Stephen Figueroa, M.D. Answers Questions On: Traumatic Brain Injury

We all sustain mild bumps on the head from time to time. However, if after hitting your head you have symptoms such as losing consciousness, vomiting, weakness, or difficulty speaking or walking, you should see a physician as soon as possible. These could be symptoms of a traumatic brain injury and immediate medical attention is needed.

A lot of the focus in neurocritical care has been the ongoing push to find a “magic bullet” – a neuroprotective agent that will limit or prevent further injury to a severely traumatized brain.

There have been many trials of medical interventions that originally looked very promising, but none have yet really delivered on that promise. However, TBI care has improved due to good all-around neurocritical care, which boils down to ensuring adequate blood flow to the brain while managing the elevated pressures in the brain. Whatever the particular type of TBI, these fundamental goals are central to the specialty.

It is very frightening for the families of people who have suffered a traumatic brain injury to see their loved one in a coma. Of course, the question they ask is: “When will he wake up?” In the early stages of a severe injury, it is just not possible to predict.

Patients look pretty sick immediately after suffering a TBI; their brain is in almost a hibernation state. It takes a week or two before we might start seeing positive signs, such as their eyes opening and being able to respond to simple commands. It’s as if they “turn back on,” and recovery can be pretty rapid after that.

I tell families, “We are going to treat your loved one aggressively for one week, then we'll see how they're doing. If they're not stable or are getting worse, it may be a sign that they won't recover. But if they're stabilized or showing signs of improvement, it makes sense to keep going forward.” I try to let the patient and the clinical course of his or her condition determine whether and to what degree the patient will recover.

While there are always clinical trials underway for TBI patients, there continue to be many unknowns. It’s a mission of academic medical centers like UT Southwestern to conduct studies to improve understanding and care of conditions such as TBI. A particular experimental therapy or diagnostic tool may not ultimately help the patients in that trial, but it just could help the next person in this situation. When I counsel families regarding research, I tell them that we don't know if a certain approach will be helpful; that is the question we are trying to answer. And the hope is that in 10 or 20 years down the road we'll have a better answer for other patients.