title: Delayed onset massive oedema and deterioration in traumatic brain injury.
abstract: A 52-year-old man fell from standing and a computed tomography (CT) scan revealed traumatic intracerebral haematoma and subarachnoid haemorrhage in the temporal cortex. He was treated without surgery and discharged. On day 30 after the accident, he had no neurological deficit. On day 37 he complained of headache and urinary incontinence, and on day 39 he was hospitalized due to progressive neurological deterioration (reduced conciousness, dilated pupils, and left hemiplegia). A CT scan revealed a diffuse low-density in the right cerebral hemisphere with marked midline shift. Emergency decompressive craniectomy and right temporal lobectomy were performed. Angiography after surgery revealed moderate vasospasm in the right middle and anterior cerebral arteries. The patient remained severely disabled. Delayed onset neurological deterioration can be caused by brain oedema and vasospasm after traumatic brain injury, despite an intervening period of improvement.
authors.affiliation: Department of Neurosurgery, Awaji Hospital, Sumoto, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kohta
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Minami
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tanaka
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kuwamura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kondoh
authors.forename: Eiji
authors.initials: E
authors.lastname: Kohmura
mesh_terms: D000058:Accidental Falls; D001929:Brain Edema / Q000150:complications / Q000209:etiology* / Q000473:pathology; D001930:Brain Injuries / Q000150:complications* / Q000473:pathology; D019299:Decompression, Surgical; D006233:Persons with Disabilities; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000473:pathology; D013702:Temporal Lobe / Q000293:injuries* / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000150:complications / Q000209:etiology* / Q000473:pathology