Severe Traumatic Brain Injury: What to Expect

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Severe Traumatic Brain Injury: What to Expect

Has a member of your family been diagnosed with a severe traumatic brain injury (TBI)? A traumatic brain injury occurs when an outside force -- such as a fall, an assault, or a motor vehicle crash -- disrupts the brain’s normal function. If your loved one has suffered a severe TBI, you may be wondering what to expect. An injury such as this can be life-changing for everyone in the family and can be complicated to understand and to cope with. While some patients are able, over time, to regain functioning to a high degree, others are not. Unfortunately, some patients never regain consciousness.


After the Injury


Your family member will probably undergo a number of tests to determine the damage to the brain. These may include classifying their injury on the Glasgow Coma Scale, CT scans or MRIs, EEGs or pressure monitors. There are various ways in which a brain injury can manifest within the brain, including:

  • Hematoma. This is a blood clot within the brain or on the surface of the brain.
  • Contusion. A bruising of brain tissue.
  • Intracerebral hemorrhage. Bleeding within the brain tissue which may be related to contusions or other brain injuries.
  • Subarachnoid hemorrhage. Bleeding into the subarachnoid space.
  • Diffuse injuries. Microscopic injuries that do not appear on CT scans.
  • Diffuse axonal injury. Impaired function and loss of axons, leading to the loss of the ability of nerve cells to communicate with each other.
  • Ischemia. Decrease in blood supply to parts of the brain.
  • Skull fractures. Fractures of the skull can affect nerves, arteries, or other structures, or press on or into the brain.


If your family member has suffered a severe TBI, it’s likely that they will be unconscious for a period of time. Patients often move through a series of states of unconsciousness:

  • Coma. In this state, the patient is completely unconscious. They may not respond to sound, touch, or pain.
  • Vegetative state. These patients are mostly unconscious but may be awake at times and respond briefly to stimuli. They can’t, however, communicate or engage in purposeful behaviours.
  • Minimally conscious state. These patients are beginning to regain consciousness and may have some awareness of their surroundings. They may be able to follow a simple command or keep their eyes focused on people or objects. They may also show appropriate emotional responses or try to communicate.
  • Emerged from minimally conscious state. These patients can communicate consistently or use at least two objects in a purposeful way. They may be able to answer simple questions by saying yes or no or perform simple tasks.
  • Post-traumatic confusional state. These patients have regained consciousness but may not be able to walk or talk or to recall memories. They may not recognize people they know. Typically, they are unable to understand where they are or why they are there and may become agitated.


People may move through these phases at different rates. Outcomes differ greatly, depending on factors such as age (young people are better able to recover) and how long the patient remains unconscious. Generally speaking, if a patient is able to follow simple commands within two to three months after the injury, the outcome will be better.


What Comes Next?


Shortly after the injury, your family member may require surgery to decrease pressure on the brain, as well as to deal with any other injuries sustained. After that, the treatment they receive will depend largely on the specifics of their case. These patients can have seizures, develop an infection, or experience a build-up of fluid on the brain. Ask your loved one’s doctor about their condition and what treatments they are receiving.


Many people with a severe TBI regain consciousness -- but remember that recovery can be a long process. Eventually, after the acute hospital stay, your family member will probably benefit from rehabilitation in a program that specializes in treating people with severe TBIs. Prepare yourself by learning as much as you can about the changes that people with these injuries often experience, including cognitive, physical, behavioral, and psychological changes. It usually helps to connect with organizations such as Brain Injury Canada and the Ontario Brain Injury Association, as well as with other families who have been affected by severe TBIs.


You should also consult a personal injury lawyer about legal issues. If you are the legal decision maker regarding medical decisions for your loved one, you should understand what your rights and obligations are in that respect. You may also want to become the legal guardian of your loved one, since they will be unable to make personal, financial, or legal decisions for themselves, at least temporarily. Finally, depending on the circumstances of your family member’s injury, they may be eligible to receive financial compensation. This type of injury may, in many cases, be considered catastrophic, and a personal injury lawyer can tell you more about what that might mean with regard to filing an insurance claim or a lawsuit.