Complications of traumatic brain injury

Abstract

Abstract: Traumatic brain injury can have a mortality rate of up to 40% in severe cases, and in those that survive the event, immediate and/or delayed complications will greatly impact life expectancy of the survivor. A complication the clinician needs to promptly recognize, prevent and manage, is cerebral herniation. It occurs when an occupying lesion causes an increase in ICP, cerebral edema, displacement and compression of cerebral parenchyma. There are 4 different types of herniation and are classified based on location: uncal, central transtentorial, subfalcine and tonsillar herniation. The delayed complications of TBI are numerous, and include: Second impact syndrome (SIS), postconcussion syndrome (PCS), posttraumatic epilepsy (PTE) and chronic traumatic encephalopathy (CTE). Second impact syndrome describes a specific form of cerebral swelling that results from a second TBI before symptoms of an initial brain injury have fully resolved. Post-concussion syndrome is an array of physical, emotional, sleep and cognitive symptoms that persist for over 3 months after a TBI. Post-traumatic epilepsy describes the occurrence of at least 2 unprovoked late-onset seizures associated with a prior TBI. The mechanism underlying this complication is still poorly understood, making it challenging for the clinician to find appropriate prophylactic measures. Chronic Traumatic Encephalopathy is a degenerative disease, mostly seen in military personnel, believed to be caused by repetitive TBIs. It encompasses four domains: cognitive, behavioral, memory and executive function; and to date can unfortunately only be diagnosed by postmortem neuropathology.