Al Jadid Maher, Alshahri Saeed, Alturki Feras, Al Ahmeri Abdullah, Alomair Abdullah, Buizran Dunya
Department of Rehabilitation Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
J Family Med Prim Care. 2025 Sep;14(9):4088-4090. doi: 10.4103/jfmpc.jfmpc_1691_24. Epub 2025 Sep 29.
This case study examines the clinical process of a 19-year-old male who sustained a severe traumatic brain injury (TBI) at age 17 following a road traffic accident (RTA), initially managed in intensive care unit (ICU) at a local private hospital, and subsequently transferred to a major tertiary hospital for advanced trauma care. The patient experienced critical complications, including elevated intracranial pressure (ICP), requiring decompressive craniotomy and placement of an external ventricular drain (EVD). Persistent cerebrospinal fluid (CSF) leaks and infections, including a Staphylococcus epidermidis infection, necessitated multiple surgical interventions and antibiotic treatments. Following initial stabilization, the patient was transferred to Prince Sultan Military Medical City (PSMMC) where he continued treatment and rehabilitation, including coma stimulation therapy (CSP), physical and occupational therapy, and medication adjustments. The patient's condition evolved from a comatose state with a Glasgow Coma Scale (GCS) score of 8/15 to a GCS score of 14/15. He showed significant improvements in cognitive function, including the ability to recognize and name action verbs, and progress in automatic speech. Despite ongoing severe dysarthria and cognitive impairment, notable gains in cognitive, functional, and speech capacities were observed through intensive rehabilitation efforts. This case highlights the complexity and necessity of a comprehensive and adaptive care strategy in managing severe TBI, underscoring the potential for recovery with a robust, individualized treatment plan.
本病例研究探讨了一名19岁男性的临床治疗过程。该男性在17岁时因道路交通事故(RTA)遭受了严重的创伤性脑损伤(TBI),最初在当地一家私立医院的重症监护病房(ICU)接受治疗,随后转至一家大型三级医院接受高级创伤护理。患者出现了严重并发症,包括颅内压(ICP)升高,需要进行去骨瓣减压术并放置外部脑室引流管(EVD)。持续性脑脊液(CSF)漏和感染,包括表皮葡萄球菌感染,需要多次手术干预和抗生素治疗。在初步稳定后,患者被转至苏丹王子军事医疗城(PSMMC)继续接受治疗和康复,包括昏迷促醒治疗(CSP)、物理和职业治疗以及药物调整。患者的病情从格拉斯哥昏迷量表(GCS)评分为8/15的昏迷状态发展为GCS评分为14/15。他在认知功能方面有显著改善,包括识别和说出动作动词的能力,以及自动言语方面的进步。尽管仍存在严重的构音障碍和认知障碍,但通过强化康复努力,在认知、功能和言语能力方面仍取得了显著进展。本病例突出了在管理严重TBI时全面和适应性护理策略的复杂性和必要性,强调了通过强有力的个体化治疗计划实现康复的潜力。