The frequency, antecedent events, and causal relationships of neurologic worsening following severe head injury

Neurologic deterioration observed following head injury is recognized as ha ving a deleterious effect on outcome. The present study examines this occur rence in detail to determine the frequency of these episodes, their anteced ent events and causal relationships in order to identify patients who are a t risk. Data was collected prospectively from a consecutive series of 427 p atients entered into the international trial of the NMDA receptor antagonis t Selfotel. Using a definition of neurologic worsening based upon objective criteria, 117 patients were identified who suffered 164 episodes of deteri oration. The occurrence of a single episode of neurologic worsening increas ed mortality by more than five-fold and reduced favorable outcomes (good or moderate on the Glasgow Outcome Scale), by more than 50%. Increased intrac ranial volume resulting in intracranial hypertension was the single most fr equent cause of neurologic worsening. This serves to emphasize the importan ce of more adequate treatments of intracranial hypertension in improving th e outcome of patients with severe head injury.