Brain injury occurs as a result of a violent shock due to an accident or assault. Primary lesion due to the trauma can lead to consciousness disorder requiring intensive care unit hospitalisation.
On arrival at the intensive care unit, the clinician’s first feeling is uncertainty about the patients’ fate : are they going to wake up or not, and should they wake up, would they fully or partially recover, or with very disabling side effects ? Initially, everything is uncertain about the prognosis.
In this context, all these patients are managed similarly with very intensive treatments : intensive care, surgery if necessary, external ventricular drain, intracranial pressure measurement and treatment of any complications. Without this support, brain injured patients would not be saved and death would be inevitable within a few hours or days.
As sedative drugs are stopped, either patients wake up quickly, in this case the goal is reached, he will have recovered consciousness, sometimes with neuropsychic after-effects, and motor impairments, often being curable.
When patients do not wake up after drugs are stopped, a multimodal MRI scan is quickly performed. Multimodal MRI enables to quantify patients’ injuries and see them in 3 dimensions. Some areas are far more important than others in terms of awakening.
Professor Louis Puybasset leads the neurointensive surgical unit at The Pitié-Salpêtrière hospital in Paris and works with teams from the Brain and Spine Institute (ICM).