Since no ANE patient is identical to another, hence no two patient treatments will be identical. The majority of patients will be placed in a drug induced coma, but not all. Attending Doctors and Neurologists will assess the situation carefully and treat the patient according to their needs. Upon returning home, patients may have ongoing or new issues manifest that require specific treatments and/or medications. This may require continual monitoring, for example, seizures, headaches and sleep issues.
Procedural & Diagnostic Tools
MRI and CT Scan
These 2 medical tests are used to examine the structure of the brain and scan in cross sections. The MRI uses magnetic fields and the CT uses x-rays. The MRI may see an injury to the brain that can go undetected in a CT scan as it has a higher resolution.
Using electrodes placed on the skull, an EEG records electrical signals coming from the brain. A slowing of these signals may indicate a lesion whilst widespread slowing may indicate a wider disturbance of the brain function. An EEG may be used to confirm diagnosis from other tests.
Intracranial Pressure Monitor
Doctors may insert one of these monitors into the skull if they are concerned about pressure from inflammation in the Acute stage of injury.
This is a diagnostic test where fluid is extracted from the spinal column. Pressure on the spinal column is measured and the cerebro-spinal (CSF) fluid is then examined for viral cultures, elevated white cell counts and blood. In the majority of cases, ANE patient’s CSF will show elevated protein and no virus’s.
A Tracheal Intubation or Tracheotomy is sometimes performed, as well as careful montoring of breathing and heart function.
It is becoming more common to have ANE warriors tested for the gene mutation, RanBP2. It is a simple blood test. Some hospitals will do the testing as a matter of course. Testing may be done “in house” at the hospital if they they have the facilities to do so. However, some hospitals may send the bloodwork overseas to an appropriate facility for testing.
Medical Assistance & Medications
Coma Inducing Drugs
A medically induced coma is when a patient receives a controlled dose of an anesthetic, typically propofol, pentobarbital or thiopental, to cause a temporary coma or a deep state of unconsciousness. This type of coma is used to protect the brain from swelling by reducing the metabolic rate of brain tissue, as well as the cerebral blood flow. Throughout a medically induced coma, a patient’s critical life functions are constantly monitored by an anesthesiologist or other physician in a critical care setting only.
These drugs can help stop or prevent seizures. Most ANE patients will have seizures at the onset of ANE. These seizures can be quite dramatic (tonic/clonic) or almost unnoticable (focal or generalized). Anti convulsant medication may have a sedative effect. The most common drug used is Keppra. For a list of other types of anti convulsant medication see – https://en.wikipedia.org/wiki/Anticonvulsant#Benzodiazepines.
Intravenous Fluids (IV’s)
Intravenous therapy is the infusion of liquid substances directly into a vein. ANE patients may have the following fluids administered through an IV line. Rehydration fluids after becoming dehydrated, antibiotics , steroids and pain management medications.
This is an anti viral drug used for the treatment of influenza. It works by slowing down the rate at which viruses infect cells. It does not eliminate the flu virus, rather it slows its progress. It needs to be taken early in the infection cycle and hence some Dr’s of ANE patients recommend it be taken at the first sign of influenza to guard against recurrence of ANE.
Nasogastric Intubation (NgTube via the nasal passage) or Gastric Intubation (GTube via abdomen walls) is a common procedure that provides access to the stomach for feeding.
Anti Inflammatory Drugs
High-dose corticosteroids are normally administered for a few days, this helps reduce swelling and pressure within the brain.
The physician may provide acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, others) — to relieve headaches and fever.
Until a bacterial infection is ruled out, antibiotics can sometimes be used for prophylactic measures. These will be used if ANE is caused by a bacteria.
Intravenous Immunoglobulin Therapy (IVIg)
This therapy can help people with weakened immune systems or other diseases to fight off infections. IVIg gives you antibodies that your body is not making on its own, so you can fight infections. Immunoglobulin is part of the blood plasma. It has antibodies in it to fight germs or disease.
Plasma can contain antibodies that attack the immune system. A machine can be used to remove the affected plasma and replace it with good plasma or a plasma substitute. This is also known as plasma exchange.
Sometimes, Melatonin is prescribed to helps control the sleep and wake cycles in ANE patients and other ABI patients.
After traumatic brain injury, some doctors are prescribing Ritalin for low arousal or initiation, poor attention and concentration, depression, and slow processing speed. There is research that shows that Ritalin may speed recovery early after moderate to severe TBI. There is also research showing that Ritalin increases mental processing speed after TBI, which can improve memory function in some people.
These drugs may sometimes be used in post-traumatic brain injury to treat agitation, disruptive behaviour and/or agressive behaviour as the brain heals.