Head trauma: how is it treated?

We spoke to Dr Andre Mochan, neurologist at Netcare Rehabilitation Hospital in Auckland Park, about the complexities of treating traumatic brain injuries.

How are brain injuries categorised?

Brain injuries are categorised according to whether the injury is an open (penetrating) or closed trauma and according to the severity of the brain trauma, which could range from a concussion to a more severe contusion. There are also varying types of bleeding or haemorrhage within and around the brain that could cause focal rain damage.

Image courtesy stock.xchnge (Kurhan)

Aside from physical factors, what other consequences are there to a traumatic brain injury?

The physical functions affected could be motor, sensory and visual deficits; moreover, there may be language/speech problems and a multitude of cognitive deficits affecting higher functions, like memory, abstract thinking and reasoning, as well as emotional and personality changes. Head injury may also result in chronic headaches, poor concentration and post-traumatic epilepsy.

Why would a person’s body temperature be reduced to help recovery?

Brain damage occurs as a result of damage to brain cells. When the body is cooled down, these cells demand less energy and can therefore survive stress or trauma easier.

What happens when there is too much intracranial pressure?

Brain injury, like injury to any other body part, leads to swelling. The problem with brain swelling is that the brain is enclosed by the skull, so there isn’t space to accommodate much swelling. This consequently leads to a build-up of pressure, which itself causes further damage to brain tissue. This may ultimately lead to a vicious cycle, with more cell injury causing more swelling and the swelling causing more cell injury. If this cycle cannot be stopped it will lead to brain death.

What do doctors usually do to prevent this?

Standard measures that are taken include certain medication, ventilation techniques, head position manipulations and hypothermia (cooling). Intracranial pressure can be measured and monitored quite easily, and this is done routinely in cases of severe traumatic brain injuries.

What types of rehabilitation therapies are done with someone with a traumatic brain injury?

Persons who have suffered a traumatic brain injury undergo neuro rehabilitation, which involves therapy rendered by a multidisciplinary team comprising an occupational therapist, a physiotherapist, speech therapist, social worker, neuropsychologist, clinical psychologist, together with medical services provided by doctors, including neurosurgeons, neurologists and rehabilitation specialists and specialised nursing care.

Integrated rehabilitation comprising all of the above services is offered at dedicated acute rehabilitation facilities. The rehabilitation process starts as soon as the patient is medically stable and could take months or even years, depending on the severity of the brain injury.

Picture: Stock.xchnge

What factors or symptoms would make doctors think that a patient’s prognosis is dire?

The initial level of consciousness, which is determined according to a coma-scoring system, the duration of loss of consciousness and whether or not there are neurological deficits – all have prognostic implications.

Why are our brains so susceptible to injury?

Brain tissue cannot repair itself or heal as easily as in cases of damage to other parts of the body, such as a broken bone.

Headway Gauteng is a registered welfare organisation dedicated to offering various support programmes to survivors of brain injury and their families. Headway is able to offer support, information, practical advice and better understanding about what
brain injuries will mean for the future and how families can make a meaningful contribution to the recovery of the injured individual. For more information visit Headway Gauteng.