Assessments and treatments after an acquired brain injury
This section explains the kinds of tests and treatments healthcare professionals may carry out.
The healthcare professionals around a child have different methods of trying to work out what’s going on.
These examinations and assessments may sometimes seem intrusive and stressful for child and parents, but the aim is to determine the best course of action.
Parents often have to take in a great deal of information at this stage. And this information comes at a time when concern for their child may make it difficult to take everything in. 1
Language you might hear
The Glasgow Coma Scale
The word ‘coma’ can be terrifyingfor a parent. But this scale is actually a standard observation professionals use to establish some basic facts. Children are given a slightly different ‘test’ to adults. This children’s version is called the Paediatric Glasgow Coma Scale. It works through a set of questions (‘what is your name?’, ‘what day is it?’). A child might also be asked to wiggle their toes or hold their fingers up. The healthcare professionals also carry out some observations, looking at how easy it is for the child to open their eyes, speak and move. A small light will be shone in their eyes to test their reaction to it. Children are given a ‘score’. A score of 3 is when the child is unconscious and cannot respond at all. The scale goes up to 15, which is when the child is fully awake and aware. This kind of assessment might take place at the scene of an accident (paramedics are trained in this scale). It will also take place at regular intervals at the hospital to check progress.2
On this page
X-rayIn cases of a head injury, an X-ray might be taken to see if the skull is broken or fractured. This is likely to happen soon after arrival at accident and emergency. ChildrenYour child will have to stay still while the X-ray is carried out. You may be able to stay in the room with your child.
CT scan3The ‘CT’ stands for Computerised Tomography. A CT scanner does a similar job to an X-ray machine, but at a much more detailed level. Rather than sending out just one ray, the CT scanner sends lots of beams from different directions. The child lies very still on a bed as they’re put into the machine. It looks like a large ring doughnut and while the scan is entirely painless, the claustrophobia and noise may be frightening for children. You may be able to talk to your child during this, via an intercom system. The result is a very detailed image of the brain. The healthcare professionals around your child should then be able to talk you through the results.
MRI scanThe ‘MRI’ stands for Magnetic Resonance Imaging. Instead of X-rays, the MRI scanner uses magnetic and radio waves to build up a picture of the brain. It gives a very detailed image, but it is different from a CT scan in only showing the brain from one angle. Children are sometimes given an anaesthetic because it’s important they remain completely still during the scan. Like the CT scanner, the MRI scanner is also a little claustrophobic. It’s also quite noisy.4
AngiogramThis is a test to look at the blood vessels in the brain. Using a small tube, dye is put into an artery that takes blood to the brain. A local anaesthetic will be used so your child doesn’t experience too much pain. This dye makes the blood vessels in the brain easy to see on an X-ray, so doctors can see if they’re damaged. This process can take between one and three hours.
ICP monitorAn intracranial pressure monitor is a small tube placed just on top of or in the brain through a tiny hole in the skull. This is done under general anaesthetic. The aim is to find out how much pressure has built up inside the skull.
EEGAn electroencephalograph is a test to measure electrical activity in the brain. Patches called electrodes are applied to the head with sticky pads to measure activity.5
The problem with swelling or bleeding in the brain is that there isn’t any room for it.
The skull is a solid box, almost fixed in size when we get past 18 months old.7
When the brain swells or bleeds the result is that there is more pressure inside this solid box.
This is raised intracranial pressure.
If there is more fluid in this small space, it can push on the brain and cause damage.8
Intracranial pressure may also lead to other complications.
The flow of blood around the brain might be interrupted. Cerebrospinal fluid – the nourishing liquid which flows around the brain – may also be affected.9
Doctors will monitor intracranial pressure closely10, and there are measures they can take to control it.
A ventilator can help increase the flow of oxygen to the brain. Alternatively, doctors might control the amount of water and salts going into the body to prevent too much fluid being present in the brain.
What do doctors mean when they talk about intracranial pressure?6
I think a lot of the doctors you see don't realise they're using jargon. It can be a bit much at first."A parent
If this intracranial pressure builds and becomes too high, doctors may attempt to bring it down. This might take the form of draining some fluid from the brain, or in some circumstances, removing a piece of the skull (known as a bone flap) to relieve the pressure. A ‘shunt’ may also be used. This is where a catheter (a small tube) is used to drain cerebrospinal fluid from the brain into another part of the body. The aim is to lower pressure in the head. In some circumstances, doctors may choose to ‘deeply sedate’. This is where a coma is induced with the aim of reducing stress to the child and managing the intracranial pressure.
Each child responds differently to their brain injury.11
But there are some broad things we can say about the aims of the healthcare professionals.
When a child is first taken to hospital, it is often referred to as acute care. The main goals here will be to:
- Manage ayour child’s pain and anxiety about what’s going on
- Control the level of pressure in the skull
- Stop any bleeding and remove any blood clots
- Make sure there’s enough blood (and oxygen) going to the brain
- Make sure your child is safe12