This is a chapter from the Family Caregiver Curriculum, Module 1: Introduction to Traumatic Brain Injury.
Doctors and nurses work very hard to prevent complications after a TBI. During the first several days to weeks after the injury, the risk of further damage from complications is high. So the health care team takes all the steps it can to control complications.
Are There Common Complications Following Severe TBI?
Some complications are a direct result of injury to the brain. Others come from being bedridden for many days or weeks. Some result from the overall shock the body is experiencing.
Here are some common complications that happen in the days or weeks after the injury:
- Increased intracranial pressure (ICP): The pressure inside the brain can increase to dangerous levels. Sometimes, the pressure is life-threatening. An ICP monitor alerts doctors to the pressure. Medications can prevent or treat high pressure.
- Edema: Swelling that occurs when the brain contains more fluid than normal. When swelling happens within the brain, there is no place for the tissue to expand. This is because the brain is encased in the skull. Swelling can cause pressure to build up. This results in damage to brain cells. It also interrupts blood flow. Medications and fluid restrictions often help. Sometimes, surgery is needed.
- Hydrocephalus: Also known as “water on the brain,” hydrocephalus happens when cerebrospinal fluid (CSF) collects in the ventricles. This condition may occur during the initial period after TBI or develop later (usually within the first year). If hydrocephalus is severe, doctors may place a shunt in the brain. The shunt drains the extra fluid from the brain to other places in the body.
- Low blood pressure: Blood carries oxygen to the brain. The brain needs oxygen. Doctors and nurses work hard to keep blood pressure from getting too low. This helps increase blood flow to the brain.
- Fever: Some parts of the brain regulate temperature. Injury to these parts may cause high fevers. This is especially true during the first hours or days after an injury. Fever is also a sign of infection. Medications and/or cooling blankets can bring the fever down.
- Pneumonia: Being in bed and not able to move around increases the risk of pneumonia. The health care team will carefully monitor your family member’s breathing and lung status. They may take frequent chest x-ray to look for pneumonia. Fever is also a sign of pneumonia, a common complication. Fortunately, antibiotics usually work to treat pneumonia.
- Brain infection: Infections may occur on the outside of the dura, below the dura, in the membranes surrounding the brain (meningitis), or within the brain itself (abscess). Depressed skull fractures or penetrating brain injuries can cause brain infections. Antibiotics treat brain infection. Sometimes, surgery is needed.
- Other infections: To treat TBI, your service member/veteran may have one or more tubes (see page 23). These tubes are needed. But they may cause infection. Body temperature readings and blood tests are ways to monitor for infection. Antibiotics control infections.
- Blood clots: Not being able to move around leads to slower blood flow throughout the body. Slower blood flow can lead to blood clots in the legs or arms. These are known as deep vein thromboses (DVT). Signs of a clot include a leg or arm that is warm, red, and swollen.
- If a DVT travels to the lungs, it is known as a pulmonary embolus (PE). A PE can be very dangerous. It requires immediate treatment. A tiny filter may be placed in a large vein called the vena cava. This keeps DVTs from reaching the lungs. This filter is usually removed later. Medication to thin the blood is often used to prevent and treat blood clots.
- Skin breakdown: Being in bed all the time and having other injuries may cause the skin to break down (bedsores). Nurses work hard to prevent bedsores by changing the person’s position often and inspecting all areas of the skin. Various treatments or topical applications may be used.
You are an important part of the team. You know your service member/veteran better than anyone. If you notice any of these signs or symptoms, tell the health care team what you are seeing or thinking. Do this even if you simply feel as if “something is wrong,” even though you can’t quite put your finger on what it is. Family members may notice small changes before anyone else. The earlier a complication is detected, the sooner it can be treated.
See more information included in Module 1: Introduction to Traumatic Brain Injury.
The Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans provides comprehensive information and resources caregivers need to care and advocate for their injured loved one and to care for themselves in the process. The Guide was developed by the Defense Health Board, the Defense and Veterans Brain Injury Center and the Department of Veterans Affairs.