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Treatments and drugs
By Mayo Clinic staffMild traumatic brain injuries usually require no treatment other than rest and perhaps over-the-counter pain relievers if you have a headache. More-severe brain injuries usually require hospitalization and often need intensive care.
Emergency care for traumatic brain injury focuses on preventing the brain damage from getting any worse. The main problem is that injured brain tissue tends to swell, and there's a finite amount of space inside the skull. If blood vessels were torn during the initial injury, pooled blood or clots take up even more of the confined space.
As the pressure increases inside the skull, brain tissue and the blood vessels that feed the brain get squeezed. The pressure alone can harm brain tissue, but damage can also occur if compressed blood vessels can't supply the brain's cells with food and oxygen. Serious brain injuries may also lead to very low blood pressure, which further reduces the amount of blood reaching brain tissue.
Medications
- Diuretics. These types of drugs reduce the amount of fluid in tissue and increase urine output. Unlike the "water pills" heart patients may take to reduce blood pressure, the diuretics used for traumatic brain injuries are administered intravenously. The most common diuretic used for brain swelling is mannitol, but some studies indicate that certain concentrations of saline solution may work just as well — particularly in children.
- Anti-seizure drugs. People who've had a moderate to severe traumatic brain injury are at higher risk of having seizures during the first week after their injury. Some doctors recommend taking an anti-seizure drug during that first week, to avoid any additional brain damage that might be caused by a seizure.
- Coma-inducing drugs. Doctors sometimes deliberately use drugs to put people into temporary comas because a comatose brain needs less oxygen to function. This is especially helpful if compressed blood vessels are unable to deliver the usual amount of food and oxygen to brain cells.
Therapy
Most people who have had a significant brain injury will require rehabilitation. They may need to relearn basic skills, such as walking or talking. The overall goal is to improve their abilities to function at home and in the community.
Therapy usually begins in the hospital. When you're well enough to leave the hospital, you may be transferred to a residential treatment facility to receive intensive training for weeks or months. Outpatient services also are available.
The type of rehabilitation needed varies by individual, depending on the severity of the brain injury and what part of the brain was injured. Therapy focuses on regaining lost skills and learning ways to compensate for abilities that have been permanently changed.
Surgery
A portion of the scalp is shaved prior to brain surgery, then a flap of skin is cut and folded back and a section of skull is removed so that the surgeon can access the brain.
- Removing clotted blood (hematomas). Many people who have traumatic brain injuries are taken straight from the emergency department to the operating room for removal of large deposits of clotted blood trapped between the skull and the brain. This reduces the pressure inside the skull and helps prevent additional brain damage.
- Repairing skull fractures. Many skull fractures heal on their own, but repairs are needed if any portion of the skull is pressing into the brain.
- Opening a window in the skull. If the pressure inside the skull cannot be controlled by any other means, one surgical option is to create an opening in the skull and leave it open until the swelling subsides — which usually happens within just a few days.
