Concurrent traumatic brain injury with aortic injury: Management dilemmas

Abstract

Background: Occurrence of concurrent traumatic brain injury and aortic injury is rare and potentially fatal trauma pattern. The incidence of traumatic brain injury associated with aortic injury is likely to be underestimated because many patients with this pathology die prior to hospital admission or imaging study. Even after diagnosis, there are difficulties in managing such a patient as different approaches are required to treat each of them. Case report: A 68-year-old man with head injury and blunt chest injury was operated. He had right frontotemporal subarachnoid haemorrhage with fracture of left temporal bone with hemopneumothorax and multiple rib fractures on the left side of the chest. Patient was evaluated with plain CT scan and CT angiogram of brain. Contrast enhanced CT scan of chest revealed rupture of the arch of aorta. Head injury was managed conservatively and emergency aortic stent grafting was done. Discussion and conclusion: Aortic injury may be missed, so the emergency physician should have high index of suspicion while dealing with polytrauma patient instead of just focussing on head injury. Head injury and aortic injury occurring together need different treatment methods which can have conflict. (A) In aortic injury, maintaining a lower systolic blood pressure is essential to prevent further haemorrhage. On the contrary blood pressure should be maintained at normal level for adequate cerebral perfusion in head injury. (B) Sedation required for aortic injury can interfere with the clinical assessment of a patient with traumatic brain injury. (C) Anticoagulants used in the treatment of aortic injury are usually contraindicated in head injury. The treatment needs a team approach by neurosurgeon, endovascular cardiologist, cardiac surgeon, emergency physician, and critical care intensivist etc., to manage patients of traumatic brain injury with aortic injury.

Keywords

• Traumatic brain injury
• aortic injury
• fatal combination