Is `brain swelling' a clinical particular kind of severe brain injury?

Introduction

Brain swelling (BS) is a kind of response observed in 15%–20% of severe head injury. Its pathophysiology is not well known yet, and its diagnosis is exclusively scanographic in emergency.

Objectives

To determine a particular difference between BS and the other kinds of severe brain injuries in their epidemiological, clinical, biological signs and evolutive result.

Material and methods

In the past 5 years, among 400 severe brain injured patients (gun shot excluded) with a Glasgow Coma Score ≤ 8.88 (22%) showed scanographic BS: no mass lesion and ventricles, cortical sulcal, basal cisterns effacement.

All patients were treated according to EBIC guidelines and epidemiological, clinical, biological, evolutive parameters were compared to these of the 312 other patients with standard traumatic lesions (STL).

Results

Whereas severity is the same in the two groups (GCS-STL = 5.07 ± 1.76/GCS-BS = 5.05 ± 1.43), three parameters, age, coagulation and evolution are different.

Age

BS is more frequent among young patients (STL = 40.31 ± 20.42 years, BS = 25.92 ± 10.14 years; P < 10^–9). No patient > 50 years developed BS. Is the reason a higher brain compliance in young patients?

Coagulation

No biological sign is different in the two groups except coagulopathy (STL = 30/254, BS 16/58; P = 0.02). More generally, BS patients (haemorrhagic shock excluded) have an intravascular brain thromboplastin rush which seems to show that BS does not result from hyperhaemia only, but from mass commotion too (Table 1).

Evolution

After 6 months, BS patients seem to have a better Glasgow outcome scale in regards with baseline GCS (Table 2).

Figure

In BS-GCS = 4-5, death and severe disability are leaded by associated primary brain stem lesion or secondary uniform herniation. In BS-GCS = 6-8, about 95% will get a social activity.

Table 1

Table 2