RESUMO
Introduction: Patient age and severity of brain injury are validated prognostic indicators in patients with polytrauma. This prospective observational study was conducted to study the influence of extracranial injuries on neurological outcome of patients with traumatic brain injury [TBI]
Methodology: Patients with TBI aged 20-60 years were enrolled and categorized into two groups: Group 1- with extracranial injuries; Group 2- without extracranial injuries. Patients with fixed and dilated pupils, brainstem injuries, delay of more than 24 hours for hospitalization, and patients who developed secondary insults were excluded
Results: Complete follow up and data collection was feasible in 33 patients of Group 1 and in 47 patients of Group 2. Severity of head injury, SOFA score, co-morbid conditions, duration of hospital stay, mortality, GCS scores on admission and delta GCS [GCS on admission - GCS at time of discharge] were comparable between the two groups. The duration of mechanical ventilation and the ISS scores were significantly higher in patients with extracranial injuries. Extracranial injuries did not influence the survival rate. Severity of head injury was the prime determinant of survival. Extracranial injuries were shown to have a synergistic effect on morbidity
Conclusion: Presence of extracranial injuries does not influence the outcome of patients with head injuries in which secondary insults like hypoxia, hypercapnia / hypocapnia, hypotension, hyperpyrexia, hypoglycemia / hyperglycemia and intracranial hypertension are avoided
RESUMO
We report a case of a 45-year-old female undergoing an emergency ventriculoperitoneal shunt surgery. The patient had brain metastatic lesions of breast carcinoma with associated hydrocephalus. She had received Adriamycin as a part of chemotherapy regimen for breast cancer. Her preoperative cardiovascular status was normal. Under general anesthesia, the patient had a sudden cardiovascular collapse. The patient had a pulseless electrical activity and required inotropic support for cardiovascular stability. The possible cause is discussed