Traumatic brain injury is a major cause of disability and death in most advanced nations, and an increasing problem in virtually all developing nations, whether from motor vehicle accident or gunshot injury. In some series, approximately one third of those injured recover completely, one third are left with significant disability, and one third either die at the time of injury or soon after, or are left in a persistent vegetative state.

The management of traumatic brain injury is initially the responsibility of the intensive care physician and the neurosurgeon, and it will be uncommon for either the neurologist or the palliative care physician to be asked to consult on such cases. In particular cases where unusual sequelae supervene, a neurological opinion may be sought.

THE SUPPORTIVE PHASE

Palliation issues

Site of care

Immediate intervention commonly involves tracheostomy and intensive care supervision. The long-term support of brain-injured individuals is more commonly a responsibility for rehabilitation teams rather than neurologists. Established brain injury is for life, and the best results of rehabilitation appear to be through continued supervision by multi-disciplinary rehabilitation teams able to support an individual over a prolonged period.

Financial matters

The best site for management of the patient may be affected by financial constraints; for example whether insurance compensation for injury is applicable. Rehabilitation may be necessary over months and years, requiring regular professional supervision or institutional care. Physical, cognitive, behavioural and psychological changes may vary, depending on the areas of the brain that are damaged.