Treatment and prognosis
Treatment primarily involves supportive care, including hyperosmolar therapy, anti-inflammatory drugs, seizure management,
antimicrobial agents and possibly surgical decompression.
With recumbent horses, especially those of extensive duration, treatment and care may be difficult, labor-intensive and challenging,
with a grave or guarded prognosis. "The inherent limitations and complications of the management of recumbent adult horses
include ongoing self-trauma from struggling; decubital ulceration; reduced ability to eat, drink, defecate and urinate; pneumonia,
cystitis, GI-tract dysfunction; compartmental and/or ischemic myopathy and neuropathy; plus considerable labor and financial
investment," Feary says.
What is most important regarding care and treatment are "excellent supportive care — maintenance of hydration, blood pressure,
nutritional needs, nursing care, pain control," says Magdesian.
According to Ragle, skull-base fracture patients are quite unstable. Brain-injured horses should be "placed in a quiet, secluded
stall and every phase of care should be performed in an attempt to prevent triggering another traumatic episode," Ragle notes.
"Some patients are unable to move about a stall freely without falling and risking further injury."
Depending on the horse and its situation, some form of constraint to alleviate further injury should be considered.
"Injury to the central nervous system (CNS) should always be taken into account after severe traumatic incidents," says K.
Feige, DVM at the Clinic of Veterinary Surgery in Zurich, Switzerland, in a paper on traumatic injury to the CNS.
"The objective evaluation of a horse with suspected traumatic CNS injury should include a thorough history, clinical and neurological
examination and individually adapted supplementary examinations," Feige suggests.
What is most remarkable in these TBI cases and what equine practitioners should realize, Magdesian points out, is "the degree
to which even severely affected horses can normalize or near-normalize in terms of neurologic status. Given time, most improve
dramatically, as long as there are no compound or markedly displaced fractures."
Is it true that the more severe the head trauma, the less likely horses are to survive? "In general yes, but even severe cases
can come back if they are not in prolonged recumbency," says Magdesian.
Within Feary's population of TBI cases, 62 percent survived to be discharged, and that is from a referral population, likely
the most severe end of the spectrum.
"Survival may be even higher in field-treated cases," Magdesian suggests.
Ed Kane is a Seattle author, researcher and consultant in animal nutrition, physiology and veterinary medicine, with a background
in horses, pets and livestock.