Traumatic Brain Injury

Your brain's reaction to an injury is similar to an ankle bruising and swelling after a bad fall. A minor TBI like a concussion can heal with rest and time, but more severe damage requires advanced care.

Types of TBIs 
There are several ways to categorize traumatic brain injuries.

• Mild, moderate, and severe: Doctors use these terms to describe the injury based upon initial signs and symptoms, like headache, fatigue, dizziness, speech problems, sensory changes, loss of consciousness, and confusion.
• Open vs. closed: This distinction is based on whether the injury punctures the skull.
• Primary vs. secondary: 
  • Primary TBI refers to the initial trauma itself.
  • Secondary TBI refers to how your body responds to the trauma, mainly with swelling. Because the brain sits inside the rigid space of your skull, too much swelling can choke off the brain’s supply of blood and oxygen.

Before we treat the primary injury, we use tests to determine its severity as quickly as possible. 

Clinical Evaluation
A a clinical evaluation includes a physical exam and a neurological exam to assess your mental status as well as language, nerve, motor, sensory, and reflex functions.

Glasgow Coma Scale
Doctors assess your level of consciousness and how well you respond to requests to open your eyes, speak, and move certain parts of your body. Higher scores indicate higher function and usually correspond with better outcomes.

Imaging Scans
CT or MRI scans help your doctors see the internal structure of your head, neck, and spine. You may also need a CT angiogram, which is a CT scan that uses injected dye to highlight blood vessels.

EEG Monitoring
Through electrodes placed on your scalp, an electroencephalogram (EEG) painlessly monitors and records brain waves.

Intracranial Pressure (ICP) Monitoring
ICP monitors use a small probe inserted through the skull to measure cerebrospinal fluid (CSF) and brain swelling.

The goals of primary TBI treatment are to stabilize the patient and prevent a secondary traumatic brain injury by controlling intracranial pressure. 

Medications 
These can help reduce swelling, prevent seizures, and relieve pain.

Surgery 
Severe and sometimes moderate TBIs may require surgery to remove blood clots, create more space for brain swelling, treat skull or facial fractures, and more.

Traumatic brain injuries can cause a wide range of complications, including headaches, seizures, coma, paralysis, loss of speech, and swallowing problems. Some may resolve over time while others can be permanent.

We specialize in assessing your function and deficits and creating an individualized rehabilitation plan to restore neurocognitive and physical abilities. These efforts begin when you’re in the hospital and continue after discharge. Our rehabilitation services include experts in:

• Communication
• Hearing loss
• Neurology 
• Neuropsychology
• Physical therapy
• Occupational therapy
• Speech-language pathology

Full Range of Treatment Options
Duke’s TBI treatment team offers every opportunity for you to thrive. We have the most advanced treatments available, and we connect you with the right rehabilitation services to match your individual needs.

Team Approach to Care
Our TBI experts -- neurologists, neurosurgeons, neurologists, neuro-intensivists, critical care specialists, neuropsychologists, therapists, and others -- meet regularly to discuss each person in our care. Some of our doctors go together to see patients in the emergency department, in the hospital, and after discharge, which is more efficient and convenient for you.

Renowned Expertise
Our craniomaxillofacial (meaning the face, mouth, jaws, and skull) trauma providers use advanced surgical techniques for reconstruction, including microsurgery, computer navigation, and individualized implant fabrication.

Specialized Neurosciences Intensive Care Unit
Our neuro ICU houses advanced equipment to monitor primary and secondary traumatic brain injuries and to measure pressure, blood flow, and oxygen levels in the brain.

Clinical Trial Participation
We participate in clinical trials that aim to develop brain monitoring technologies and new treatments to help people with traumatic brain injuries, strokes, and other serious neurological conditions. Through the Translational Brain Injury Research Center, we are investigating genetic and molecular factors that may affect the brain’s response to injury.