Types of Brain Injuries

TYPES OF BRAIN INJURIES

Minor and Moderate Head Injury

The patient would be assessed as described above. Any patient who has suffered a head injury must be observed for at least 4 hours. The following are the minimum criteria for obligatory admission to hospital:

· Loss of consciousness (post-traumatic amnesia) of greater than 10 minutes

· Persistent drowsiness

· Focal neurological deficits

· Skull fracture

· Persisting nausea or vomiting after 4 hours’ observation

· If the patient does not have adequate care at home

The further management of these patients will be careful observation; the neurological observations should be recorded on a chart displaying the features of the Glasgow coma scale. If there has been a period of significant loss of consciousness, or if the patient is drowsy, then the following measures should be instituted to minimize the development of cerebral swelling:

· Head of the bed elevated 20⁰

· Mild fluid restriction to 2-2.5 litres per day in an adult

Should the patient’s neurological state deteriorate an immediate CT scan is essential to re-evaluate the intracranial pathology; further treatment will depend on the outcome.

Severe head injury

The management of a patient following a severe head injury depends on the patient’s neurological state and the intracranial pathology resulting from the trauma. In general, the following apply:

1. The patient has a clinical assessment and CT scan as described previously.

2. If the CT scan shows an intracranial haematoma causing shift of the underlying brain structures then this should be evacuated immediately.

3. If there is no surgical lesion, and following the operation, the management consists of:

a. Careful observation suing a chart with the Glasgow coma scale.

b. Measures to decrease brain swelling, these include:

i. Careful management of the airway to ensure adequate oxygenation and ventilation. Hypercapnia will cause cerebral vasodilation and so exacerbate brain swelling.

ii. Elevation of the head of the bed 20⁰

iii. Fluid and electrolyte balance