EC Neurology

Background: Severe traumatic brain injury (TBI) is a life-threatening emergency whose prognosis depends closely on how early the airway is protected. Aspiration pneumonia is a frequent and largely preventable complication.

Case Presentation: We report a previously healthy 19-year-old man involved in a high-energy road traffic accident (motorcycle, ejection, no helmet), admitted with a Glasgow Coma Scale (GCS) of 11/15 and vomiting. Imaging showed multiple haemorrhagic contusions, intraventricular haemorrhage and early ground-glass lung opacities. Intubation was deferred because the GCS was deemed “non-severe” and was performed only 24h later, after deterioration to 8/15. On day 3 the patient developed severe aspiration pneumonia (Fever 39°C, desaturation to 86% on 100% FiO₂, purulent secretions, a “crazy-paving” pattern) complicated by septic shock.

Outcome: With empirical antibiotics, neuro-ventilatory critical care and a tracheostomy on day 10, the outcome was favourable (18 ventilator-days, 29 ICU-days).

Conclusion: This case shows that the decision to intubate a head-injured patient must never rest on an isolated GCS value, but on global, repeated clinical assessment.

Keywords: Severe Traumatic Brain Injury; Aspiration Pneumonia; Intubation; Glasgow Coma Scale; Secondary Brain Injury; Critical Care

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