Bilateral cortical atrophy after severe brain trauma and extradural homatoma

Abstract

-We report the case of a severe head injured 43-year old male patient with a large extradural hematoma, Glasgow Coma Scale 3 and dilated fixed pupils. Patient was promptly submitted to surgical evacuation of the lesion, but remained in persistent vegetative state in the post-operative time. Head computed tomography scans performed before surgery, and at early and late post-operative periods comparatively revealed extreme bilateral cortical atrophy. Late consequences of severe head trauma drastically affect the prognosis of patients, being its prevention, and neuroprotection against secondary injury still a therapeutical challenge for neurosurgeons.KEY WORDS: brain atrophy, extradural hematoma, epidural hematoma, severe head injury, secondary injury. Atrofia cortical bilateral após traumatismo cranioencefálico grave e hematoma extraduralRESUMO -Relatamos o caso de um paciente de 43 anos, com traumatismo cranioencefálico grave, com grande hematoma extradural, Escala de Coma de Glasgow 3 e pupilas fixas e dilatadas. O paciente foi prontamente submetido à evacuação cirúrgica da lesão mas permaneceu em estado vegetativo persistente no período pós-operatório. As TC de crânio realizadas antes da cirurgia e nos períodos pós-operatórios precoce e tardio revelaram comparativamente extrema atrofia cerebral bilateral. As conseqüências tardias do traumatismo craniano grave afetam drasticamente o prognóstico dos pacientes, sendo sua prevenção, e a neuroproteção contra a injúria secundária ainda um desafio terapêutico para os neurocirurgiões. PALAVRAS-CHAVE: atrofia cerebral, hematoma extradural, hematoma epidural, traumatismo craniano grave, injúria secundária.

The Vegetative State and Stem Cells: Therapeutic Considerations

“…Note enlarged sulci, particularly in the fronto-temporal lobes (C,F) . Reproduced from Louzada et al (65) with permission.…”