From the Guidelines
The prognosis for a young man with minimal neurological symptoms, such as headache, epistaxis, and anosmia, and MRI findings of hemorrhagic brain contusions, is generally favorable, with most patients recovering well over weeks to months. The MRI findings, including a focal hemorrhagic contusion in the left basifrontal lobe with surrounding edema and a smaller lesion in the right anterior frontal lobe, are concerning, but the limited neurological symptoms suggest that the injuries are not severely affecting brain function 1. The anosmia (loss of smell) may be related to direct trauma to the olfactory nerves in the frontal region and could potentially improve with time, though sometimes smell impairment persists.
Key Considerations
- The patient's symptoms, such as headache and epistaxis, are likely related to the traumatic brain injury, and close monitoring is essential to ensure that these symptoms do not worsen 1.
- The MRI findings are consistent with hemorrhagic brain contusions, which are common in traumatic brain injuries, and the presence of surrounding edema suggests that the injuries are acute 1.
- The patient should be advised to rest, avoid strenuous activities and contact sports, and seek immediate medical attention if new or worsening symptoms develop, such as increased headache severity, confusion, weakness, or seizures.
Management and Follow-up
- Close medical follow-up is essential, including repeat imaging to monitor the resolution of the contusions and edema 1.
- The patient should be educated on the signs and symptoms of worsening brain injury, such as increased headache severity, confusion, weakness, or seizures, and instructed to seek immediate medical attention if these symptoms develop 1.
- The use of MRI in the follow-up of traumatic brain injuries is recognized as providing prognostic information that is important for clinical management, and T2W FLAIR sequences have been shown to be more sensitive than NCCT in detecting subacute subarachnoid hemorrhage, small subdural hematoma, brain contusions, and brain stem injuries 1.
From the Research
Prognosis of Young Man with Minimal Neurological Symptoms
The patient's MRI report indicates a focal area of altered signal intensity involving the left basifrontal lobe, likely a hemorrhagic brain contusion with surrounding edema, as well as a small suggestive/enhancing focus of altered signal intensity in the right anterior frontal lobe, possibly a small focal hemorrhagic contusion/calcifying granulomatous lesion 2.
Symptoms and Treatment
The patient is experiencing headaches, few drops of blood from the nose, and anosmia. Studies have shown that acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain 3. However, there is no association between treatment with ibuprofen, acetaminophen, or both and the presence of headache at 7 days post-concussion 2.
Management of Postconcussive Headaches
A pilot study found that routine analgesia administration, including acetaminophen and ibuprofen, was feasible and effective for postconcussive headache management in children and youth 4. Patients who received acetaminophen, ibuprofen, or both had significantly less headache days, episodes of headache, and lower headache intensity than those who received standard care.
Important Considerations
It is essential to note that acetaminophen is a safe and effective analgesic and antipyretic agent when taken in the recommended dosage, but accidental or intentional overdose can lead to hepatotoxicity 5. Nonselective NSAIDs should be used with caution in patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease 3.
- Key points to consider:
- The patient's symptoms and MRI report suggest a hemorrhagic brain contusion with surrounding edema.
- Acetaminophen and NSAIDs are first-line treatment options for acute mild to moderate pain.
- Routine analgesia administration may be effective for postconcussive headache management.
- Caution should be exercised when using acetaminophen and NSAIDs due to potential side effects and interactions.