Cautionary case: Low glasgow coma scale scores, brainstem involvement, decompressive craniectomy, full recovery, and one more reason for advocacy/collaboration

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Abstract

Presurgical selection criteria for decompressive craniectomy (DC) for treatment of severe traumatic brain injury remain controversial. Proposed criteria to improve outcomes include high admission Glasgow Coma Scale scores (≥7) and exclusion of patients having brainstem involvement. Neurosurgeons may be unaware of long-term functional outcomes in their DC patients. Therefore, to underscore an exceptional outcome that may have been facilitated by DC, while highlighting need for caution in development of potentially overly restrictive presurgical selection criteria, this case report of a 21-yr-old premed college student admitted with severe traumatic brain injury, Glasgow Coma Scale score of 3, left fixed dilated pupil, and brainstem signs, who had emergency DC, is presented. Nine years after the trauma, she was employed full time as a physician, and only residual symptom, an occasional headache, remained. Thus, caution is necessary in the development of DC presurgical selection guidelines, as this case had excellent long-term functional outcome that may have been facilitated by DC despite initial low Glasgow Coma Scale scores and signs of brainstem involvement. Also, this case highlights one more reason for multispecialty physician advocacy, collaboration, and comparative effectiveness research.

Original languageEnglish
Pages (from-to)154-158
Number of pages5
JournalAmerican Journal of Physical Medicine and Rehabilitation
Volume94
Issue number2
DOIs
StatePublished - Jan 1 2015

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Decompressive Craniectomy
Glasgow Coma Scale
Brain Stem
Patient Selection
Comparative Effectiveness Research
Pupil Disorders
Physicians
Headache
Emergencies
Guidelines
Students
Wounds and Injuries

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

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title = "Cautionary case: Low glasgow coma scale scores, brainstem involvement, decompressive craniectomy, full recovery, and one more reason for advocacy/collaboration",
abstract = "Presurgical selection criteria for decompressive craniectomy (DC) for treatment of severe traumatic brain injury remain controversial. Proposed criteria to improve outcomes include high admission Glasgow Coma Scale scores (≥7) and exclusion of patients having brainstem involvement. Neurosurgeons may be unaware of long-term functional outcomes in their DC patients. Therefore, to underscore an exceptional outcome that may have been facilitated by DC, while highlighting need for caution in development of potentially overly restrictive presurgical selection criteria, this case report of a 21-yr-old premed college student admitted with severe traumatic brain injury, Glasgow Coma Scale score of 3, left fixed dilated pupil, and brainstem signs, who had emergency DC, is presented. Nine years after the trauma, she was employed full time as a physician, and only residual symptom, an occasional headache, remained. Thus, caution is necessary in the development of DC presurgical selection guidelines, as this case had excellent long-term functional outcome that may have been facilitated by DC despite initial low Glasgow Coma Scale scores and signs of brainstem involvement. Also, this case highlights one more reason for multispecialty physician advocacy, collaboration, and comparative effectiveness research.",
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