Medical complications of head injury

Kaufman, Howard H.; Timberlake, Gregory A.; Voelker, Joseph L.; Pait, T. Glenn

doi:10.1016/s0025-7125(16)30271-1

Cited by 68 publications

(35 citation statements)

References 60 publications

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“…Disorders of salt and water balance, in particular diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), are common complications in the acute phase of traumatic brain injury (TBI) (1). Available information on the frequency of post-traumatic DI is principally derived by retrospective data collection (2,3) and there have been no prospective studies attempting to accurately define the natural history of DI following TBI.…”

Section: Introductionmentioning

confidence: 99%

The natural history of post-traumatic neurohypophysial dysfunction

Agha¹,

Sherlock²,

Phillips³

et al. 2005

eur j endocrinol

155

124

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Background and objectives: Posterior pituitary function remains poorly investigated after traumatic brain injury (TBI). We report the results of a study designed to prospectively define the natural history of post-traumatic diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) using standard reliable methodology. Design and methods: 50 consecutive patients with severe or moderate TBI (initial Glasgow Coma Scale (GCS) score 3/15 -13/15) were prospectively studied on three occasions: at the acute phase and at 6 months and at 12 months following TBI. In the acute phase, DI was diagnosed either by the presence of hypernatraemia in association with hypotonic polyuria or by the water-deprivation test (WDT) and, at 6 and 12 months by the WDT in all patients. Normative data on response to the WDT were obtained from healthy matched volunteers. Functional outcome was assessed using the Glasgow Outcome Scale (GOS). Results: 13 patients (26%) had DI in the acute post-TBI phase, of whom nine patients recovered by 6 months and one additional patient recovered by 12 months. Of the remaining three patients with permanent DI, two had partial vasopressin deficiency. Acute-phase peak plasma osmolality correlated negatively with the initial GCS scores (r ¼ 2 0.39, P ¼ 0.005) and with the GOS scores (r ¼ 20.45, P ¼ 0.001). Seven patients had SIADH in the acute phase of TBI but none did at 6 or 12 months. No new cases of DI or SIADH were noted after the acute phase.Conclusion: This prospective study shows that posterior pituitary dysfunction is common following TBI. Most cases recover completely but there is an appreciable frequency of long-term DI which can be subtle and should be recognized and managed appropriately.

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Section: Introductionmentioning

confidence: 99%

The natural history of post-traumatic neurohypophysial dysfunction

Agha¹,

Sherlock²,

Phillips³

et al. 2005

eur j endocrinol

155

124

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“…The HO frequency in TBI patients varies from 10-22.5% 10, 16 . DVT and secondary pulmonary emboli also occur frequently in TBI patients 26,32 . None of our patients presented with HO or DVT.…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation outcome after traumatic brain injury

2007

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SummaryRehabilitation goals after traumatic brain injury are improving function, increasing the level of independence as high as possible, preventing complications and providing an acceptable environment to the patient. Several complications can be encountered during the rehabilitation period which lead to physical, cognitive and neurobehavioral impairments that cause major delay in functional improvement. This prospective study was designed in order to investigate the complications and their relations with functional recovery in patients that were included in the acute phase of a rehabilitation program.Thirty traumatic brain injured patients admitted to the Intensive Care Units of Uludag University School of Medicine were included in the study. Rehabilitation program consisted in appropriate positioning, range of motion exercises, postural drainage and respiratory exercises. Complications that were encountered during intensive care rehabilitation program were recorded. All patients were evaluated by Functional Independence Measure, Disability Rating Scale and Ranchos Los Amigos Levels of Cognitive Function Scale at admission and discharge.Improvement was observed in patients in terms of functional outcome and disability levels. Pneumonia, athelectasis, anemia and meningitis were the most frequent complications. Deterioration in functional outcome and disability levels was noted as the number of these complications increased.In conclusion, rehabilitation has an important role in the management of traumatic brain injured patients. Reduction of frequency of complications and improvement in functional outcome and disability levels can be achieved through rehabilitation programs. Long-term controlled studies with large number of patients are needed in order to obtain accurate data on factors associated with rehabilitation outcomes.KEY WORDS: Traumatic brain injury. Rehabilitation. Complication. Resultados de la rehabilitacion despues de sufrir un traumatismo craneoencefálico ResumenEntre los objetivos de la rehabilitación después de un traumatismo craneoencefálico está la mejoría de la función cerebral el aumento del grado de independencia la prevención de complicaciones y la obtención de un ambiente acceptable para el paciente. Durante el período de la rehabilitación pueden producirse varias complicaciones que conducen a discapacidades físicas, cognitivas y otras neurológicas que causan un importante retraso en la mejoría funcional. Este estudio ha sido diseñado para investigar las complicaciones observadas en los pacientes que se incluyeron en un programa de rehabilitación en fase aguda, sus relaciones con el estado funcional y los factores que tienen impacto en los resultados de la rehabilitación.Se incluyen en el estudio treinta pacientes con traumatismo craneoencefálico admitidos en la Unidad de Cuidados Intensivos de la Escuela de Medicina de la Universidad de Uludag. El programa de rehabilitación consistió en rehabilitación postural, una serie de ejercicios de movimiento, y ejercicios respiratorios. Se regist...

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“…Dysnatraemias are the commonest biochemical abnormalities occurring early after TBI (34). One study of 38 patients five weeks after TBI defined 8 patients (21%) as having DI, on the basis of paired plasma and urine osmolalities (35).…”

Section: Posterior Pituitarymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients

Garrahy

Sherlock

Thompson

2017

European Journal of Endocrinology

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Advances in the management of traumatic brain injury, subarachnoid haemorrhage and intracranial tumours have led to improved survival rates and an increased focus on quality of life of survivors. Endocrine sequelae of the acute brain insult and subsequent neurosurgery, peri-operative fluid administration and/or cranial irradiation are now well described. Unrecognised acute hypopituitarism, particularly ACTH/cortisol deficiency and diabetes insipidus, can be life threatening. Although hypopituitarism may be transient, up to 30% of survivors of TBI have chronic hypopituitarism, which can diminish quality of life and hamper rehabilitation. Patients who survive SAH may also develop hypopituitarism, though it is less common than after TBI. The growth hormone axis is most frequently affected. There is also accumulating evidence that survivors of intracranial malignancy, who have required cranial irradiation, may develop hypopituitarism. The time course of the development of hormone deficits is varied, and predictors of pituitary dysfunction are unreliable. Furthermore, diagnosis of GH and ACTH deficiency require dynamic testing that can be resource intensive. Thus the surveillance and management of neuroendocrine dysfunction in neurosurgical patients poses significant logistic challenges to endocrine services. However, diagnosis and management of pituitary dysfunction can be rewarding. Appropriate hormone replacement can improve quality of life, prevent complications such as muscle atrophy, infection and osteoporosis and improve engagement with physiotherapy and rehabilitation.

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Medical complications of head injury

Cited by 68 publications

References 60 publications

The natural history of post-traumatic neurohypophysial dysfunction

The natural history of post-traumatic neurohypophysial dysfunction

Rehabilitation outcome after traumatic brain injury

MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients

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