Acute Cognitive Impairment after Traumatic Brain Injury with Bilateral Hygroma

Evaluation and Management

The assessment of traumatic brain injury (TBI) severity should be based on clinical and radiological criteria (cranial CT scan) to determine the extent of the injury and the presence of bilateral hygromas, as recommended by the American Academy of Neurology 1
Monitoring of intracranial pressure (ICP) is recommended in patients with severe TBI and signs of intracranial hypertension on cranial CT scan, according to the Brain Injury Foundation 2

During the first days after TBI, it is recommended to restrict physical and cognitive activities to minimize symptom exacerbation, as suggested by the American Academy of Pediatrics 3, 4
In cases of refractory intracranial hypertension, consider external ventricular drainage in selected cases, as recommended by the Neurocritical Care Society 2
Craniectomy may be considered in cases of refractory intracranial hypertension after multidisciplinary discussion, according to the American Association of Neurological Surgeons 2

After the initial restriction period, patients and families should be guided to gradually resume activities that do not exacerbate symptoms, with rigorous monitoring of symptom expression, as recommended by the American Academy of Pediatrics 3, 4
Implement an active rehabilitation program with progressive reintroduction of non-contact aerobic activity that does not exacerbate symptoms, as suggested by the American College of Sports Medicine 3, 4

Patients should return to full activity when they have returned to pre-morbid performance and remain symptom-free at rest and with increasing levels of physical exertion, as recommended by the American Academy of Pediatrics 3, 4
For patients returning to school or work, advise on the process of gradually increasing the duration and intensity of academic/work activities as tolerated, according to the American Academy of Pediatrics 3