Before you keep reading
Depending on the condition of the person with a brain injury, they may be in the hospital and unable to process the information on this page. Parents, siblings, and caregivers can use this information as well. If you are the one in the hospital, you might already have gone through some of these stages.
A brain injury will most likely be diagnosed either by a doctor or in a hospital, depending on the cause of the injury. For concussions, acute care refers to initial testing and diagnosis and doesn’t typically require a stay in the hospital. Moderate to severe traumatic brain injuries and non-traumatic brain injuries most often involve going to an emergency room where people access support for acute care. Acute care means short-term, immediate medical care. In acute care, health care professionals will continue with diagnosis, medical treatment, surgery and after surgery care (if surgery is needed).
Depending on how serious the injury (or injuries) is, you will be in acute care for a few days to a few weeks. You will then be moved to a different place (which could be another part of the hospital).
Let’s talk about:
Diagnosis tests & tools for brain injury
Diagnosing a brain injury involves medical tests that will help the medical team learn more about the injury. The following are some examples of tests that may be done.
Please note:
- You may not need all of these tests
- The hospital may not have the ability to perform some of these tests
- Test results may not be received immediately and will be shared when possible.
- Any questions should be shared with the doctor
Remember: there are no set tests of concussions. You can learn more about concussions on that page of our website.
The Glasgow Coma Scale helps medical professionals identify the severity of brain injuries by measuring the responsiveness of the patient. This is the first test administered after a brain injury, often by first responders or emergency room staff. It’s a simple test and gives a score based on the following things:
- Eyes opening
- Verbal response
- Motor response
Based on the individual category scores, the patient is given a total coma score.
- Severe: a score of 8 or less
- Moderate: a score of 9-12
- Mild: a score of 13-15
This is a non-invasive test. The results will help determine the next steps in treatment and recovery.
The Rancho Los Amigos scale is used to help track the patient’s recovery. There are 8 levels of recovery on the Rancho Los Amigos scale. For each stage, there are a series of checkpoints the person must meet to move to the next stage. Every brain injury is unique and recovery time will vary from person to person, so this scale is only used as a guide
A computed tomography (CT) scan uses X-ray machines and computers to take pictures of the inside of the body. Doctors may order a CT scan if there is a suspected head injury. CT scans do not show concussions, but do show structural injury to the brain such as bleeding, bruising, or signs of a stroke. This test is non-invasive, but does require exposure to radiation.
EEG stands for electroencephalogram (electro-en-ceph-a-lo-gram). It measures electrical activity in the brain. Small discs are attached to the scalp (it’s painless) and doctors use brain waves to help with their diagnosis. This is a non-invasive test.
MRI stands for magnetic resonance imaging. It uses magnetic forces, radio waves, and a computer to create 3-D images of organs, bones, and the brain.
To get an MRI, you will be given a gown to wear and you’ll need to remove your clothes and jewelry. Before an MRI,you or your parents should tell your doctors if you have any metal in your body, including pins from broken bones. You cannot get an MRI if you have:
- A cochlear implant (which is a hearing aid)
- Clips for brain aneurysms
- A pacemaker or heart defibrillator
Please note: most endovascular coils (which are used in treating aneurysms) are now MRI compatible, but should still be disclosed to the health care provider before the test.
The MRI machine is a long tube with a sliding surface that you’ll lay on. You have to stay still and quiet for a long period of time. If you are afraid of small spaces or have trouble staying still, doctors may offer some options to help you.
An MRI is a loud test, with lots of clanging noises. If you are sensitive to loud noises, this should be shared with the doctor.
During the MRI
You will lie down on a movable table, which will then slide into the cylinder of the MRI machine. You will be able to talk to the person administering the test at all times and must listen carefully for any instructions. Generally, an MRI will be done taking pictures after about 30-45 minutes – this could be longer depending on the number of pictures needed.
Medical staff in acute care
When you’re in the acute care section of the hospital, you will interact with a few different types of medical professionals.
Physicians (Doctors)
Physicians/doctors will be the ones to help make diagnoses and handle acute treatment. This includes the doctors in emergency rooms.
