Dysautonomic crisis in patients with severe TBI in the period of rehabilitation
Keywords:
dysautonomi, brain injuries, diagnostic imaging.Abstract
Objective: to describe clinical manifestations of DC, treatment and imaging findings in patients with severe TBI during rehabilitation period.Methods: patients with severe TBI (GCS <8 in the accident) who presented DC were admitted to rehab, description of symptoms caused by the crisis, specific treatment and correlate imaging in MRI.
Results: from 59 patients, 10 (16%) had DC, 60% male, mean age 32.Hospitalization period in ICU between 24 - 150 days.
Requirements in the ICU: 60% ICP monitoring and neurosurgery, 100% Mechanical ventilation and treatment of infections, 90% received anticonvulsants. On admission to rehabilitation 60% showed DRS 9, 100% GCS <8 and 80% Rancho Los Amigos (RLA) Level II. At discharge 50% persisted GCS <8, 9, RLA DRS level II and 60% had GOS Level 2, Level 3 20% and 20% level 5.
Clinical manifestations: tachycardia 100%, 90% perspiration and hyperextension, 80% hypertension, 60% hyperthermia and abnormal movements. It was treated in emergency ward, 100% of cases with diazepam solving the clinical profile.
Neuroimaging: 100% Diffuse axonal injury, 70% intracranial hemorrhage, subdural hemorrhage 40% and 10% subarachnoid hemorrhage.
Discussion: the prognosis of these patients in the short and long term is bad, which can be translated into a worse score on functional scales. Regarding the imaging findings, the results are very heterogeneous, a type of radiological predictor of the picture cannot be identified, but it could be inferred that the Diffuse axonal injury,can be a predisposing factor.
References
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2. Mills S, Wood K. Database Update. Traumatic Brain Injury Facts and Figures January 2005;11:8 11.
3. Dirección general de estadística de la Municipalidad de Rosario, Pcia. Santa Fe, Argentina. 2004 (obtenido de la base del hospital de emergencia Clemente Álvarez, 21 de junio de 2010).
4. Fundación Luchemos por la vida. Disponible en red: www.luchemos.org.ar (obtenido el 23 de junio de 2010).
5. Marchio P, Previgliano I, Goldini E, Murillo-Cabezas J. Traumatismo craneoencefálico en la ciudad de Buenos Aires: estudio epidemiológico prospectivo de base poblacional. Neurocirugía 2006;17:14-22.
6. Harrison CL. Traumatic Brain Injuryregistries in the United States: and overview. Brain Injury 1992;6:203-212.
7. Brain Trauma Foundation. American Association of Neurological Surgeons. Part 2: early indicators of prognosis in severe traumatic brain injury. New York: Brain Trauma Foundation 2000.http://www. braintrauma.org/guidelines (obtenida el 10 de junio de 2010).
8. Bermejo Pareja, E. Díaz Guzmán, J. Porta- Etessam J. Cien escalas de interés en Neurología. Prous Science 2001;2.
9. Gabbe J, Cameron P, Finche P. The status of the Glasgow Coma Scale. Emergency Medicine 2003;15:353-360.
10. Moore L, Lavoie A, Camden C. Stadistical Validation of the Glasgow Coma Score. J Trauma 2006;60:1238-1244.
11. Fernández-Ortega JF, Prieto-Palomino MA, Muñoz-López A, Lebrón-Gallardo M, Arias- Verdú D, García-Caballero M, Quesada- García G. Crisis disautonómicas en pacientes ingresados en una unidad de cuidados intensivos tras un traumatismo craneoencefálico grave. Rev Neurol 2004;39(8):715-718.
12. Expósito-Tirado JA, Forastero Fernández-Salguero P, Cruz-Reina MC, Del Pino-Algarrada R, Fernández-Luque A, Olmo-Vega JA, Rodríguez-Burgos MC. Complicaciones de los traumatismos craneoencefálicos en una unidad hospitalaria de rehabilitación: serie de 126 casos. Rev Neurol 2003;36(12): 1126-1132.
13. Young P, Finn B, Pellegrini D, Soloaga E, Buetman J. Tormenta simpática paroxística siguiendo a injuria axonal difusa. Rev Medicina (Buenos Aires) 2006;66:439-442.
14. De Tanti A, Gasperini G, Rossini M. Paroxysmal episodic hypothalamic instability with hypothermia after traumatic brain injury. Brain Inj 2005;19:1277-1283.
How to Cite
1.
Longoni M, Bennazar L. J, Tejada V. J, J. G. Dysautonomic crisis in patients with severe TBI in the period of rehabilitation. Rev. Colomb. Med. Fis. Rehabil. [Internet]. 2012 Apr. 14 [cited 2024 May 11];21(1):49-54. Available from: https://revistacmfr.org/index.php/rcmfr/article/view/6
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