Why a swollen brain is a problem

(This was written by a doc who is not involved in Wiley's care, but wanted to explain why his doc was doing some of the things he was doing.)

The brain swells up considerably during the first several days after trauma. Wiley's brain sustained some injury as a result of the original trauma but the most important thing right now is to limit any further damage caused by brain swelling in response to that trauma. Since the brain is housed in a rigid shell, if there is no place for the swelling to be released then the swollen brain would get pushed down towards the spinal cord which is the only opening there is. But that is also where the blood supply for the brain goes in and out so if the brain pushes downward through the opening than it would effectively cut off its own blood supply which leads to death. This is why it is so essential that the brain be allowed to swell outwards through openings made by the surgeon. That is why a portion of the skull was removed (temporarily). There is also now a catheter into the center cavity of the brain that can monitor pressures every second and let the doctor know when it is getting too high.

Another way to help the brain not swell is to force more carbon dioxide into the blood stream. This is done by hyperventilating the patient. Wiley is on a ventilator to make this possible and he is on medication to keep him in a comatose state so that they can keep him quiet while he is on the ventilator. Once they are certain that the risk of brain swelling is over, they will reattach the portion of skull bone that has been removed and take him off the ventilator and reduce the medications that are sedating him. It is only after that point that we will really know how much damage to the brain there is. But even then, it will take many weeks to understand the full extent. Brain injury recovery is measured in weeks and months and sometimes years, not days.