Complications of Traumatic Brain Injury

Many additional medical problems, namely complications, may develop in patients with brain damage. Care should be taken in terms of complications both in the acute period and during the physical therapy and rehabilitation process .

Fever and Infection

Infections are common problems after brain injury. Usually, they first show symptoms with fever. Lung and urinary tract infections are the most common infections. For this reason, when fever is high in a patient with brain damage, urinalysis, urine culture and chest x-ray are taken together with blood tests. Antibiotic treatment is started when the focus of infection is determined. Initially, treatment is started for the most common microorganisms; this is called empirical therapy. When blood, urine or sputum cultures come out after a few days, it may be necessary to change the antibiotic for the causative microorganism.

Fever may also occur for non-infectious reasons. Conditions such as the formation of a clot in the vein or the formation of a clot in the muscle, and bone formation in the muscle can also cause fever. Sometimes the brain injury itself can be responsible for the fever. The part of the brain called the hypothalamus regulates body temperature. In damage to the hypothalamus, the control of body temperature may be impaired.

Formation of Clot in the Vein

Intravascular clot formation is most commonly seen in the veins of the legs. This condition is called deep vein thrombosis (DVT). DVT can occur in almost 40% of brain injury patients. The main importance of clot formation is due to the risk that the clot will break off from where it formed and mix with the circulation and block the pulmonary vessels. Symptoms of DVT are swelling, redness, and pain where the clot formed. Doppler ultrasonography can be performed if DVT is suspected. If the clot reaches the lung, this condition is called pulmonary thromboembolism. If pulmonary thromboembolism is suspected, lung computed tomography (CT) and CT angiography examinations may be required.

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Patients with brain damage should be followed closely in terms of DVT and anticoagulant and anticoagulant treatment should be started when necessary.

Epilepsy (Seizure)

An epileptic seizure is a self-activating part of the brain. The risk of seizures may vary depending on the type of damage. While the risk of developing a seizure is 5 percent in closed head injuries, the rate increases to 50 percent in penetrating injuries in which the brain tissue is directly affected. Seizure symptoms may differ according to the activated brain tissue. For example, activity in the part of the brain that controls the arm can lead to involuntary arm movements. Sometimes it may present as abnormal sensation or loss of consciousness. Anti-seizure medications can be started in patients at high risk of seizures. For the decision to start medication, brain waves can be evaluated with EEG examination. If the patient has had a seizure after brain damage, anti-seizure drugs called antiepileptic are started. The duration of use of these drugs varies from patient to patient; six month,

Hydrocephalus (Increased Water in the Brain)

There are spaces in the brain where fluid called cerebrospinal fluid circulates. As a result of brain damage, the channels through which this fluid circulates may become blocked; There may be fluid accumulation. This is called hydrocephalus. It is estimated to occur in about five percent of patients with brain damage. The fluid increase can compress the brain tissue. The symptoms of hydrocephalus can be vague. Deterioration in the level of consciousness, slowdown in recovery or even regression can be seen. If hydrocephalus is suspected, a brain CT is performed.

If there is hydrocephalus, it is evaluated by a neurosurgeon. Shunt surgery can be performed depending on the situation. In this surgery, cerebrospinal fluid is allowed to flow from the place where it accumulates through a channel.

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Intramuscular Calcification (Heterotopic Ossification)

A complication called heterotopic ossification may occur in 10-20 percent of patients with brain damage. Extra bone tissue occurs around the patient’s large joints such as shoulders, hips, and knees. It gives symptoms such as pain, swelling, temperature increase, stiffness. This bone tissue can be seen on X-rays. In the early period, scintigraphy may be useful in the diagnosis.

Fractures and Nerve Injuries

In most of the brain injuries, there are additional problems such as other fractures and nerve injury as a result of trauma. Nerve injury may occur in the arm or leg. Since brain damage is a vital problem, other injuries may be overlooked in the first days or their treatment may be secondary. It is difficult to detect nerve damage in an unconscious or drowsy patient. In the rehabilitation process, it is necessary to pay attention to these problems.

Hypertension

Hypertension may develop in some brain-damaged patients. Injury to the part of the brain that controls blood pressure can lead to this.

Spastisite

Due to the loss of control of the brain over the muscles, the tension of the muscles on the affected side of the body may increase; Involuntary muscle contractions may occur. This is called spasticity. The wrist, fingers and elbow of the patient with spasticity may remain in a bent position. If care is not taken, stiffness or contracture may occur in the joints. Spasticity can cause pain and make movements difficult. Joint movements, stretching exercises, splinting, anti-spasticity drugs, botulinum toxin A injections are the methods that can be used in treatment.

Other Complications

Tracheostomy may be required in patients with respiratory problems. Complications may develop due to tracheostomy. Pressure sores may occur if the patient is not positioned appropriately and if frequent position changes are not taken into account. Problems with urination can lead to different problems.

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