Severe Traumatic Brain Injury: A Case Report

Abstract

Background: Traumatic brain injury remains a challenging and complicated disease process to care for, despite the advance of technology used to monitor and guide treatment. Currently, the mainstay of treatment is aimed at limiting secondary brain injury, with the help of multiple specialties in a critical care setting. Prognosis after TBI is often even more challenging than the treatment itself, although there are various exam and imaging findings that are associated with poor outcome. These findings are important because they can be used to guide families and loved ones when making decisions about goals of care.

Case report: In this case report, we demonstrate the unanticipated recovery of a 28-year-old male patient who presented with a severe traumatic brain injury after being in a motorcycle accident without wearing a helmet. He presented with several exam and imaging findings that are statistically associated with increased mortality and morbidity.

Conclusions: The care of severe traumatic brain injuries is challenging and dynamic. This case highlights the unexpected recovery of a patient and serves as a reminder that there is variability among patients.

Figure 1.

10/30/14 Presenting Head CT showing traumatic subarachnoid hemorrhage in sylvian fissure and left frontal and temporal subdural hemorrhage.

Figure 2.

10/30/14 Presenting Head CT showing effaced suprasellar cistern and left temporal subdural hemorrhage.

Figure 3.

10/30/14 Presenting Head CT showing cerebral edema with effacement of third ventricle, bilateral traumatic subarachnoid hemorrhage, and left frontal/temporal subdural hematoma.

Figure 4.

10/30/14 Presenting Head CT showing left frontal and parietal subdural hematoma, bilateral traumatic subarachnoid hemorrhage, and cerebral edema worse in left hemisphere with 5.38 mm of left to right midline shift.

Figure 5.

10/30/14 CT head after left craniectomy for decompression showing improved midline shift and evolving bilateral traumatic subarachnoid hemorrhage.

Figure 6.

10/30/14 Head CT after ventriculostomy showing catheter tip in frontal horn of right lateral ventricle.

Figure 7.

11/1/14 Chest x-ray showing bilateral interstitial infiltrate and left base atelectasis and pleural effusion.

Figure 8.

11/4/14 Chest x-ray showing worsening interstitial and alveolar infiltrates and pleural effusions bilaterally.

Figure 9.

11/14/14 New left occipital horn intraventricular hemorrhage, increased external herniation of left frontal contusion, and resolving diffuse cerebral edema with decreased effacement of third ventricle.

Figure 10.

8/3/15 Improved external herniation and increase in hydrocephalus secondary to prior brain injury.