injury. A patient may opt for acupuncture or acupressure techniques for overcoming the motor deficits and disabilities. A patient may use various herbal supplements that improve the overall condition of the patient.