🧠 Vet’s 2025 Guide to Traumatic Brain Injury in Horses

By Dr Duncan Houston BVSc

1. What is Traumatic Brain Injury (TBI)?

TBI refers to damage to the brain caused by a sudden force or impact to the head—from incidents like flipping, kicks, trailer accidents, or collisions. It's a medical emergency—early response can mean the difference between recovery and long-term deficits :contentReference[oaicite:3]{index=3}.

2. Common Causes of Head Trauma

• Flipping over backwards during training or cross‑tying :contentReference[oaicite:4]{index=4}
• Kicks or collisions with fences, trailers, vehicles, or other horses :contentReference[oaicite:5]{index=5}
• Falling or being struck by loose objects

3. Recognising Signs of TBI

• Loss of consciousness or unresponsiveness (“down horse”) :contentReference[oaicite:6]{index=6}
• Seizures, ataxia, loss of balance, abnormal or wandering gait :contentReference[oaicite:7]{index=7}
• Nystagmus, unequal pupils, sudden blindness, facial asymmetry :contentReference[oaicite:8]{index=8}
• Bleeding from nose/ears, slowed breathing, stupor or coma :contentReference[oaicite:9]{index=9}

4. Emergency Response (First Aid)

1. Call your vet and treat as a medical emergency — while remaining cautious, as an injured horse may be confused or unpredictable :contentReference[oaicite:10]{index=10}
2. Move the horse to a quiet, shaded, padded area if safe—but do not force movement if unstable.
3. Keep airway clear, monitor breathing & heart rate, begin fluid therapy if vet advises :contentReference[oaicite:11]{index=11}
4. Avoid opioids—they decrease cerebral perfusion; use NSAIDs or sedatives like alpha‑2 agonists if needed :contentReference[oaicite:12]{index=12}

5. Veterinary Diagnostics

• Neurological exam: gait evaluation, cranial nerve function, proprioception tests :contentReference[oaicite:13]{index=13}
• Imaging: CT or MRI to detect fractures, hemorrhage, edema; CT is excellent for bone and MRI for soft tissue :contentReference[oaicite:14]{index=14}
• Radiographs and endoscopy to evaluate facial or skull fractures :contentReference[oaicite:15]{index=15}
• Bloodwork & CSF analysis to assess inflammation, bleeding, infection risk :contentReference[oaicite:16]{index=16}

6. Treatment & Hospital Care

• Maintain cerebral perfusion pressure — IV fluids, avoid low blood pressure :contentReference[oaicite:17]{index=17}
• Control intracranial pressure with hypertonic saline or mannitol, plus corticosteroids or DMSO :contentReference[oaicite:18]{index=18}
• Treat seizures with diazepam, midazolam or phenobarbital if needed :contentReference[oaicite:19]{index=19}
• Manage fractures or wounds with surgical fixation, drainage, antibiotics :contentReference[oaicite:20]{index=20}
• Provide ongoing pain control and supportive care—avoid NSAID overdose and monitor gut function.

7. Monitoring & Recovery Phases

• Frequently assess mentation, gait, pupil reflexes, and wound healing.
• Gradually allow movement—from stall rest to controlled hand-walking as mentation improves.
• Longer term: specialized neurological rehab exercises—balance pads, obstacle training, proprioceptive drills.
• Repeat imaging or neurological exams before resuming intense work or riding.

8. Prognosis Factors

Prognosis depends on severity and response to treatment:

• Foals and mild concussion—often make full recovery :contentReference[oaicite:21]{index=21}
• Basilar or skull fractures—guarded prognosis; but many can heal well with proper management :contentReference[oaicite:22]{index=22}
• Long recumbency, ongoing ataxia, or delayed treatment—poorer outcomes :contentReference[oaicite:23]{index=23}

9. Prevention Strategies

• Proper training—avoid halter/cross‑tie habits that cause panic or flipping :contentReference[oaicite:24]{index=24}
• Safe environment—padded stalls, smooth trailer loading, collision-free fencing
• Wear helmets or head protection for horses prone to falling
• Respond to head trauma quickly—even subtle signs warrant veterinary evaluation

10. Ask A Vet Integration 🩺

Use Ask A Vet to:

• Upload videos/images of your horse’s behavior for early triage
• Get guided first‑aid steps—positioning, fluids, sedation support
• Coordinate emergency vet care—remote instructions before arrival
• Monitor and adapt rehabilitation routines remotely
• Receive reminders for follow‑up exams and imaging

Download the Ask A Vet app now to ensure timely, expert guidance during head injury emergencies and throughout recovery in 2025! ❤️

11. Summary Table

12. Final Thoughts

Traumatic brain injury poses serious challenges—but with fast recognition, expert care, and guided rehabilitation, many horses can recover fully. Equine TBI requires a team: immediate veterinary care, advanced diagnostics, and long-term monitoring. Ask A Vet's telehealth tools ensure owners can access help quickly and confidently, supporting each horse’s safe, complete recovery into 2025 and beyond. 🧠❤️