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CASE REPORT
Year : 2019  |  Volume : 16  |  Issue : 4  |  Page : 244-246

Pericontusional penumbra in patients with traumatic brain injury


1 Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
2 Department of Anesthesia, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
3 Neurosurgery-Critical Care, RED LATINO, Organizacion Latinoamericana de Trauma y Cuidado Neurointensivo, Bogota, Colombia

Correspondence Address:
Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_23_19

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Recently, a number of studies have recognized the importance of traumatic pericontusional penumbra as a potential target for therapeutic interventions to prevent the secondary brain damage. We report an illustrative case of a 40-year-old female patient who was brought to the emergency room with the alleged history of fall from the bike. Computed tomography scan brain showed left sylvian and left temporoparietal subarachnoid hemorrhage, patchy contusion of the left frontal and temporal lobes, linear fracture of the right temporal bone with edema, mass effect, and mild midline shift. After 6 h of intensive care unit stay, the patient developed pupillary asymmetry and a repeat scan showed significant increase in the size of cerebral contusions with gross pericontusional edema, mass effect, and midline shift. The patient underwent urgent left frontotemporoparietal craniotomy and evacuation of the contused brain and hematoma. Pericontusional penumbra is increasingly recognized and strategies are being suggested to salvage the apparently hypoxic (not yet ischemic) brain to preserve the neurological functions and to improve functional outcome. In future, we need more studies to support the concept of pericontusional penumbra and further characterize the imaging findings for early clinical diagnosis and to plan early appropriate intervention.


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