Brain Injury: How Bad Is It?

Knowing which area of the brain has been injured is important.Knowing which area of the brain has been injured is important since each area of the brain controls different functions. Diagnostic exams and tests can be done to find general information about where the damage is located and how much damage has been done.

MRI of the brain

An MRI of the brain

These exams and tests can include some or all the following:

– A neurological exam is a series of questions and simple commands asked by the neurologist to see if the patient can open their eyes, move, speak, and understand what is happening around them. Examples are: “What is your name?” “Where are you?” “ What day is it?” “ Wiggle your toes.” “Hold up two fingers.”

– Regular xrays are pictures of bones which show if they are broken or fractured.

– A CT (CAT) Scan is a painless, special x-ray of the brain or other parts of the body.

– An MRI (Magnetic Resonance Imaging) Scan is a painless, but noisy, special x-ray that takes pictures of body tissues. An MRI can show a skull fracture and bleeding in or around the brain.

– An EEG (Electroencephalograph) is also a painless test where electrodes are attached to the head to measure the electrical activity of the brain.

– An angiogram is a study of the blood vessels of the brain. Dye is put into an artery that supplies blood to the brain. This test can tell if the arteries or veins are damaged.

– An ICP (Intracranial Pressure) monitor is a small tube placed through a small hole in the skull and directly into, or on top of, the brain. The ICP monitor measures pressure inside the brain. A craniotomy is done to drill a hole in the skull.

The Glasgow Coma Scale (GCS) is an objective way of measuring the level of consciousness after a trauma by checking three types of responses—eye opening, motor responses (movements), and verbal responses (talking; knowing time, place, and who they are). The GCS is performed in the emergency room and intensive care unit to help decide the seriousness of the brain injury and the need for ICP monitoring. See more about the Glasgow Coma Scale below.

Glasgow Coma Scale

Mother of 16 year old with TBI
“I learned more about brain injuries by talking to the doctors and especially the nurses who cared for my son. Most tried to be as honest as possible about the prognosis. The truth is, it’s a waiting game.”

– Mother of a 16- year-old who survived a two-week coma and a five-month hospital stay after a car accident.

The Glasgow Coma Scale score is determined by testing eye opening, verbal response, and motor response and adding the three values together. Possible total scores range from 3 to 15. The scale below shows the rates for best response only for older children and adults. Patients who have been intubated and cannot respond verbally may have a “t” noted at end of their score. Since they cannot respond verbally, the best possible score would be 11t. For motor response testing, obeying verbal commands is the best response possible. If there is no response to verbal commands, painful stimulus is applied. The GCS for a dead person would be 3.

Certain scores on the Glasgow Coma Scale have significance. Patients with a Glasgow Coma Scale score of 7 or less are considered comatose. Patients with a Glasgow Coma Scale score of 8 or less are considered to have suffered a severe head injury.

Glascow Coma Scale

Test

Best Score

Patient’s Response

Eye Opening

Spontaneously
To speech
To pain
None

4
3
2
1

Opens eyes spontaneously
Opens eyes to verbal command
Opens eyes in response to painful stimulus
Doesn’t open eyes in response to stimulus

Motor Response

Obeys Commands
Localizes to Pain
Withdraws to Pain
Abnormal flexion
Abnormal extension
None

6
5
4
3
2
1

Reacts to verbal command
Identifies localized pain
Flexes and withdraws from painful stimulus
Assumes a decorticate posture*
Assumes a decerebrate posture*
No response; lies flaccid

Verbal Response

Oriented
Confused conversation
Inappropriate words
Incomprehensible sounds
None

5
4
3
2
1

Is oriented and converses
Is disoriented and confused
Replies randomly with incorrect words
Moans or screams
No response




*Decorticate Posture is the position of a comatose patient where the arms are rigidly flexed at the elbows and wrists. The legs also may be flexed with toes rigidly pointed. The decorticate posture indicates a lesion in the brain. In some instances the posture may be produced by applying a painful stimulus to a comatose patient.

*Decerebrate Posture is the position of a patient, who is usually comatose, in which the arms are rigidly straight and internally rotated and the legs are extended with the toes rigidly pointed. It is usually observed in patients afflicted by compression of the brainstem at a low level.


Traumatic Brain Injury Booklet CoverBrain Injury: A guide for family and friends

Table of Contents

What is a Brain Injury?
How Bad Is It?
How the Brain Functions
Common Problems During Early Recovery
The Intensive Care Unit (ICU)
Understanding Coma
How Does an Injured Brain Heal?
How You Can Help With Recovery
• Where Will the Journey Go From Here?
How Will I Ever Get Through This?
Where to Go for Help
• Books for Families Coping With Brain Injury

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