What is the best treatment for swelling in the brain?

Q: My father-in-law (60 yrs), while riding a 2 wheeler, met with a hit-and-run accident with a car. An immediate CT Scan showed a blood clot on the right side of the brain while the left lobe was severely injured and moved from left to right by 0.8cms. He was opearted withinn within half an hour. He is on artificial ventillation from the day of operation and 10 days later a tracheostomy was done. Right now he is hyperventillated and paralysed. Other parameters like BP, sugar, pulse rate (118) etc are normal. The doctor says that the brain is swollen and swelling (oedema) has to come down naturally. They are giving him MANNITOL. Today is the 16th day and till now the doctor has not told annything regarding his recovery. I would request you to give your frank opinion and would like if you could suggest any other medicine so that the brain swelling can come down. thank you anitha

A:Its clear your father-in-law suffered a very major head injury. The clot that was removed was only a small part of his problem and there are other areas of brain damage. That he still requires a ventilator after 15-20 days implies major brain damage. Head injury patients recover after seven weeks of coma so the only thing to do is carry on. There is no other good treatment for cerebral oedema except Mannitol and hyperventilation. After 4-5 days Mannitol is not useful and can be stopped. Is your father in law conscious i.e. when the paralysis injection is not given does he respond look around obey? If he is, the end result is likely to be good.