This year’s theme for Brain Injury Awareness Month, observed each year in March, focuses on recognizing the patient as an individual and acknowledging that every brain injury is different.
This patient-centered approach is the guiding philosophy for the physicians in UTMB’s Department of Neurology, who offer individualized care for every type of brain injury. From the moment a patient is seen, the team begins working to evaluate the injury and the patient’s needs to determine the best course of action.
“When the patient comes to the emergency department, we like to evaluate in different ways. One, the most important one, is the neurological exam,” says Chilvana Patel, MD, FANA, FAAN, Associate Professor in the Department of Neurology.
Acquired brain injuries – those that are not hereditary, degenerative, congenital, or induced by birth trauma – may be traumatic, meaning an external force causes alteration in brain function or other evidence of brain pathology, or non-traumatic, in which internal factors like lack of oxygen, toxin exposure, or pressure from a tumor cause damage.
The standard evaluation tool for neurological examination is the Glasgow Coma Scale, which looks at verbal, ocular, and motor responses. If the score indicates further assessment is needed, the next step is neuroimaging. Depending on those findings, additional neurological testing and imaging may help determine whether the patient should be admitted.
Todd Masel, MD, MBA, Professor and Chair for Clinical Affairs in the Department of Neurology, says the range of services to treat brain injury patients is wide.
“A lot of these patients have seizures, so we treat their seizures. We also often will refer them for neuropsychological testing to help assess their cognitive function. And in addition, we have some lab panels that we can order to see if the brain injury happened to cause some endocrine abnormalities that can actually easily be treated,” he says.
Neurology will also screen for secondary injuries, making sure there has not been any damage to a blood vessel caused by the trauma. Damaged blood vessels in the neck could eventually lead to strokes.
Concussions from sports injuries are common, and fortunately about 80 percent are mild. Even those who have lost consciousness can be discharged from the emergency department if there is no sign of brain deficit, a normal exam and CT scan, and the loss of consciousness was transient.
“We give reassurance to the patients and their families that, when it comes to a mild concussion, a lot of these symptoms are going to get better on their own with time,” says Dr. Masel says. “Just giving reassurance helps a lot in these cases.”
In all other cases of brain injury, Dr. Masel says it’s best to err on the side of caution and refer the patient to Neurology.
For traumatic brain injuries in the moderate to severe category, the patient will need an immediate neurological exam, imaging study, and many will need a hospital admission. The neurologists will look for signs of brain damage, hemorrhages in the brain, or any signs of vessel dissection.
“Unfortunately, the moderate to severe kind of brain injury usually results in permanent damage, and they need a long course in the hospital and physical therapy and rehabilitation. So even after the discharge, they need long-term care,” Dr. Patel says.
Many patients benefit from UTMB’s inpatient Rehabilitation Services, which include Physical Therapy and Occupational Therapy. Upon discharge, they are able to transfer to outpatient services, which are offered at all UTMB campuses.
Dr. Patel notes that spasticity, a tightening of the muscles caused by disrupted signals from the brain, is common among moderate to severe brain injury patients. Treatment is administered in the form of medication and Botox injections, which help them complete their daily activities, like dressing and feeding.
“It’s giving them some independence to go back to their life,” she explains.
UTMB’s Department of Neurology has inpatient and outpatient coverage at Galveston, League City, and Clear Lake campuses, and outpatient coverage at Angleton Danbury campus.
 |  | Todd Masel, MD, MBA, sees patients at Clear Lake Campus and the Primary Care Pavilion in Galveston. Chilvana Patel, MD, sees patients at Clear Lake Campus. |