Exploration of assistance and rehabilitation possibilities for neurosurgical patients with late complications after craniocerebral injuries based on one patient case
More details
Hide details
Division of Neurosurgery, the University of Warmia and Mazury Hospital with the Independent Health Care Center in Olsztyn, Poland
Department of Neurology and Neurosurgery, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Poland
Joanna Białkowska   

Department of Neurology and Neurosurgery, Faculty of Medical Sciences, University of Warmia and Mazury, Warszawska 30, 10-082 Olsztyn, Poland. Tel.: +4889 728 32 33 18; fax: +4889 524 53 84.
Submission date: 2011-06-27
Acceptance date: 2011-11-01
Publication date: 2020-04-10
Pol. Ann. Med. 2012;19(1):58–62
Craniocerebral injuries (CCIs) are the most frequent causes of death and longterm disability concerning people younger than 25 years of age in Poland. Their incidence is 180–220 per 100 thousand people. According to available data, 10% of patients after head injury suffer from severe craniocerebral trauma defined as a condition in which the level of awareness and responsiveness remains significantly decreased after resuscitation or worsens within 48 h following injury. Currently, due to the advances in knowledge and development of technology in the field of neurosurgery and anesthesiology, more and more patients survive and consequently require additional diagnosis, surgery and prolonged rehabilitation.

The aim of this work was to present the case of a patient with craniocerebral trauma, who remained in a vegetative state for 8 months, and then, following the surgical treatment of late complications in the form of hydrocephalus performed in the Division of Neurosurgery at the University Hospital in Olsztyn and long-term rehabilitation, regained full mobility.

Material and methods:
The study is based on the analysis of medical records concerning a patient treated in numerous centers for 16 months after craniocerebral trauma.

Results and discussion:
The most common complications after CCIs include coma, impaired cognition, multiple joint contractures, hydrocephalus, ossification mainly related to hips, knees, shoulders and elbows, urinary tract infections and respiratory tract infections. Often these patients have undergone a tracheotomy, have had catheters inserted into their bladders, and are fed by probe. Inadequate care and a deficiency in protein and vitamin supplements can result in the development of decubitus ulcers. A patient after craniocerebral trauma requires intense movement rehabilitation, neuropsychological and neurologopedic rehabilitation. It is necessary to proceed appropriately in order to achieve bladder automaticity. After the stabilization of vital signs, the patient should be included in a comprehensive diagnostic and rehabilitation program provided by neurologists, neurosurgeons, orthopedic surgeons, ENT physicians, specialists in rehabilitation and physiotherapy, based on specified standards. Nurses and other care providers, medical and other health care personnel dealing with such patients should be adequately trained. The patient’s family needs to be educated as well.

Patients after CCIs require long-term interdisciplinary monitoring and periodic diagnostic tests. Consequently, a long-term plan concerning the treatment of such patients should be developed.

None declared.
Białkowska J, Janowska E. Rehabilitacja behawioralna chorych po udarze mózgu leczonych w oddziale rehabilitacji ZOZ MSWIA z WMCO w Olsztynie [Behavioral rehabilitation of patients after stroke treated in the rehabilitation ward at the Health Centre of the Ministry of Internal Affairs and Administration and the Warmia and Mazury Oncological Centre]. Rocz Med. 2007;14(1):53–58.
Białkowska J, Januszko L. Pourazowy zespół apaliczny – program rehabilitacji [Post-traumatic apallic syndrome – rehabilitation programme]. Poste˛py Rehabil. 1999;13(2):121–125.
Broder JS. Head computed tomography interpretation in trauma: a primer. Psychiatry Clin North Am. 2010;33(4):821–854.
Greenberg MS. Handbook of Neurosurgery. New York: Thieme; 2006.
Maksymowicz W. Neurochirurgia w zarysie [Outline of Neurosurgery]. Warszawa: PZWL; 1999.
Masson F, Thicoipe M, Aye P, Mokni T, Senjean P, Schmitt V, et al. Epidemiology of severe brain injuries: a prospective population-based study. J Trauma. 2001;51(3):481–489.
Omalu BI, Fitzsimmons RP, Hammers J, Baiks J. Chronic traumatic encephalopathy in a professional American wrestler. J Forensic Nurs. 2010;6(3):130–136.
Stabrawa R, Trzebiński H, Grochmal-Bach B, Markiewicz K, Olszewski H, Łapkiewicz E. Frontal syndrome in patients awakened from prolonged post-traumatic coma. Acta Neuropsychol. 2008;6(3):268–278.
Szrajber B, Pufal A, Wójcik A. Ocena systemu rehabilitacji i jakości życia pacjentów po przebytej śpiączce pourazowej [Assessment of rehabilitation and the quality of life in patients awakened from posttraumatic coma]. Postępy Rehabil. 2009;23(1):21–28.