Gutiérrez-Morales JL, Alarcón-Dionet EA, Zamora-Scott JE

Language: Spanish
References: 12
Page: 105-115
PDF size: 1079.59 Kb.

ABSTRACT

Introduction: Traumatic brain injury is an insult to the brain parenchyma, which is not degenerative or congenital and involves external forces; it is accompanied by changes in the transient or permanent memory, psychological and functional features, and altered consciousness. The diffuse axonal injury is frequent in the TBI, which sometimes leads to coma and eventually to permanent disability or death of the patient.
Case report: A 17-year-old male suffered motorcycle accident. He presented to hospital with clinically poor general conditions. We proceeded to advanced airway management; endopleural tube was placed due to right pneumothorax. Surgery was performed 24 hours later finding hemoperitoneum, splenic trauma grade IV, hepatic trauma grade II, trauma transverse colon and two nonprogressive retroperitoneal hematoma. He was transferred to ICU under mechanical ventilatory assistance, hemodynamically prone to hypotension, sedation due to brain trauma and cerebral edema. Laboratory results reported anemia and leukocytosis. Gasometrical analytics showed compensated respiratory acidosis. Head CT showed the presence of bilateral maxillary hemoseno, ethmoid and sphenoid, severe cerebral edema. Subarachnoid hemorrhage on the interhemispheric fissure, and multiples hypodensities. It was diagnosed with severe brain injury, diffuse axonal injury (DAI), frontal hemorrhage and hypoxic encephalopathy. The expected outcome is an evolution to persistent vegetative state.
Conclusion: Patients suffering DAI post TBI should be evaluated early to carry out the correct therapeutic measures and thus reduce neurological sequelae.

REFERENCES

1. Villareal-Reyna G. Lesión axonal difusa, contusión y daño del tallo cerebral. [citado 12 Oct 2015] Disponible en: http://www.neurocirugiaendovascular.com

2. Garduño HF. Lesiones axonales difusas en niños con traumacraneoencefálico. Rev Mex Pediatr 2010; 77:128-131

3. Hortobágyi T, Al-Sarraj S. The Significance of Diffuse Axonal Injury: how to diagnose it and what does it tell us?. ACNR 2008; 8: 16-18.

4. Casas FC. Traumatismos craneoencefálicos. Protocolos Diagnóstico Terapeúticos de la AEP: Neurología Pediátrica 2008; 118: 118-127.

5. Smith DH, Meaney DF. Axonal Damage in Traumatic Brain Injury. Neurosci 2000; 6: 483-495.

6. Levine JM, Kumar MA. Traumatic Brain Injury. Neurocritical Care Society Practice Update. 2013

7. Meythaler JM, Peduzzi JD, Eleftheriou E, Novack TA. Current Concepts: Diffuse Axonal Injury- Associated Traumatic Brain Injury. Arch Phys Med Rehabil 2001; 82: 1461-1471.

8. Sanjith S. Traumatic axonal injury in mild to moderate head injury – an illustrated review. IJNT 2011; 8: 71-76.

9. Smith DH, Hicks R, Povlishock JT. Therapy Development for Diffuse Axonal Injury. J Neurotrauma 2013; 30: 307–323

10. Cruz BL y col. Estrategias de diagnóstico y tratamiento para el manejo del traumatismo craneoencefálico en adultos. TRAUMA 2007; 10: 46-57.

11. Guidelines for the Management of Severe Traumatic Brain Injury. Brain Trauma Foundation. J Neurotrauma 2007; 24: S7-S13.

12. Roberts I, et al. CRASH trial collaborators. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebocontrolled trial. Lancet 2004; 364: 1321-1328.