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Clinical Neuroscience News, February 2013

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Case Study: Acute Closed TBI and Secondary Sequelae

Rick Madhok, MD

A 59-year-old woman was struck by an automobile after running into the road after her dogs. The impact resulted in a severe closed head wound. On arrival in the ER, her GCS was 9 and an initial CT scan showed diffuse hemorrhaging and a small frontotemporal hematoma.

After stabilization, she was moved to the ICU and placed on an intracranial pressure monitor. Over the next few days, the intracranial injury evolved, generating an increase in intracranial pressure. When the patient proved unresponsive to medical therapy, a bifrontal craniotomy was performed and a shunt was inserted into her right ventricle to provide drainage. The patient remained in the hospital for six weeks and was then discharged to a subacute rehabilitation facility.

A month later, she was readmitted to the hospital for acute secondary hydrocephalus, which required insertion of another right external ventricular drain. The patient remained in hospital for another six weeks, undergoing a bifrontal cranioplasty when the swelling subsided. Within two months she was making substantial progress, able to track moving objects and to speak haltingly. Within four months she had regained spontaneous movement of all four extremities as well as her ability to read and process written words. She continues to make progress through rehabilitation.

Acute Closed TBI Acute Closed TBI
CT scan without contrast demonstrating diffuse injury CT scan without contrast showing evolution of intracranial injury with increase of intracranial pressure.  Patient is unresponsive to medical therapy.
Acute Closed TBI Acute Closed TBI
CT scan without contrast demonstrating decompressive craniectomy CT scan without contrast demonstrating cranial reconstruction and shunt placement


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