Medical Complications and Comorbidity Management
Core concepts
Know the common complications after brain injury: seizures (early vs late post-traumatic epilepsy), hydrocephalus (communicating after subarachnoid blood), heterotopic ossification, spasticity/contractures, venous thromboembolism (prophylaxis is essential), dysphagia and aspiration, pressure injuries, neuroendocrine dysfunction (hypopituitarism after TBI), and autonomic dysfunction/paroxysmal sympathetic hyperactivity (tachycardia, hypertension, diaphoresis, posturing). Understand sleep-wake disorders and their effect on cognition and mood. Manage pain and recognize that substance use is a common comorbidity.
Traps
Questions test whether you recognize paroxysmal sympathetic hyperactivity as distinct from seizures (no epileptiform correlate). Do not miss late post-traumatic epilepsy as a cause of new spells months after injury. Remember that VTE prophylaxis is often delayed in the presence of intracranial hemorrhage - balance risk. Do not attribute new decline in a recovering patient to "plateau" - consider hydrocephalus or endocrine dysfunction.
Rule of thumb
New neurologic decline after initial recovery → think hydrocephalus, seizure, infection, or endocrine cause before assuming progression of original injury.
Worked example
A patient with prior subarachnoid hemorrhage develops gait decline and incontinence months later. Think communicating hydrocephalus; imaging and CSF dynamics guide shunt evaluation.