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traumatic_brain_injury_complications

Traumatic brain injury complications

1. ≈ 75% will exhibit an traumatic intracranial hematoma

a) may be present on initial evaluation and can then worsen

b) may develop in a delayed fashion

delayed epidural hematoma (EDH)

delayed subdural hematoma (SDH)

delayed traumatic contusions

Posttraumatic diffuse cerebral edema

Tension pneumocephalus

Hyponatremia

Hypoxia: etiologies include pneumothorax, MI, CHF…

Hepatic encephalopathy

Hypoglycemia: including insulin reaction

Adrenal insufficiency

Drug or alcohol withdrawal

Dural sinus thrombosis

Carotid artery dissection (or rarely, vertebral)

c) SAH: due to rupture of aneurysm (spontaneous or posttraumatic) or carotid cavernous fistula (CCF)

Cerebral embolism: including fat embolism syndrome

Hypotension (shock)

Alzheimer’s disease

Brain abscess

Brain edema

Brain edema can result from a combination of several pathological mechanisms associated with primary and secondary injury patterns in traumatic brain injury (TBI).

As pressure within the skull increases, brain tissue displacement can lead to brain herniation, resulting in disability or death.

see Anticoagulation in traumatic brain injury.

Harris et al, suggest a link between head injury and Parkinson's disease and indicates further scrutiny of workplace incurred head injuries is warranted 1).

Cerebral contusion

Cortical cerebral contusions are one of the most common computed tomography (CT) findings in head injury 2) 3).

Cerebrospinal fluid otorrhea

Cerebrospinal fluid rhinorrhea

Chronic traumatic encephalopathy

Deep vein thrombosis

Delayed deterioration

Disseminated intravascular coagulation

Empty sella syndrome

Growing skull fracture

Nerve palsy

Olfactory loss

Olfactory loss due to head trauma is a frequent finding. It is attributed to the tearing or severing of the olfactory fibers at the cribriform plate. In contrast, posttraumatic gustatory loss is observed and reported rarely and the underlying mechanism is less understood. Rahban et al. present a case of a concomitant post-traumatic anosmia and ageusia. Imaging showed a considerable frontobasal brain damage and it is speculated that the gustatory impairment is due to a central injury of the secondary taste cortex. Based on this observation, Rahban et al.we believe that this clinical presentation might be much more frequent than previously reported 4).

Autonomic impairment after acute traumatic brain injury has been associated independently with both increased morbidity and mortality. Links between autonomic impairment and increased intracranial pressure or impaired cerebral autoregulation have been described as well. However, relationships between autonomic impairment, intracranial pressure, impaired cerebral autoregulation, and outcome remain poorly explored.

Osteomyelitis of the skull

Pituitary dysfunction

Diabetes insipidus.

see Posttraumatic hypopituitarism

hypogonadotropic hypogonadism

Postconcussive syndrome

Posttraumatic epilepsy

Posttraumatic hydrocephalus

Posttraumatic meningitis

Posttraumatic stress disorder

Pulmonary embolism

Secondary Parkinsonism

SIADH

Subdural empyema

Traumatic intracranial hemorrhage

References

1)
Harris MA, Shen H, Marion SA, Tsui JK, Teschke K. Head injuries and Parkinson's disease in a case-control study. Occup Environ Med. 2013 Dec;70(12):839-44. doi: 10.1136/oemed-2013-101444. Epub 2013 Sep 18. PubMed PMID: 24142978.
2)
Becker DP, Miller JD, Ward JD, Greenberg RP, Young HF, Sakalas R. The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg. 1977 Oct;47(4):491-502. PubMed PMID: 903803.
3)
Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger J; Surgical Management of Traumatic Brain Injury Author Group.. Surgical management of traumatic parenchymal lesions. Neurosurgery. 2006 Mar;58(3 Suppl):S25-46; discussion Si-iv. Review. PubMed PMID: 16540746.
4)
Rahban C, Ailianou A, Jacot E, Landis BN. [Concomitant anosmia and ageusia: a case report]. Rev Med Suisse. 2015 Sep 30;11(488):1787-90. French. PubMed PMID: 26619700.
traumatic_brain_injury_complications.txt · Last modified: 2019/07/04 12:53 by administrador