Watchful Waiting in Head Trauma

Despite the advances in medical imaging, there continue to be areas in which actual interventional advances have lagged these radiological improvements. This is especially true in the management of head trauma. The truth is that we still do not fully understand the brain and its complex circuitry. Well, perhaps I should rephrase that and say that we do not understand well enough to allow it to guide us in surgical procedures. Aside from conceptual brain mapping and the functional topography of the brain, the brain is still an organ that we do not confidently understand enough to warrant surgical interventions.

So if you think that you will be in good hands if you suffer from head trauma, think again.

If you are the unlucky soul who suffers head trauma, you will likely be shipped to an Emergency Department and sent through a CT scanner. What this series of computed tomography images will show is your bone, brain, vessels, and its cavities. One of the most common findings on a CT scan after blunt head trauma is hemorrhage of the veins or arteries around the brain. Unless the fluid has accumulated enough to compress on your brain or to cause a “midline shift” (shift of the midline of the brain due to compression), you will be observed for improvement in neurological status and sent for repeat CT imaging over the next few days.

That’s right, in most situations of traumatic brain injury you will be observed in the hospital – we really can’t do much else but watch. In medical lingo we call this “Watchful Waiting”.

The one situation where we actually do anything is when there is significant neurological deficit or midline shift. Those situations warrant surgical decompression and hematoma evacuation by a neurosurgeon. What this amounts to is a surgeon drilling holes in your skull to drain the blood and relieve pressure on your brain.

Even after that procedure is done, we do what we do best in head trauma – we watchfully wait for improvement.