Neurology

What is an acute brain Injury?

The brain can be injured for different reasons, the most common causes include:

• Trauma to the head;
• Blockage of a blood vessel to the brain;
• Bleeding into or around the brain;
• The after-effects of when the heart stops during a cardiac arrest.

Sometimes a brain injury can damage a vital area of the brain or involve such a large part of the brain that it places a patient’s life in danger. When patients become this ill because of their brain damage, symptoms may include:

• Unable to stay awake;
• Cannot breathe properly;
• Cannot regulate the proper level of blood pressure.

So far, modern medicine has not found any specific medications or procedures that can repair these damaged brain cells. Unfortunately, once the damage has been done, it cannot be reversed. However, in the right environment, the brain does have the potential to recover and adapt to the existing brain injury.

In the ICU, medications may be used to help reduce pressure that builds up around the brain from swelling or bleeding. Additionally, surgery may be needed to further help relieve pressure on the brain.

Pressure in the brain (intracranial pressure)

The pressure inside the skull may rise in patients with head injuries or after a stroke. This pressure, also called intracranial pressure, can obstruct the flow of blood to the brain. Values up to 20 mm Hg are acceptable, but the team may decide to use higher values on some patients.

Recovery after a brain injury is dependent on the patient and the injury. This can make it hard to provide an accurate estimate of just how much your loved one will recover and how long it will take; other factors that will affect this recovery process include the age of your loved one, and any previous medical problems. Much of the recovery takes place in the first 6 months. With a severe brain injury, a patient may suffer life-changing and debilitating problems including mental, behavioural, and physical disabilities.

Delirium

Delirium is a common condition among hospitalized patients, especially those in the ICU. Patients with delirium may have the following symptoms:

• An inability to focus and maintain attention, which typically fluctuates over the course of the day;
• Can't think clearly or remember recent events;
• Disoriented, forgetful, and can't express themselves clearly;
• Very sleepy or very agitated;
• May see or hear things that do not exist (visual or auditory hallucinations);
• May not recognize their family members or may be convinced that the hospital staff wants to harm them.

Unfortunately, we do not fully understand why some patients develop this state of confusion. But many ICU patients are particularly vulnerable. The following conditions may increase the risk of delirium:

• Conditions affecting the brain such as a stroke, head trauma, Parkinson's disease and dementia;
• Advanced age;
• Hearing or visual impairment.

Both the ICU team and family members can help with the prevention of delirium by making the ICU environment feel a little more normal. These measures include:

• Limiting noise and light at night to favor sleep;
• Getting patients out of bed when possible;
• Re-orienting patients so they are aware of the time of day, where they are and who are the people around them;
• Limiting the use of catheters and physical restraints;
• Providing enough, but not too much stimulation;
• Treating pain appropriately;
• Providing hearing aids and eyeglasses to the patients who need them.

Delirium can last hours, days, weeks, or even months. It is often the last thing to improve once the other medical conditions have resolved. Even when the symptoms of delirium appear to have resolved, patients and family members may continue to notice changes in memory or ability to complete certain daily tasks.