Brain Injury

Evaluation begins with a rapid clinical assessment, including Glasgow Coma Scale (GCS) scoring, pupillary examination, and systematic neurological testing. Computed tomography (CT) of the head is the cornerstone of acute TBI imaging: it is fast, broadly available, and reliably detects hemorrhage, contusions, and skull fractures that may require immediate surgery. Magnetic resonance imaging (MRI) is reserved for the subacute setting or when clinical findings are not explained by CT, particularly to identify diffuse axonal injury. In patients with severe TBI, invasive intracranial pressure monitoring — via a surgically placed catheter or bolt — provides continuous real-time data that guides intensive care management and informs prognostication.

Management of mild TBI centers on symptom control, cognitive rest, and a graded return to normal activity guided by ongoing clinical assessment. Moderate and severe TBI requires intensive care unit admission with a multi-pronged strategy aimed at preventing secondary brain injury. Core priorities include ensuring adequate oxygenation and blood pressure, reducing elevated intracranial pressure through head positioning, sedation, osmotherapy, and — when other measures fail — decompressive craniectomy (surgical removal of part of the skull to allow the swollen brain to expand without further compression).

Surgical evacuation is indicated for hematomas large enough to compress critical brain structures and risk herniation. Following stabilization, structured multidisciplinary rehabilitation is the cornerstone of long-term recovery, encompassing physical therapy, occupational therapy, speech-language pathology, neuropsychology, and mental health support. Recovery trajectories for moderate to severe TBI extend over months to years, and many patients benefit from long-term follow-up to address evolving cognitive, physical, and emotional challenges.