Nurses
Nurses are in charge of monitoring vital signs (like breathing and heartbeat) and possible medical issues. Some nurses specialize in different areas of health, including critical/acute care, stroke, or even brain injury. The nurses are your best support during this period of time—they spend the most time with you, have excellent medical knowledge, are responsible for continuing pain management and patient comfort, and help communicate with other members of the medical team.
Please note: a nurse is not permitted to share test results with you or family members. Doctors are the ones that must do that.
Neurosurgeon
If your brain is under pressure from bleeding or swelling, or if there is some damaged tissue, you will need surgery and will be referred to a neurosurgeon. Neurosurgeons are the ones who will be performing the actual surgery and arranging follow-up tests to monitor the results.
Neurologist
A neurologist diagnoses and treats disorders of the nervous system, including brain injury and stroke. They will be a big part of figuring out which parts of the brain have been damaged, and the next steps to take.
Questions to ask the medical team
When you are ready, there are some questions that you or your parents/caregivers can ask the medical team about the following things:
Diagnosis
- Is the diagnosis a concussion, a moderate, or a severe brain injury?
- What tests will you be doing and why are you doing them?
- What do you have to do to complete these tests?
- Can anyone stay with me while the tests are completed?
- Are there any complications at this stage of the brain injury?
- Will I need surgery? If so, what kind of surgery, and what will it involve?
Treatment
- What treatments should I have for this type of brain injury and what are the risks and benefits of treatment?
- How long will I stay in acute care?
- What rehabilitation centres/services will be available to me?
- Who will be on my recovery team?
- Will my family be able to visit often?
- What kinds of support are available for people living with brain injury?
What if I'm experiencing some pain?
You may be experiencing pain immediately after your injury, especially if you were in a traumatic accident. Any pain that is short-term is called acute pain. Acute pain can come from almost anything associated with both physical injuries and brain injuries. For example, a person who was in a motor vehicle accident could experience painful headaches, bone, muscle and/or tissue damage, or severe abdominal pain all at the same time. Pain is difficult to treat sometimes because it is experienced differently by every person, so it’s hard for people to understand exactly how someone else may be feeling it. Not all pain can be seen by imaging tests or be easily explained by doctors. For example, back pain is incredibly real, but it isn’t always visible. It’s complex and difficult for many people to explain their pain and what is causing it. The doctors in charge of the patient’s care will work with the patient to identify and manage acute pain as effectively as possible.
Why doctors can’t predict recovery time
It’s normal to want to know as much as you can, as soon as you can about your injury. But because brain injuries can affect people in different ways, doctors can’t always predict what will happen or how you will recover. Typically, this is called prognosis—predicting what the outcome of recovery will look like.
Doctors will do their best to give you some timelines. But biology, time, and treatment can all impact your recovery. That’s why it’s important to work with medical professionals to update prognoses and make recommendations.
Comas & persistent vegetative state
You may have been in a coma. That’s a heavy thing to think about, but it can be helpful to know what a coma is to help you understand your injury. If you feel this will be too much to learn about right now, please skip this section. You can also ask someone else to read this section if they have questions.
When someone is in a coma, they are unconscious with little to no responses to any sort of stimuli (something that triggers a reaction from your body, like lights or noises). They also don’t have a natural sleep-wake cycle. In some cases, they may not be able to breathe on their own and be on a ventilator/respirator machine to help with that. A persistent vegetative state is when a coma lasts for a long time. Comas and persistent vegetative states are commonly caused by:
- Head trauma
- Swelling in the brain
- Bleeding in the brain
- Stroke
- Oxygen deprivation
In some cases, a coma will be medically induced (started by a health care professional) to give someone time to heal. Nurses will change the person’s position and stretch their limbs regularly to keep them from developing sores and losing their range of movement while they are in a coma.
This can be scary—it’s hard to know what is happening or when/if the person will wake up. One of the most common questions asked is if people in comas/persistent vegetative states are aware of what is going on. The answer is a bit complex: studies have explored this topic and found that some patients show increased brain activity when they hear the voices of people they know, but they may not be able to recall that when they wake up.
As a person’s brain function improves, they may start to have natural sleep-wake cycles. They might open their eyes, respond to their environment, and speak. Doctors will use tools like the Glasgow Coma Scale and the Rancho Los Amigos test to track progress.
Information from this page is from https://braininjurycanada.ca/en/hospital/
