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Brain Injury: Complications and Medical Problems

Rehabilitation Institute of Chicago-Brain Injury Team, Rehabilitation Institute of Chicago, LIFE CENTER

Brain Injury: Complications and Medical Problems

Many medical issues may arise during the hospitalization of someone with a brain injury. This briefly discusses some of the most commonly encountered complications. Please check with your health care team for additional information.

Fever and Infection

Infections are very common after a brain injury. Usually the first evidence that a person has an infection is a fever. The most common locations of infections are the lungs (pneumonia) and the bladder. That is why when a patient has a temperature, the physician will often order tests of the urine, known as a urinalysis and culture, as well as an x-ray of the chest. Once the location of the infection is discovered, antibiotics are started to treat the infection.

Conditions other than infections can cause fevers. These include blood clots and heterotopic bone, which are discussed later. Sometimes the fever can be a result of the brain injury itself and not the result of an infection. This happens when the part of the brain that controls the body’s temperature is damaged.

Blood Clots (Deep Venous Thrombosis)

This condition refers to blood clots that form in the legs, not the brain, of people. These clots are very common in people with brain injuries; they occur in approximately 40 percent of patients. These clots can break off from the blood vessels of the leg and travel to the lungs where they can cause severe damage or even death. For this reason, your team will be monitoring closely for signs that they have developed. In addition, the person may be given medicine (such as an injection of a “blood thinner”) to reduce the risk of their development.

Should the physician suspect that a blood clot has formed, he or she may order a test called Dopplers or blood flows. If a clot in the lung is suspected, a test called a spiral CT scan may be ordered. If a blood clot is discovered, most likely the person will be started on a strong blood thinner to treat it.

Seizures (Epilepsy)

The risk of seizures depends on the type of injury. In people with a closed head injury, about five percent will develop seizures. In those with a penetrating injury, the percentage can approach 50 percent. A seizure occurs when a part of the brain becomes active on its own. The symptoms of the seizure depend on which area of the brain is involved. For instance, if the area of the brain that controls movement of the arm is affected, the seizure would consist of twitching or shaking of that arm. Not all seizures involve movement. Instead, they can cause an abnormal sensation in the body or changes in mental function. Usually, however, seizure in people with brain injuries can cause a loss of consciousness and shaking of the whole body.

If a person has not had a seizure, the physician may still decide to start an antiseizure (anticonvulsant or anti-epileptic) medicine to help prevent seizures. This decision is based on issues such as the risk of someone having a seizure and the side effects of the medication. When the risk of developing seizures is low, the physician may decide not to start a medicine, unless the patient actually has a seizure. Sometimes, results of a test known as an EEG test may be obtained to help make the decision.

If a patient has already had one or more seizures, especially that occurred 24 hours after the injury, the person will be treated with anti-epileptic medicines. Most likely, the person will remain on these medicines for six months to one year, at which time the need for them will be reassessed.

Hydrocephalus

This condition occurs when there is a build up of fluid in the hollow spaces of the brain known as ventricles. This extra fluid can squeeze the rest of the brain and cause symptoms. The symptoms are not very specific, however. Often, the first signs may be a subtle change in a patient’s level of arousal or a slowing of his or her recovery. Of course, many other factors can cause these changes. The physician may order a CT scan if hydrocephalus is suspected.

If the CT scan shows that the patient has hydrocephalus, then a decision will be made in consultation with the neurosurgeon about the type of hydrocephalus and if it would improve with the placement of a shunt. Hydrocephalus is thought to occur in about five percent of people with brain injuries. The percentage is higher in those people with severe brain injuries.

Heterotopic Ossification

This refers to formation of extra bone in the body. The extra bone most often forms in the large joints of the body such as the hip or the shoulder. It can cause pain, swelling, inflammation and tightening of the joint. No one knows for certain why people with brain injuries and other conditions are likely to develop heterotopic bone formation. However, approximately 10 to 20 percent of people with brain injuries develop it.

If the physician suspects it, he or she may order tests to help diagnose it. These tests include not only plain x-rays, but sometimes a test called a bone scan. If a person is diagnosed with heterotopic ossification, the treatment can include range of motion exercises by the therapists, medicines or even surgery.

Fractures and Nerve Injuries

Because most people with brain injuries have been involved in trauma, for instance an automobile collision, they are likely to have other injuries as well. Approximately 30 percent of people with brain injuries have fractures and the same number have injuries to the nerves of the arms and legs. Sometimes, these injuries are not discovered until the person is in rehabilitation. Several reasons exist for this. During the initial hospitalization, the focus is on life threatening conditions. Other more minor issues are not a priority. Also, many fractures and nerve injuries are extremely difficult to diagnose when someone is comatose or minimally conscious because the primary symptoms of these injuries are pain and difficulty moving. As a person becomes more alert, however, the team may order additional tests, such as x-rays or an EMG, (see “Common Tests and Procedures”) to diagnose the problem.

High Blood Pressure (Hypertension)

Less than 10 percent of people will have high blood pressure after a brain injury. This is usually because of damage to the part of the brain that controls blood pressure but your physician may run tests to eliminate other possible causes. The patient will also be started on a medicine to help control the blood pressure (it is called an anti-hypertensive).

Spasticity

This is one of the most common problems faced by people with brain injuries. In this situation, certain muscles of the body are tight or hypertonic because they cannot fully relax. For instance, the elbow can be bent almost completely, so that the hand is almost to the shoulder. If one tried to straighten the elbow out, it would be extremely difficult because of the tightness. Spasticity prevents the person from using the body part and can be painful. Besides, even when the person would be unable to use the body part anyway, for instance, because it is paralyzed, the spasticity can interfere with the ability of another to provide care. For example, if the elbow is bent as described earlier, it may be impossible to dress the patient or even clean the crook of the elbow.

Therapies play a crucial role in the treatment of spasticity. In addition, the patient may be started on a medicine to help relax the muscles. Other treatment options are nerve block, botulinum toxin injections and surgery.

Other Problems

Issues with respiratory care including tracheostomies, feeding and nutrition including feeding tubes, swallowing problems including aspiration, bowel and bladder management and skin breakdown are covered in other sections of this guide.

Copyright 2008 Rehabilitation Institute of Chicago, LIFE Center. Reprinted with permission. www.ric.org.

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