A Rare Recovery of Ventriculitis In Traumatic Brain Injury: Nursing Care Perspective.
Muhammad Khairul Maula YAHYA ALI(1), Ahmad Syafwan AWANG(1), Marlina MOHD NAWAWI(1), Mohd Noor Faizal KAMARUDIN(1), Al Hafiz IBRAHIM(2,3), Muhammad Hafiz HANAFI(*2,3) .

(1) Nursing Unit, Hospital Universiti Sains Malaysia, USM Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
(2) Rehabilitation Medicine Unit, Hospital Universiti Sains Malaysia, USM Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
(3) School of Medical Sciences, Universiti Sains Malaysia, USM Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.

Abstract

Introduction: Ventriculitis is a life-threatening and dangerous clinical emergency of traumatic brain injury (TBI) which if left untreated, commonly associated with death and disability. Ventriculitis typically presents with headache, nausea, vomiting, vertigo, mental instability, or even slurred speech Hence, if left untreated promptly and correctly, it may lead to severe consequences of seizures, and even death. Nursing care in ventriculitis patient is quite challenging as the symptoms of patients can change from bad to worst within minutes.
Method: A 17-year-old man, came with alleged motor vehicle accident with initial Glasgow Coma Scale (GCS) of E1V1M5. Posterior Fossa Craniectomy was done together with External Ventricular Drainage to treat his intracranial haemorrhage and hydrocephalus. However he was not showing sign of improvement and the only positive sign was his EEG found that he is not brain death. The patient was monitored closely to prevent complication of immobility together with regular sensory and motor facilitation activity by the nursing and the rehabilitation team. Amazingly, after 36 days of consistent stimulation protocol, the patient showing progression from coma (Rancho Los Amigos Scale I) to vegetative state (Rancho Los Amigos Scale III). He was discharge in with ability to follow one step command consistently without any symptoms of agitation (Rancho Los Amigos Scale V).
Results: All investigations were done to rule out other causes of coma, and we came to the conclusion that his prolonged coma and elevated white blood cells (WBC) count is due to the ventriculitis . It stresses that complications of disorder of consciousness can occur without signs and symptoms of infections (except for increase in WBC), in comatose patients. There was no further deterioration of consciousness once the ventriculitis was properly managed.

Conclusion: In summary, the most important thing in this totally preventable condition is to distinguish the cause of prolonged coma, together with the ability to manage accordingly through effective communication in multidisciplinary management.

Keywords: Traumatic brain injury; Ventriculitis; Multidisciplinary; Nursing Care; Coma.

Topic: Nursing Management and Education